Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji).
Department of Mount Sinai Hospital, Sidney Liswood Health Sciences Library, Toronto, ON, Canada (Ms. Ryu).
J Minim Invasive Gynecol. 2020 Nov-Dec;27(7):1503-1510. doi: 10.1016/j.jmig.2020.05.007. Epub 2020 May 16.
To determine whether dienogest therapy after endometriosis surgery reduces the risk of endometriosis recurrence compared with expectant management.
Ovid MEDLINE, Ovid EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov, and International Standard Randomized Controlled Trial Number Registry were searched from inception to March 2019 for observational and randomized controlled trials.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Medical Subject Heading terms and keywords such as "dienogest," "endometriosis," and "recurrence" were used to identify relevant studies.
TABULATION, INTEGRATION, AND RESULTS: The search yielded 328 studies, 10 of which were eligible for inclusion, representing 1184 patients treated with dienogest and 846 expectantly managed controls. Among these studies, 9 looked exclusively at endometrioma recurrence, whereas 1 used reappearance of symptoms as evidence of disease recurrence. Data on both incidence of and time to recurrence of endometriosis were extracted. The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months (95% confidence interval [CI], 1.43-3.11) versus 29 per 100 women managed expectantly over a mean follow-up of 36 months (95% CI, 25.66-31.74). The likelihood of recurrence was significantly reduced with postoperative dienogest (log odds -1.96, CI, -2.53 to -1.38, p <.001).
Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of postoperative disease recurrence than those who were expectantly managed.
确定与期待治疗相比，内美通治疗子宫内膜异位症手术后是否降低了子宫内膜异位症复发的风险。
从建库至 2019 年 3 月，我们对 Ovid MEDLINE、Ovid EMBASE、PubMed、Cochrane 中央对照试验注册库、Web of Science、LILACS、clinicaltrials.gov 和国际标准随机对照试验注册库进行了检索，以查找观察性和随机对照试验。
我们遵循了系统评价和荟萃分析的首选报告项目。使用了医学主题词和关键词，如“dienogest”“endometriosis”和“recurrence”，以识别相关研究。
表格制作、综合和结果：搜索结果得到 328 项研究，其中 10 项符合纳入标准，共纳入 1184 例接受 dienogest 治疗和 846 例期待治疗的对照患者。其中 9 项研究专门观察了内异症囊肿的复发情况，而 1 项研究则以症状再次出现作为疾病复发的证据。提取了内异症复发的发生率和复发时间的数据。接受 dienogest 治疗的患者中，子宫内膜异位症复发的发生率为每 100 名女性中有 2 例，平均随访 29 个月（95%置信区间[CI]，1.43-3.11），而期待治疗的患者中，每 100 名女性中有 29 例，平均随访 36 个月（95% CI，25.66-31.74）。术后接受 dienogest 治疗显著降低了复发的可能性（对数优势比-1.96，CI，-2.53 至-1.38，p<0.001）。
与期待治疗相比，接受内美通治疗的子宫内膜异位症患者在接受保守手术后疾病复发的风险显著降低。
