Liu Yijun, Gong Han, Gou Jinhai, Liu Xinghui, Li Zhengyu
Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China.
Front Med (Lausanne). 2021 Apr 7;8:652505. doi: 10.3389/fmed.2021.652505. eCollection 2021.
This study aimed to comprehensively assess the value of Dienogest (DNG) as a maintenance treatment following conservative surgery for endometriosis in terms of the outcomes of disease and pregnancy. We searched for relevant studies and trials up to November 2020 from PubMed, Cochrane Library, Medline, and EMBASE databases as well as the Web of Science. Patients who received DNG maintenance treatment were compared to those who received other treatments (OT), including the levonorgestrel-releasing intrauterine system (LNG-IUS) and gonadotropin-releasing hormone analogs (GnRH-a), or non-treatment (NT). The primary outcomes were disease recurrence and pregnancy rates. Eleven studies were included in this meta-analysis. The pooled analysis indicated that DNG maintenance treatment was associated with a lower rate of disease recurrence. A significant difference was observed in DNG maintenance treatment compared with NT, but not with OT, in the pregnancy rates postoperatively. Moreover, DNG maintenance treatment was related to a significant increase in vaginal bleeding and weight gain. DNG can be recommended as a maintenance treatment for patients with endometriosis to decrease the rates of disease recurrence following conservative surgery. However, DNG maintenance treatment has no advantage in improving pregnancy rates compared to OT.
本研究旨在从疾病结局和妊娠结局方面全面评估地诺孕素（DNG）作为子宫内膜异位症保守手术后维持治疗的价值。我们检索了截至2020年11月的相关研究和试验，检索数据库包括PubMed、Cochrane图书馆、Medline、EMBASE数据库以及Web of Science。将接受DNG维持治疗的患者与接受其他治疗（OT）的患者进行比较，其他治疗包括左炔诺孕酮宫内节育系统（LNG-IUS）和促性腺激素释放激素类似物（GnRH-a），或与未接受治疗（NT）的患者进行比较。主要结局为疾病复发率和妊娠率。本荟萃分析纳入了11项研究。汇总分析表明，DNG维持治疗与较低的疾病复发率相关。术后妊娠率方面，DNG维持治疗与NT相比有显著差异，但与OT相比无显著差异。此外，DNG维持治疗与阴道出血和体重增加显著增加有关。对于子宫内膜异位症患者，可推荐DNG作为维持治疗以降低保守手术后的疾病复发率。然而，与OT相比，DNG维持治疗在提高妊娠率方面并无优势。
