The Safety And Efficacy Of HUS And SSLF In The Treatment Of Pelvic Organ Prolapse :A Meta-analysis

Objective: By means of meta-analysis,to objectively evaluated the efficacy and safety of high sacral ligament suspension and sacrospinous ligament fixation in the treatment of pelvic organ prolapse,to provide evidence-based medical evidence for clinical decision-making.Methods: The Chinese and English literature published in Pub Med,The Cochrane Library,Web of Science,EMbase,CNKI,VIP database and Wan Fang databases were retrieved by computer,collect all studies related to high sacral ligament suspension and sacrospinous ligament fixation for the treatment of pelvic organ prolapse.The retrieval time range is set as January 1990 to January 2020.According to the established inclusion criteria and exclusion criteria,the retrieved documents were screened,evaluated and extracted.Statistical software Rev Man 5.3 provided by the Cochrane collaboration was used for the analysis.Results: A total of 8 literatures were included,including 3 retrospective cohort studies,5 randomized control studies,2 English literatures and 6 Chinese literatures,all of which were high-quality studies.The total number of patients was 667,including 330 in the sacral ligament suspension group and 337 in the sacrospinous ligament fixation group.Meta-analysis results showed that:(1)in the HUS and SSLF group,blood loss(MD = 0.59,95% CI: 3.42 ~ 2.25,P = 0.68),the operation time(MD = 2.84,95% CI: 2.49 ~ 8.18,P = 0.30),length of stay(MD = 0.03,95% CI: 0.18 ~ 0.24,P = 0.79),there was no statistically significant difference,the subgroup analysis showed that the HUS combined hysterectomy group prolong operation time than SSLF group,difference was statistically significant(MD=9.75,95%CI:1.15~18.36,P=0.03).(2)the anatomical success(OR=0.59,95%CI: 0.14~-2.56,Z=0.70,P=0.48)and postoperative repeat operation rate(OR=1.29,95%CI: 0.38~4.43,Z=0.41,P=0.68)in the HUS group and the SSLF group were not significantly different,and the difference was not statistically significant.(3)compared with the SSLF group,the postoperative recurrence rate of the HUS group and the SSLF group was same,and the difference was not statistically significant(OR=0.98,95%CI: 0:40~2.39,Z=0.05,P=0.96).The subgroup analysis indicated that,compared with the SSLF group,the recurrence rate of the HUS uterus retention group was not significantly increased,and the difference was not statistically significant(OR=0.74,95%CI:Compared with the SSLF group,the recurrence rate of the HUS combined hysterectomy group was no different(OR=1.28,95%CI =-0.33~4.98,Z=0.35,P=0.73).(4)there was no significant difference in PISQ-12 score(MD=2.44,95%CI:-1.94-6.82,P=0.27),PFDI-20 score(MD=-1,09,95%CI:-2.57~0.40,P=0.15)and PFIQ-7score(MD=-0.15,95%CI:-0.78-0.47,P=0.63)between the HUS group and the SSLF group.(5)compared with the SSLF group,the incidence of postoperative infection(OR=0.77,95%CI: 0.19~3.20,Z=0.36,P=0.72),incidence of sexual disturbance(OR=0.24,95%CI: 0.05~1.15,Z=1.78,P=0.07),incidence of postoperative thigh pain OR waist discomfort(OR=0.38,95%CI: 0.09~1.42,Z=1.46,P=0.15),ureteral injury(OR= 3.22,95%CI: 0.33~31.47,Z=1.00,P=0.32)did not increase significantly.Conclusion: Both HUS and SSLF are safe and effective methods for the treatment of pelvic organ prolapse,with no significant difference in anatomical cure rates and similar subjective curative effects.Both HUS and SSLF can improve postoperative pelvic floor life quality and sexual life quality,but the difference in sexual life quality is unstable,and patients with higher sexual life quality requirements should carefully choose SSLF.From the perspective of short-term effect,HUS with uterine retention does not increase the rate of postoperative recurrence,and the uterus can be decided according to whether the uterus is diseased and the patient's will.Compared with SSLF,HUS with hysterectomy increased the operative time.The differences between HUS and SSLF in various complications were not significant and the safety was similar.In clinical application,the operative style should be determined according to the patient's actual situation and the surgeon's specific expertise.