Department of Obstetrics and Gynecology, Mount Sinai Hospital and Women's College Hospital, Toronto, ON; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Peter Lougheed Centre, University of Calgary, Calgary, AB.
Department of Obstetrics and Gynecology, Mount Sinai Hospital and Women's College Hospital, Toronto, ON; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON.
J Obstet Gynaecol Can. 2020 Jun;42(6):787-797.e2. doi: 10.1016/j.jogc.2019.06.011. Epub 2019 Oct 31.
This investigation sought systematically to review and meta-analyze evidence on reproductive outcomes following uterine artery occlusion (UAO) at myomectomy. Databases searched included PubMed, EMBASE, Ovid MEDLINE, Web of Science, and ClinicalTrials.gov. Eligible studies included observational and randomized controlled trials in which patients underwent abdominal, laparoscopic, or robotic myomectomy and in which at least one measure of clinical pregnancy rate, live birth rate, or ovarian reserve was reported. The primary outcome was live birth rate. Secondary outcomes included clinical pregnancy rate, miscarriage rate, adverse pregnancy outcomes, and measures of ovarian reserve. Twelve articles involving 689 women were included in the systematic review. The intervention group underwent UAO at laparoscopic or abdominal myomectomy (UAO+M) (n = 470). The control group underwent myomectomy alone (n = 219). Seven articles involving 420 women were included in the meta-analysis (201 underwent UAO+M; 219 underwent myomectomy alone). Live births occurred in 54 of 201 (27%) women in the UAO+M group and in 74 of 219 (34%) women in the control group. Clinical pregnancies occurred in 73 of 201 (36%) women in the UAO+M group and in 102 of 219 (47%) control subjects. There was no difference in live birth rates (odds ratio 0.89; 95% CI 0.56-1.43; P = 0.51; 7 studies, 420 patients) or clinical pregnancy rates (odds ratio 0.81; 95% confidence interval 0.53-1.24; P = 0.33; 7 studies, 420 patients) between the UAO+M and control groups. Data on miscarriage rates, adverse pregnancy outcomes, and measures of ovarian reserve precluded meta-analysis. In conclusion, UAO at myomectomy is not associated with reductions in live birth or clinical pregnancy rates. Before routine use can be recommended in women desiring future fertility, more research is required on reproductive outcomes and effects on ovarian reserve.
本研究旨在系统性地回顾和荟萃分析子宫动脉阻断（UAO）在子宫肌瘤剔除术中对生殖结局的影响。检索的数据库包括 PubMed、EMBASE、Ovid MEDLINE、Web of Science 和 ClinicalTrials.gov。纳入的研究包括观察性研究和随机对照试验，其中患者接受了腹式、腹腔镜或机器人子宫肌瘤剔除术，且至少报告了一项临床妊娠率、活产率或卵巢储备的测量指标。主要结局为活产率。次要结局包括临床妊娠率、流产率、不良妊娠结局和卵巢储备测量指标。系统评价纳入了 12 篇文章，共 689 名患者。干预组（UAO+M）在腹腔镜或腹式子宫肌瘤剔除术中进行 UAO（n=470）。对照组仅行子宫肌瘤剔除术（n=219）。荟萃分析纳入了 7 篇文章，共 420 名患者（201 名患者接受 UAO+M，219 名患者接受单纯子宫肌瘤剔除术）。UAO+M 组有 54 名（27%）患者活产，对照组有 74 名（34%）患者活产。UAO+M 组有 73 名（36%）患者临床妊娠，对照组有 102 名（47%）患者临床妊娠。两组活产率（比值比 0.89；95%置信区间 0.56-1.43；P=0.51；7 项研究，420 名患者）或临床妊娠率（比值比 0.81；95%置信区间 0.53-1.24；P=0.33；7 项研究，420 名患者）无差异。流产率、不良妊娠结局和卵巢储备测量指标的数据不适合进行荟萃分析。总之，子宫肌瘤剔除术中行 UAO 并不能降低活产率或临床妊娠率。在推荐有生育要求的女性常规使用之前，需要更多关于生殖结局和对卵巢储备影响的研究。
