Goyal Manu, Dawood Ayman Shehata, Elbohoty Shereen B, Abbas Ahmed M, Singh Pratibha, Melana Nitesh, Singh Surjit
Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India.
Assistant professor of Obstetrics and Gynecology, Tanta University, Tanta, Egypt.
Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:145-157. doi: 10.1016/j.ejogrb.2020.11.008. Epub 2020 Nov 11.
A lot of debate is present about Cesarean myomectomy (CM) in women with uterine myoma whether to consider it a feasible and safe procedure or an absolute contraindication.
To assess the safety and feasibility of myomectomy during cesarean section in women with uterine myoma.
Electronic search was made on MEDLINE, EMBASE, Cochrane Library, ISI web of knowledge and Scopus from January 1, 2008 to December 31, 2019 using terms "Caesarean section", "Myomectomy", "Fibroid", "Caesarean myomectomy".
All full length studies either prospective or retrospective that address caesarean myomectomy were included.
The outcomes studied were haemorrhage, mean change in haemoglobin, operative time, need for blood transfusion, febrile morbidity and duration of hospital stay.
Total 249 studies were assessed for eligibility and 17 studies included in analysis with 6545 women. There were 4702 (71.85 %) women in caesarean myomectomy (CM) group and 1843 (28.15 %) women in cesarean section (CS) group. There was statistically significant but clinically insignificant decrease in hemoglobin [MD = 0.27, 95 %CI = 0.08-0.45, p = 0.005; very low quality], significant higher need for blood transfusion [RR = 1.45, 95 %CI = 1.05-1.99, p = 0.02; high quality] in CM group versus CS alone. The mean operative time (minutes) [MD = 14.77, 95 %CI = 6.91-22.64, p = 0.0002; moderate quality] and mean hospital stay (days) [MD = 0.36, 95 %CI = 0.19-0.53, p < 0.00001; high quality] was significantly less in CM group, though of not any clinical significance. No difference in incidence of haemorrhage [RR = 1.16, 95 %CI = 0.86-1.56, p = 0.32; moderate quality evidence] and fever [RR = 1.17, 95 %CI = 0.83-1.65), p = 0.36; moderate quality] in two groups.
The meta-analysis suggests CM is associated with clinical insignificant increase in operative time, blood loss and hospital stay, especially with multiple and large size myomas. CM should be preferred over CS alone especially by experienced surgeons with appropriate haemostatic techniques and tertiary care centres.
对于患有子宫肌瘤的女性行剖宫产肌瘤切除术（CM），存在很多争议，即该手术是可行且安全的，还是绝对禁忌的。
评估患有子宫肌瘤的女性在剖宫产时行肌瘤切除术的安全性和可行性。
于2008年1月1日至2019年12月31日在MEDLINE、EMBASE、Cochrane图书馆、ISI知识网和Scopus数据库进行电子检索，检索词为“剖宫产”“肌瘤切除术”“纤维瘤”“剖宫产肌瘤切除术”。
纳入所有涉及剖宫产肌瘤切除术的前瞻性或回顾性的完整研究。
研究的结局指标包括出血、血红蛋白平均变化、手术时间、输血需求、发热性疾病及住院时间。
共评估了249项研究的纳入资格，17项研究纳入分析，涉及6545名女性。剖宫产肌瘤切除术（CM）组有4702名女性（71.85%），剖宫产（CS）组有1843名女性（28.15%）。CM组血红蛋白有统计学显著但临床无显著意义的下降[MD = 0.27，95%CI = 0.08 - 0.45，p = 0.005；极低质量]，输血需求显著高于单纯剖宫产组[RR = 1.45，95%CI = 1.05 - 1.99，p = 0.02；高质量]。CM组平均手术时间（分钟）[MD = 14.77，95%CI = 6.91 - 22.64，p = 0.0002；中等质量]和平均住院时间（天）[MD = 0.36，95%CI = 0.19 - 0.53，p < 0.00001；高质量]显著更短，尽管无临床意义。两组在出血发生率[RR = 1.16，95%CI = 0.86 - 1.56，p = 0.32；中等质量证据]和发热发生率[RR = 1.17，95%CI = 0.83 - 1.65，p = 0.36；中等质量]上无差异。
荟萃分析表明，CM与手术时间、失血量和住院时间的临床无显著意义的增加相关，尤其是对于多发和大尺寸肌瘤。尤其是在有适当止血技术的经验丰富的外科医生和三级护理中心，CM应优于单纯剖宫产。
