Xiong Qian, Zhang Tiansong, Su Shujun
Department of Gynecology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Gynecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou, China.
Clin Transl Sci. 2020 Mar;13(2):372-380. doi: 10.1111/cts.12721. Epub 2020 Jan 25.
This network meta-analysis was conducted to compare the efficacy of six interventions, including anti-blocking agents, intrauterine contraceptive devices (IUDs), estrogens, intrauterine balloon, Foley catheter, and amnion graft for the prevention of intrauterine adhesions (IUAs). We searched PubMed, Embase, and Cochrane Library from inception to December 2016. Cohort studies meeting these six interventions in the prevention of IUAs were included. The combination of direct and indirect evidence was conducted to assess the odds ratio (OR) or weighted mean differences and surface under the cumulative ranking curves of the six interventions in the prevention of postoperative IUAs. Finally, 12 eligible cohort studies were included in this network meta-analysis. The results of this network meta-analysis demonstrated that during 1 to 2 months after operation, compared with the surgical group, anti-blocking agent, and estrogens presented with relatively low ratios of postoperative IUAs (OR = 0.30 95% confidence interval (CI) = 0.10-0.67; OR = 0.12, 95% CI = 0.01-0.78, respectively). Compared with IUDs, estrogens exerted comparatively low ratio of postoperative IUAs (OR = 0.10, 95% CI = 0.01-0.90), which indicated that anti-blocking agent and estrogens had relatively better prevention efficacy. The cluster analysis showed that estrogens had relatively better efficacy in the prevention postoperative IUAs. Overall, our findings support that estrogens had relatively better efficacy in the prevention of postoperative IUAs.
本网络荟萃分析旨在比较六种干预措施预防宫腔粘连（IUAs）的疗效，这六种干预措施包括抗粘连剂、宫内节育器（IUDs）、雌激素、宫腔球囊、Foley导管和羊膜移植。我们检索了自数据库建库至2016年12月的PubMed、Embase和Cochrane图书馆。纳入了符合这六种干预措施预防IUAs的队列研究。采用直接和间接证据相结合的方法，评估六种干预措施预防术后IUAs的比值比（OR）或加权平均差以及累积排序曲线下面积。最终，12项符合条件的队列研究纳入了本网络荟萃分析。本网络荟萃分析结果表明，术后1至2个月，与手术组相比，抗粘连剂和雌激素术后发生IUAs的比例相对较低（OR分别为0.30，95%置信区间（CI）=0.10 - 0.67；OR = 0.12，95% CI = 0.01 - 0.78）。与IUDs相比，雌激素术后发生IUAs的比例相对较低（OR = 0.10，95% CI = 0.01 - 0.90），这表明抗粘连剂和雌激素具有相对较好的预防效果。聚类分析表明，雌激素在预防术后IUAs方面具有相对较好的疗效。总体而言，我们的研究结果支持雌激素在预防术后IUAs方面具有相对较好的疗效。
