Yin X, Cheng J, Ansari S H, Campo R, Di W, Li W, Bigatti G
Sino European Life Expert Centre-Department of Obstetrics and Gynaecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory of Gynaecologic Oncology, China.
Facts Views Vis Obgyn. 2018 Dec;10(4):207-213.
The use of mechanical tissue removal systems is more frequently implemented as the first line approach for the treatment of intrauterine pathology. Scientific evidence is provided that their use is easier and faster than the conventional resectoscope. It is necessary to objectively evaluate the results on tissue removal systems for the treatment of endometrial pathology as the reports in the literature are still conflicting.
To review and compare mechanical hysteroscopic tissue removal systems (Truclear®, Myosure® or IBS®) versus conventional bipolar and monopolar resectoscopy for the treatment of polyp and myoma removal. Operation time, completeness of tissue removal, complication rate, fluid deficit, tolerability and learning curve were evaluated.
Electronic databases PubMed; Medline and Web of Science were searched for papers published from 1st January 2010 to 1st May 2019 using terms: ("hysteroscopic" or "hysteroscopy" or "hysteroscopic surgery") and ("myoma" or "polyps"). Studies were included if they were retrospective, observational and prospective randomized clinical controlled trials if they investigated the techniques between the tissue removal systems (Truclear®, Myosure® or IBS®) and conventional resectoscopy for the treatment of intrauterine pathology. Data were extracted from the included studies by two independent reviewers. Meta-analysis was performed by Rev Man 5 software (Cochrane Collaboration, London, UK). Results: Overall, 498 patients were analysed from five studies in which there was no difference in age and size of pathology treated either by the hysteroscopic tissue removal systems and the conventional resectoscope. Hysteroscopic tissue removal systems showed a significantly higher success rate of complete endometrial pathology removal (P=0.002) and a significantly shorter operation time for polyp removal (P<0.0001) compared to conventional resectoscopy. No significant differences, in terms of complications rate, were found (P=0.09). The fluid deficit was significantly higher in the tissue removal system group, compared to conventional resectoscopy (P=0.02).
Hysteroscopic tissue removal systems showed a major advantage in successful removal of the pathology and total operation time. It is likely that the tissue removal systems are more accessible and have a lower complication profile including perforation, via falsa and bleeding due to its specific action mechanism and shorter operation time but higher-quality trials will be required to confirm this hypothesis.
机械组织切除系统作为治疗子宫内病变的一线方法应用得越来越频繁。有科学证据表明，其使用比传统的电切镜更容易、更快捷。由于文献报道仍存在矛盾，因此有必要客观评估组织切除系统治疗子宫内膜病变的效果。
回顾并比较机械宫腔镜组织切除系统（Truclear®、Myosure®或IBS®）与传统双极和单极电切镜在治疗息肉和肌瘤切除方面的效果。评估手术时间、组织切除的完整性、并发症发生率、液体缺失量、耐受性和学习曲线。
在电子数据库PubMed、Medline和Web of Science中检索2010年1月1日至2019年5月1日发表的论文，检索词为：（“宫腔镜检查的”或“宫腔镜检查”或“宫腔镜手术”）和（“肌瘤”或“息肉”）。如果研究是回顾性、观察性和前瞻性随机临床对照试验，且研究了组织切除系统（Truclear®、Myosure®或IBS®）与传统电切镜治疗子宫内病变的技术，则纳入研究。由两名独立的评审员从纳入的研究中提取数据。使用Rev Man 5软件（英国伦敦Cochrane协作网）进行荟萃分析。结果：总体而言，五项研究共分析了498例患者，宫腔镜组织切除系统和传统电切镜治疗的病变在年龄和大小上没有差异。与传统电切镜相比，宫腔镜组织切除系统在完全切除子宫内膜病变方面成功率显著更高（P = 0.002），切除息肉的手术时间显著更短（P < 0.0001）。在并发症发生率方面未发现显著差异（P = 0.09）。与传统电切镜相比，组织切除系统组的液体缺失量显著更高（P = 0.02）。
宫腔镜组织切除系统在成功切除病变和总手术时间方面显示出主要优势。由于其特定的作用机制和较短的手术时间，组织切除系统可能更容易操作，并发症发生率更低，包括穿孔、经子宫壁间和出血，但需要更高质量的试验来证实这一假设。
