Zheng Fei, Xin Xin, He Fei, Liu Jianyong, Cui Yuechong
Department of Obstetrics and Gynecology, Yiwu Maternity and Children Hospital, Jinhua, Zhejiang 322000, P.R. China.
Department of Obstetrics and Gynecology, Benxi Central Hospital, Benxi, Liaoning 117000, P.R. China.
Exp Ther Med. 2020 Apr;19(4):2672-2678. doi: 10.3892/etm.2020.8483. Epub 2020 Feb 3.
Intrauterine adhesion (IUA) is a severe complication that occurs following abortion, and hyaluronic acid gel has been used to prevent IUA following intrauterine operation. The present study aimed to systematically evaluate the efficacy of hyaluronic acid gel in preventing IUA following intrauterine operation. In the current study, a literature search was performed using PubMed, Cochrane Library and EMbase databases for randomized controlled clinical trials that used hyaluronic acid gel as an adjuvant therapy following intrauterine operation. The terms 'hyaluronic acid', 'intrauterine adhesions', 'Asherman's syndrome', 'IUA', 'dilatation and curettage', 'abortion' and 'hysteroscopic' were used to search for articles published online before July 31, 2018. RevMan 5.3 software was used to analyze the indicators of uterine cavity adhesion formation and pregnancy rates following intrauterine operation. A total of seven randomized controlled clinical studies were included, consisting of 952 patients who underwent intrauterine operation. The meta-analysis indicated that the use of hyaluronic acid gel reduced the incidence of IUA [relative risk (RR)=0.42; 95% confidence interval (CI)=0.30-0.57; P<0.001] and the score for IUA after an intrauterine operation (mean difference=-1.29; 95%=-1.73 to -0.84; P<0.001). A subgroup analysis revealed that the preventive effect of hyaluronic acid gel on IUA was not affected by the type of intrauterine operation, namely abortion (RR=0.40; 95% CI=0.26-0.62; P<0.001) and hysteroscopy (RR=0.44; 95% CI=0.28-0.68; P<0.001). The preventive effect of hyaluronic acid gel on IUA was also not affected by primary disorders/diseases including the following: Abortion (RR=0.48; 95% CI=0.29-0.78; P=0.003); IUA (RR=0.38; 95% CI=0.21-0.67; P<0.001) and submucosal myoma of the uterus, endometrial polyps or mediastinum uterus (RR=0.40; 95% CI=0.18-0.90; P=0.03). Hyaluronic acid gel improved pregnancy rates after intrauterine operations (RR=1.94; 95% CI=1.46-2.60; P<0.001). In conclusion, hyaluronic acid gel was indicated to significantly reduce the incidence of IUA following intrauterine operation, regardless of the type of intrauterine operation or the presence of primary diseases. Treatment with hyaluronic acid gel was also revealed to increase pregnancy rates following intrauterine operation.
宫腔粘连（IUA）是流产后发生的一种严重并发症，透明质酸凝胶已被用于预防宫腔手术后的IUA。本研究旨在系统评价透明质酸凝胶预防宫腔手术后IUA的疗效。在本研究中，使用PubMed、Cochrane图书馆和EMbase数据库进行文献检索，以查找将透明质酸凝胶用作宫腔手术后辅助治疗的随机对照临床试验。使用“透明质酸”、“宫腔粘连”、“阿谢曼综合征”、“IUA”、“刮宫术”、“流产”和“宫腔镜检查”等术语检索2018年7月31日前在线发表的文章。使用RevMan 5.3软件分析宫腔手术后宫腔粘连形成指标和妊娠率。共纳入7项随机对照临床研究，包括952例行宫腔手术的患者。荟萃分析表明，使用透明质酸凝胶可降低IUA的发生率[相对危险度（RR）=0.42；95%置信区间（CI）=0.30-0.57；P<0.001]以及宫腔手术后IUA的评分（平均差=-1.29；95%=-1.73至-0.84；P<0.001）。亚组分析显示，透明质酸凝胶对IUA的预防作用不受宫腔手术类型的影响，即流产（RR=0.40；95%CI=0.26-0.62；P<0.001）和宫腔镜检查（RR=0.44；95%CI=0.28-0.68；P<0.001）。透明质酸凝胶对IUA的预防作用也不受以下原发性疾病的影响：流产（RR=0.48；95%CI=0.29-0.78；P=0.003）；IUA（RR=0.38；95%CI=0.21-0.67；P<0.001）以及子宫黏膜下肌瘤、子宫内膜息肉或子宫纵隔（RR=0.40；95%CI=0.18-0.90；P=0.03）。透明质酸凝胶提高了宫腔手术后的妊娠率（RR=1.94；95%CI=1.46-2.60；P<0.001）。总之，无论宫腔手术类型或原发性疾病的存在与否，透明质酸凝胶均显示可显著降低宫腔手术后IUA的发生率。还发现，使用透明质酸凝胶治疗可提高宫腔手术后的妊娠率。
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