Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK.
Department of Obstetrics and Gynaecology, St Mary's Hospital Paddington, London, UK.
BJOG. 2021 Feb;128(3):476-483. doi: 10.1111/1471-0528.16389. Epub 2020 Jul 28.
Excessive blood loss is a significant risk of myomectomy with the potential need for hysterectomy.
To study the effectiveness of preoperative misoprostol compared with placebo at open myomectomy on intra- and postoperative outcomes.
PubMed, Cochrane, Scopus, MEDLINE and EMBASE.
Randomised control studies of women undergoing open myomectomy for symptomatic fibroids who were given either misoprostol or placebo preoperatively.
The revised Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias. Primary outcomes were blood loss, drop in haemoglobin and need for blood transfusion. Secondary outcomes were operative time, postoperative pyrexia and length of postoperative stay. Pooled effect sizes with corresponding 95% CI were calculated using random effects models. Data were analysed using two statistical models for statistical reliability.
Eight studies were included with a total of 385 patients, of which 192 received misoprostol. Preoperative misoprostol was significantly associated with lower blood loss by -170.32 ml (95% CI -201.53 to -139.10), lower drop in haemoglobin by -0.48 g/dl (95% CI -0.65 to -0.31), reduced need for blood transfusion (odds ratio [OR] -0.48, 95% CI -0.65 to -0.31), and a reduction in operative time by -11.64 minutes (95% CI -15.73 to -7.54). There was no difference in postoperative pyrexia or length of postoperative stay.
Moderate- to high-quality studies have established that misoprostol minimises blood loss and need for blood transfusion at open myomectomy. This low-cost and readily available drug should be routinely administered prior to open myomectomy to improve clinical outcomes.
Use of misoprostol at open myomectomy reduces blood loss and need for blood transfusion with no impact on postoperative pyrexia.
子宫肌瘤剔除术中失血过多是一个显著的风险，有可能需要进行子宫切除术。
研究术前米索前列醇与安慰剂在开腹子宫肌瘤剔除术中对围手术期结局的影响。
检索 PubMed、Cochrane、Scopus、MEDLINE 和 EMBASE。
对因症状性子宫肌瘤而行开腹子宫肌瘤剔除术的妇女进行的随机对照研究，这些妇女术前接受米索前列醇或安慰剂治疗。
使用修订后的 Cochrane 随机试验偏倚风险工具评估偏倚风险。主要结局指标为出血量、血红蛋白下降和输血需求。次要结局指标为手术时间、术后发热和术后住院时间。使用随机效应模型计算合并效应大小及其相应的 95%置信区间。使用两种统计模型进行数据分析以确保统计可靠性。
纳入 8 项研究，共 385 例患者，其中 192 例接受米索前列醇治疗。术前使用米索前列醇与出血量减少 170.32ml（95%置信区间 -201.53 至 -139.10）、血红蛋白下降 0.48g/dl（95%置信区间 -0.65 至 -0.31）、减少输血需求（比值比 [OR] -0.48，95%置信区间 -0.65 至 -0.31）和手术时间缩短 11.64 分钟（95%置信区间 -15.73 至 -7.54）显著相关。术后发热和术后住院时间无差异。
中高质量研究表明，米索前列醇可减少开腹子宫肌瘤剔除术的出血量和输血需求。这种低成本且易于获得的药物应常规用于开腹子宫肌瘤剔除术之前，以改善临床结局。
在开腹子宫肌瘤剔除术中使用米索前列醇可减少出血量和输血需求，而对术后发热无影响。
