Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt).
Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt).
J Minim Invasive Gynecol. 2021 Mar;28(3):587-597. doi: 10.1016/j.jmig.2020.11.028. Epub 2020 Dec 10.
The aim of this systematic review and meta-analysis was to perform an updated analysis of the literature in regard to the surgical management of minimal to mild endometriosis. This study evaluated women of reproductive age with superficial endometriosis to determine if the results of surgical excision compared with those of ablation in improved pain scores postoperatively.
The following databases were searched from inception to May 2020 for relevant studies: Cochrane Central Register of Controlled Trials, PubMed (MEDLINE), Ovid (MEDLINE), Scopus, and Web of Science.
From our literature search, a total of 2633 articles were identified and screened. Ultimately, 4 randomized controlled trials were selected and included in our systematic review. The combined total number of subjects was 346 from these 4 studies, with sample sizes ranging from 24 to 170 participants. Data from 3 of the included studies were able to be compared and analyzed for a meta-analysis. The primary outcome was reduction in the visual analog scale (VAS) score for endometriosis-associated pain (dysmenorrhea, dyschezia, and dyspareunia), with follow-up time ranging from 6 to 60 months postoperatively.
TABULATION, INTEGRATION, AND RESULTS: Data extracted from each study included the mean reduction in the VAS score from baseline. A random-effects model was used owing to significant heterogeneity across the studies. Statistical analyses were performed using Review Manager 5.3 software (Cochrane Collaboration, London, United Kingdom). The meta-analyses showed no significant differences between the excision and ablation groups in the mean reduction in VAS scores from baseline to 12 months postoperatively for dysmenorrhea (mean difference [MD] -0.03; 95% confidence interval [CI], -1.27 to 1.22; p = .97), dyschezia (MD 0.46; 95% CI, -1.09 to 2.02; p = .56), and dyspareunia (MD 0.10; 95% CI, -2.36 to 2.56; p = .94). In addition, there were no significant differences between the excision and ablation groups in mean VAS scores at the 12-month follow-up and beyond for dysmenorrhea (MD -0.11; 95% CI, -2.14 to 1.93; p = .92), dyschezia (MD 0.01; 95% CI, -0.70 to 0.72; p = .99), and dyspareunia (MD 0.34; 95% CI, -1.61 to 2.30; p = .73).
On the basis of the data from our systematic review and pooled meta-analysis, no significant difference between laparoscopic excision and ablation was noted in regard to improving pain from minimal to mild endometriosis. However, to make definitive conclusions on this topic, larger randomized controlled trials are needed with longer follow-up.
本系统评价和荟萃分析的目的是对轻度至轻度子宫内膜异位症的文献进行更新分析。本研究评估了有浅表子宫内膜异位症的育龄妇女，以确定手术切除与消融相比是否能改善术后疼痛评分。
从成立到 2020 年 5 月，我们对以下数据库进行了搜索，以寻找相关研究：Cochrane 对照试验中心注册库、PubMed（MEDLINE）、Ovid（MEDLINE）、Scopus 和 Web of Science。
从我们的文献搜索中，共确定了 2633 篇文章并进行了筛选。最终，选择了 4 项随机对照试验进行系统评价。这 4 项研究的综合受试者总数为 346 人，样本量范围为 24 至 170 人。其中 3 项研究的数据可进行比较和分析，进行荟萃分析。主要结果是术后 6 至 60 个月时子宫内膜异位症相关疼痛（痛经、排便困难和性交困难）的视觉模拟量表（VAS）评分降低，随访时间从 6 至 60 个月。
表格、整合和结果：从每项研究中提取的 VAS 评分从基线的平均降低值。由于研究之间存在显著异质性，因此使用了随机效应模型。使用 Review Manager 5.3 软件（Cochrane 协作组，英国伦敦）进行统计分析。荟萃分析显示，在术后 12 个月时，痛经（平均差异[MD] -0.03；95%置信区间[CI]，-1.27 至 1.22；p=0.97）、排便困难（MD 0.46；95%CI，-1.09 至 2.02；p=0.56）和性交困难（MD 0.10；95%CI，-2.36 至 2.56；p=0.94）的 VAS 评分从基线到 12 个月时，切除组和消融组之间没有显著差异。此外，在痛经（MD -0.11；95%CI，-2.14 至 1.93；p=0.92）、排便困难（MD 0.01；95%CI，-0.70 至 0.72；p=0.99）和性交困难（MD 0.34；95%CI，-1.61 至 2.30；p=0.73）的 12 个月随访及以后，切除组和消融组之间的 VAS 评分也没有显著差异。
根据我们的系统评价和汇总荟萃分析的数据，腹腔镜切除和消融在改善轻度至轻度子宫内膜异位症引起的疼痛方面没有显著差异。然而，为了对此主题得出明确结论，需要进行具有更长随访时间的更大规模的随机对照试验。
