Departments of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China.
Department of Reproductive Endocrinology, Chongqing Health Center for Women and Children, Chongqing, China.
J Minim Invasive Gynecol. 2018 May-Jun;25(4):589-599. doi: 10.1016/j.jmig.2017.09.006. Epub 2017 Sep 8.
Intrauterine adhesions (IUAs) can lead to partial or complete closure of the uterine cavity, which may result in symptoms including abnormal menstruation, infertility, and pelvic pain. A network meta-analysis was performed to assess the effect of adjuvant therapy on the prevention and treatment of IUAs. We searched electronic databases, including PubMed, Embase, and the Cochrane Library, up to May 5, 2017, without language restrictions. The primary outcomes in the present analysis were the rate of IUAs for prevention and the rate of IUA recurrence for treatment. The secondary outcomes included the IUA score and the rate of severity of IUAs. The treatments were then ranked by the surface under the cumulative ranking curve (SUCRA). We included 20 articles that involved a total of 1891 patients in our analysis. In the outcomes of prevention-related studies, an alginate hyaluronate-carboxymethylcellulose membrane (ACH) (n = 10, SUCRA score = 93.3%) was the adjuvant treatment that most effectively reduced IUA incidence. It was followed by intercoat (n = 10, SUCRA score = 74.7%) and misoprostol (n = 10, SUCRA score = 68.6%). In addition, auto-cross-linked hyaluronic acid (ACP) (n = 3, SUCRA score = 83.2%) and intercoat (n = 3, SUCRA score = 66.4%) each corresponded to a relatively high preventive effect against severe IUAs. In the treatment-related studies, ACP plus a balloon (n = 4, SUCRA score = 96.3%) and a freeze-dried amnion graft plus a balloon (n = 4, SUCRA score = 62.7%) most effectively reduced IUA recurrence and had a high probability of most effectively reducing IUA scores. Therefore, according to the prophylactic analysis, ACH and intercoat were most likely to prevent IUA development. In our analysis of agents used to prevent severe IUAs, we found that ACP and intercoat provided significant advantages and had high reliability. In our analysis of treatments, ACP plus a balloon and freeze-dried amniotic agents plus a balloon were most likely to reduce IUA recurrence and IUA scores after adhesiolysis.
宫腔粘连（IUAs）可导致子宫腔部分或完全闭锁，引起包括异常月经、不孕和盆腔痛在内的多种症状。本网状荟萃分析旨在评估辅助治疗对预防和治疗 IUAs 的效果。我们检索了电子数据库，包括 PubMed、Embase 和 Cochrane 图书馆，检索时间截至 2017 年 5 月 5 日，未对语言进行限制。本分析的主要结局为预防 IUAs 的发生率和治疗 IUAs 复发的发生率。次要结局包括 IUAs 评分和 IUAs 严重程度的发生率。随后通过累积排序曲线下面积（SUCRA）对治疗方法进行排序。我们纳入了 20 项研究，共纳入了 1891 例患者。在预防相关研究的结局中，藻酸-透明质酸羧甲基纤维素膜（ACH）（n=10，SUCRA 评分=93.3%）是降低 IUAs 发生率最有效的辅助治疗方法。其次是内涂层（n=10，SUCRA 评分=74.7%）和米索前列醇（n=10，SUCRA 评分=68.6%）。此外，自交联透明质酸（ACP）（n=3，SUCRA 评分=83.2%）和内涂层（n=3，SUCRA 评分=66.4%）也分别对应着相对较高的预防重度 IUAs 的效果。在治疗相关研究中，ACP 联合球囊（n=4，SUCRA 评分=96.3%）和冻干羊膜联合球囊（n=4，SUCRA 评分=62.7%）最有效地降低了 IUAs 的复发率，且有很高的可能性最有效地降低 IUAs 评分。因此，根据预防分析，ACH 和内涂层最有可能预防 IUAs 的发生。在我们对用于预防重度 IUAs 的药物的分析中，我们发现 ACP 和内涂层具有显著优势且可信度高。在我们对治疗方法的分析中，ACP 联合球囊和冻干羊膜联合球囊在粘连松解术后最有可能降低 IUAs 的复发率和 IUAs 评分。
