De Franciscis Pasquale, Riemma Gaetano, Schiattarella Antonio, Cobellis Luigi, Colacurci Nicola, Vitale Salvatore Giovanni, Cianci Antonio, Lohmeyer Franziska Michaela, La Verde Marco
Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy.
J Gynecol Obstet Hum Reprod. 2020 Sep;49(7):101763. doi: 10.1016/j.jogoh.2020.101763. Epub 2020 Apr 21.
The aim of this systematic literature review and meta-analysis is to assess the impact of hysteroscopic metroplasty for dysmorphic uteri on reproductive outcomes in women with recurrent miscarriages. Available studies were identified through a PubMed, Scopus, and Cochrane search until June 2019. Live-birth rate, clinical pregnancy and miscarriage rate after hysteroscopic metroplasty was evaluated. DerSimonian and Laird's random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I2-statistics. Six out of 164 published studies met the inclusion criteria. All (n = 221) women underwent metroplasty, using 5Fr-hysteroscope with bipolar electrodes or 26Fr/28Fr-resectoscope in outpatient or inpatient settings. After 6 to 60-month follow-up, reported live-birth rate was 50% (0.37-0.63 95% CI) from a clinical pregnancy rate of 73% (0.51-0.91 95% CI) and miscarriage rate was 23% (0.15-0.30 95% CI). Hysteroscopic metroplasty for dysmorphic uteri led half of the women who experienced recurrent miscarriages at least one live birth and is correlated to few surgical and obstetric complications. However, randomized clinical trials and case-control studies are unavailable due to ethical constrains; inhomogenity of follow-up durations and standardized protocols regarding preoperative diagnosis and post-surgical management resrict our conclusions.
本系统文献综述和荟萃分析的目的是评估宫腔镜子宫成形术治疗子宫畸形对复发性流产女性生殖结局的影响。通过PubMed、Scopus和Cochrane检索，确定截至2019年6月的现有研究。评估宫腔镜子宫成形术后的活产率、临床妊娠率和流产率。采用DerSimonian和Laird随机效应模型计算相对风险，采用Freeman-Tukey双反正弦法进行合并估计，并采用精确方法稳定方差和可信区间。使用I²统计量对异质性进行量化。164项已发表研究中有6项符合纳入标准。所有（n = 221）女性均接受了子宫成形术，在门诊或住院环境中使用带有双极电极的5Fr宫腔镜或26Fr/28Fr电切镜。经过6至60个月的随访，报告的活产率为50%（0.37 - 0.63，95%可信区间），临床妊娠率为73%（0.51 - 0.91，95%可信区间），流产率为23%（0.15 - 0.30，95%可信区间）。宫腔镜子宫成形术治疗子宫畸形使一半经历复发性流产的女性至少有一次活产，且与较少的手术和产科并发症相关。然而，由于伦理限制，缺乏随机临床试验和病例对照研究；随访时间的不均匀性以及术前诊断和术后管理的标准化方案限制了我们的结论。
