Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Fertil Steril. 2020 Jan;113(1):224-233.e6. doi: 10.1016/j.fertnstert.2019.09.016. Epub 2019 Nov 18.
To synthesize evidence on the most effective pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy.
Systematic review and network meta-analysis of randomized controlled trials (RCTs).
Not applicable.
Trials assessing efficacy of pharmacological interventions during different types of myomectomy.
Misoprostol, oxytocin, vasopressin, tranexamic acid (TXA), epinephrine, or ascorbic acid.
Intraoperative blood loss and need for blood transfusion.
The present review included 26 randomized control trials (RCTs) (N = 1627). For minimally invasive procedures (9 RCTs; 474 patients), network meta-analysis showed that oxytocin (mean difference [MD] -175.5 mL, 95% confidence interval [CI] -30.1.07, -49.93), ornipressin (MD -149.6 mL, 95% CI - 178.22, -120.98), misoprostol, bupivacaine plus epinephrine, and vasopressin were effective in reducing myomectomy blood loss, but the evidence is of low quality. Ranking score of treatments included in subgroup analysis of minimally invasive myomectomy showed that oxytocin ranked first in reducing blood loss, followed by ornipressin. For open myomectomy (17 RCTs; 1,153 patients), network meta-analysis showed that vasopressin plus misoprostol (MD -652.97 mL, 95% CI - 1113.69, -174.26), oxytocin, TXA, and misoprostol were effective; however, the evidence is of low quality. Vasopressin plus misoprostol ranked first in reducing blood loss during open myomectomy (P = .97).
There is low-quality evidence to support uterotonics, especially oxytocin, and peripheral vasoconstrictors as effective options in reducing blood loss and need for blood transfusion during minimally invasive myomectomy. Oxytocin is the most effective intervention in minimally invasive myomectomy. For open myomectomy, a combination of uterotonics and peripheral vasoconstrictors is needed to effectively reduce blood loss.
综合评估在开放性和微创子宫肌瘤剔除术中减少出血的最有效药物干预措施。
系统综述和随机对照试验的网络荟萃分析。
不适用。
评估不同类型子宫肌瘤剔除术中药物干预效果的试验。
米索前列醇、催产素、血管加压素、氨甲环酸（TXA）、肾上腺素或抗坏血酸。
术中出血量和输血需求。
本综述纳入了 26 项随机对照试验（RCT）（N=1627）。对于微创手术（9 项 RCT；474 例患者），网络荟萃分析显示催产素（平均差值 [MD] -175.5 毫升，95%置信区间 [CI] -30.1.07，-49.93）、垂体后叶素（MD -149.6 毫升，95% CI -178.22，-120.98）、米索前列醇、布比卡因加肾上腺素和血管加压素可有效减少子宫肌瘤剔除术的出血量，但证据质量较低。微创手术亚组分析中纳入治疗的排序评分显示，催产素在减少出血量方面排名第一，垂体后叶素紧随其后。对于开放性子宫肌瘤剔除术（17 项 RCT；1153 例患者），网络荟萃分析显示血管加压素加米索前列醇（MD -652.97 毫升，95% CI -1113.69，-174.26）、催产素、TXA 和米索前列醇有效；然而，证据质量较低。血管加压素加米索前列醇在减少开放性子宫肌瘤剔除术中的出血量方面排名第一（P=0.97）。
低质量证据支持缩宫素，尤其是催产素和外周血管收缩剂作为减少微创手术中出血量和输血需求的有效选择。催产素是微创手术中最有效的干预措施。对于开放性子宫肌瘤剔除术，需要联合使用缩宫素和外周血管收缩剂才能有效减少出血量。
