背景:阴部神经卡压(PNE)是一种未诊断的疾病,会影响骨盆功能谱,主要是疼痛,南特诊断标准概述。尽管有许多手术减压技术可用于其管理,在疗效和安全性方面缺乏共识.本研究进行了系统回顾和荟萃分析,以评估主要手术减压技术的疗效和并发症发生率。
方法:在PubMed®中进行了全面的文献检索,Embase®,WebofScience®,和ClinicalTrails.gov®在2023年4月19日。初步筛选涉及标题和摘要评估,随后对摘要和全文文章进行检索和评估。包括评估阴部神经手术释放前后疼痛结果的研究。没有全文的研究,专注于诊断方法或仅与LUTS相关的结果,消化症状,或者性功能障碍,被排除在外。使用美国国立卫生研究院(NIH)研究质量评估工具进行偏倚风险评估。研究基于三种手术技术进行分类:会阴,跨臀肌,和腹腔镜经腹膜。采用随机效应荟萃分析和亚组分析。进行荟萃回归分析以研究协变量对观察结果的影响。
结果:19项研究,包括810名患者,包括在内。所有技术的总显着疼痛缓解率估计为0.67(95%CI0.54至0.78),具有相当大的异质性(I2=80.4%)。亚组分析显示不同技术的成功率:腹腔镜(0.91,95%CI0.64至0.98),会阴(0.69,95%CI0.52至0.82),和跨臀肌(0.50,95%CI0.37至0.63)。腹腔镜技术的并发症发生率为16.0%。Meta回归显示患者年龄和中位随访时间显著影响预后。
结论:虽然比较手术技术具有挑战性,这项荟萃分析突出了重要的结局差异.腹腔镜技术似乎最有希望改善疼痛。然而,该研究还强调需要进一步稳健,由于不同研究的显著异质性和偏见的高风险,需要长期研究。PROSPERO数据库:CRD42023496564。
BACKGROUND: Pudendal nerve entrapment (PNE) is an underdiagnosed condition affecting a spectrum of pelvic functions, primarily pain, as outlined by Nantes diagnostic criteria. Although numerous surgical decompression techniques are available for its management, consensus on efficacy and safety is lacking. This study conducts a systematic review and meta-analysis to assess the efficacy and complication rates of the main surgical decompression techniques.
METHODS: A comprehensive literature search was conducted in PubMed®, Embase®, Web of Science®, and ClinicalTrails.gov® on 19th of April 2023. Initial screening involved title and abstract evaluation, with subsequent retrieval and assessment of abstracts and full-text articles. Studies assessing pain outcomes before and after surgical release of the pudendal nerve were included. Studies without full-text, focusing on diagnostic methods or with outcomes relating solely to LUTS, digestive symptoms, or sexual dysfunction, were excluded. Risk of bias assessement was conducted using the National Institute of Health (NIH) Study Quality Assessment tool. Studies were categorized based on three surgical techniques: perineal, transgluteal, and laparoscopic transperitoneal. Random-effects meta-analysis with subgroup analysis were used. Meta-regression analyses were conducted to investigate the influence of covariates on the observed outcomes.
RESULTS: Nineteen studies, comprising 810 patients, were included. The overall significant pain relief rate across all techniques was estimated at 0.67 (95% CI 0.54 to 0.78) with considerable heterogeneity (I2 = 80.4%). Subgroup analysis revealed success rate for different techniques: laparoscopic (0.91, 95% CI 0.64 to 0.98), perineal (0.69, 95% CI 0.52 to 0.82), and transgluteal (0.50, 95% CI 0.37 to 0.63). The laparoscopic technique exhibited a complication rate of 16.0%. Meta-regression indicated that patient age and median follow-up significantly influenced outcomes.
CONCLUSIONS: While comparing surgical techniques is challenging, this meta-analysis highlights important outcome differences. The laparoscopic technique appears most promising for pain improvement. However, the study also emphasizes the need for further robust, long-term research due to significant heterogeneity across studies and prevelent risk of bias. PROSPERO database: CRD42023496564.