Tsiami A, Chaimani A, Mavridis D, Siskou M, Assimakopoulos E, Sotiriadis A
Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
Ultrasound Obstet Gynecol. 2016 Oct;48(4):434-445. doi: 10.1002/uog.15900. Epub 2016 Sep 13.
The presence of hydrosalpinx impairs the outcome of in-vitro fertilization embryo transfer (IVF-ET). Surgical methods to either aspirate the fluid or isolate the affected Fallopian tubes have been attempted as a means of improving outcome. The aim of this network meta-analysis was to compare the effectiveness of surgical treatments for hydrosalpinx before IVF-ET.
An electronic search of MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (Central) and the US Registry of clinical trials for articles published from inception to July 2015 was performed. Eligibility criteria included randomized controlled trials of women with hydrosalpinx before IVF-ET comparing ultrasound-guided aspiration of the fluid, tubal occlusion, salpingectomy or no intervention. Ongoing pregnancy was the primary outcome and clinical pregnancy, ectopic pregnancy and miscarriage were secondary outcomes. A random-effects network meta-analysis synthesizing direct and indirect evidence from the included trials was carried out. We estimated the relative effect sizes as risk ratios (RRs) and obtained the relative ranking of the interventions using cumulative ranking curves. The quality of evidence according to GRADE guidelines, adapted for network meta-analysis, was assessed.
Proximal tubal occlusion (RR, 3.22 (95% CI, 1.27-8.14)) and salpingectomy (RR, 2.24 (95% CI, 1.27-3.95)) for treatment of hydrosalpinx were superior to no intervention for ongoing pregnancy. For an outcome of clinical pregnancy, all three interventions appeared to be superior to no intervention. No superiority could be ascertained between the three surgical methods for any of the outcomes. In terms of relative ranking, tubal occlusion was the best surgical treatment followed by salpingectomy for ongoing and clinical pregnancy rates. No significant statistical inconsistency was detected; however, the point estimates for some inconsistency factors and their CIs were relatively large. The small study number and sizes were the main limitations. The quality of evidence was commonly low/very low, especially when aspiration was involved, indicating that the results were not conclusive and should be interpreted with caution.
Proximal tubal occlusion, salpingectomy and aspiration for treatment of hydrosalpinx scored consistently better than did no intervention for the outcome of IVF-ET. In terms of relative ranking, proximal tubal occlusion appeared to be the most effective intervention, followed by salpingectomy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
输卵管积水的存在会损害体外受精胚胎移植（IVF-ET）的结局。已尝试采用手术方法抽吸液体或隔离受影响的输卵管，以此作为改善结局的一种手段。本网状荟萃分析的目的是比较IVF-ET前输卵管积水手术治疗的有效性。
对MEDLINE、Scopus、Cochrane对照试验中央注册库（Central）以及美国临床试验注册库进行电子检索，以查找自数据库建立至2015年7月发表的文章。纳入标准包括对IVF-ET前输卵管积水女性进行的随机对照试验，比较超声引导下液体抽吸、输卵管阻塞、输卵管切除术或不干预。持续妊娠是主要结局，临床妊娠、异位妊娠和流产是次要结局。开展了一项随机效应网状荟萃分析，综合纳入试验的直接和间接证据。我们将相对效应量估计为风险比（RRs），并使用累积排序曲线获得干预措施的相对排名。根据适用于网状荟萃分析的GRADE指南评估证据质量。
对于持续妊娠，输卵管近端阻塞（RR，3.22（95%CI，1.27 - 8.14））和输卵管切除术（RR，2.24（95%CI，1.27 - 3.95））治疗输卵管积水优于不干预。对于临床妊娠结局，所有三种干预措施似乎均优于不干预。对于任何结局，三种手术方法之间均未确定有优越性。就相对排名而言，对于持续妊娠率和临床妊娠率，输卵管阻塞是最佳手术治疗方法，其次是输卵管切除术。未检测到显著的统计学异质性；然而，一些异质性因素的点估计值及其可信区间相对较大。研究数量少和样本量小是主要局限性。证据质量通常较低/非常低，尤其是涉及抽吸时，表明结果不具有决定性，应谨慎解读。
对于IVF-ET结局，输卵管近端阻塞、输卵管切除术和抽吸治疗输卵管积水的效果始终优于不干预。就相对排名而言，输卵管近端阻塞似乎是最有效的干预措施，其次是输卵管切除术。版权所有©2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
