Department of Obstetrics and Gynaecology, USL Umbria 1, Alta Valle del Tevere Hospital, Città di Castello (PG), Umbria, Italy.
Department of Medicine, University of Perugia, Perugia, Italy.
Biomed Res Int. 2020 Jan 8;2020:4208497. doi: 10.1155/2020/4208497. eCollection 2020.
To assess the feasibility rate of one-step hysteroscopic myomectomy according to the technique adopted.
In July 2016, PubMed, ClinicalTrials.gov, SCOPUS, Scielo, and AJOL databases were used for searching references. Series of in-patient hysteroscopic myomectomies reporting success rate in only one-step procedure, categorization of submucous fibroids, explanation of the surgical technique, and description of patients were considered eligible for meta-analysis (retrospective, prospective randomized studies). Two authors extracted the data. Rate of myomectomies accomplished in only a surgical step and rate of intraoperative complications were extracted per protocol. A modified GRADE score was used for quality assessment. Random-effect models were already assumed. Mean rates were compared among subgroups.
One thousand two hundred and fifty-seven studies were screened and 241 of these were read for eligibility. Seventy-eight series were included in qualitative synthesis and 24 series were included in quantitative synthesis. Wide heterogeneity was found. In series with <50% of G2 myomas treated, the slicing technique feasibility rate was 86.5% while techniques for enucleating the deep portion of the myomas showed a feasibility rate of 92.3% ( < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% ( < 0.001). In series with ≥50% of G2 myomas treated, the slicing technique feasibility rate was 70.6% while techniques for enucleating the deep portion of myomas showed a feasibility rate of 88.4% (.
In case of submucous myomas with intramural development, the slicing technique was correlated with a lower rate of in-patient hysteroscopic myomectomies accomplished in a one-step procedure and a higher complications rate.
根据采用的技术评估一步式宫腔镜子宫肌瘤切除术的可行性率。
2016 年 7 月，检索了 PubMed、ClinicalTrials.gov、SCOPUS、Scielo 和 AJOL 数据库的参考文献。纳入仅报告一步手术成功率、黏膜下肌瘤分类、手术技术说明和患者描述的一系列住院宫腔镜子宫肌瘤切除术的系列研究，符合荟萃分析条件（回顾性、前瞻性随机研究）。两位作者提取数据。按照方案提取仅在手术步骤中完成的子宫肌瘤切除术的成功率和术中并发症发生率。采用改良 GRADE 评分进行质量评估。已经假设随机效应模型。比较了亚组之间的平均率。
筛选出 1257 篇研究，其中 241 篇进行了资格审查。78 项研究进行了定性综合分析，24 项研究进行了定量综合分析。发现存在广泛的异质性。在治疗<50%的 G2 型肌瘤的系列研究中，切割技术的可行性率为 86.5%，而用于切除肌瘤深部的技术的可行性率为 92.3%（<0.001）。在治疗≥50%的 G2 型肌瘤的系列研究中，切割技术的可行性率为 70.6%，而用于切除肌瘤深部的技术的可行性率为 88.4%（<0.001）。在治疗≥50%的 G2 型肌瘤的系列研究中，切割技术的可行性率为 70.6%，而用于切除肌瘤深部的技术的可行性率为 88.4%（<0.001）。
对于有向肌层内生长的黏膜下肌瘤，切割技术与住院宫腔镜子宫肌瘤切除术一步完成的成功率较低和并发症发生率较高相关。
