Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Changwon, Korea.
Eur Radiol. 2022 Mar;32(3):1726-1737. doi: 10.1007/s00330-021-08270-5. Epub 2021 Sep 27.
To determine the efficacy and safety of ultrasound (US)-guided sclerotherapy for the treatment of ovarian endometrioma through a systematic review and meta-analysis.
MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with endometrioma who were treated with US-guided sclerotherapy. Meta-analyses of recurrence, pain resolution, pregnancy, technical success, and complication rates were analyzed. Subgroup analyses were conducted regarding the indwelling time of sclerotherapy (≤ 10 min vs > 10 min).
Twenty-eight studies (1301 patients) were included. The pooled technical efficacy was 98.3%. The pooled estimates of recurrence, pain resolution, and pregnancy rate were 13.8%, 85.9%, and 37.6%, respectively. The pooled major complication rate was 1.7%. A sclerotherapy time > 10 min had a lower pooled recurrence rate than a time ≤ 10 min (11.2% vs 20.9%; p = 0.106). Direct comparisons showed that the recurrence rate was significantly lower with sclerotherapy > 10 min than with sclerotherapy ≤ 10 min (OR, 0.2; p = 0.015). Regarding pregnancy rates, sclerotherapy of > 10 min showed no significant difference compared with sclerotherapy of ≤ 10 min (35.9% vs 38.8%; p = 0.664). Direct comparisons with surgery showed that sclerotherapy increased the pregnancy rate compared with surgery (OR, 2.0; p = 0.042). There was no significant difference in AMH level before and after sclerotherapy (p = 0.951). There was no significant difference in major complication rates between sclerotherapy > 10 min and ≤ 10 min (p = 0.837).
US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma.
• US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. • Sclerotherapy of more than 10 min had a lower recurrence rate than sclerotherapy less than or equal to 10 min. There was no significant difference in major complication rates between sclerotherapy of > 10 min and ≤ 10 min. • Future randomized controlled trials are warranted to compare the outcomes of US-guided sclerotherapy with surgery.
通过系统评价和荟萃分析，确定超声引导下硬化疗法治疗卵巢子宫内膜异位症的疗效和安全性。
检索 MEDLINE 和 EMBASE 数据库，以获取报告接受超声引导下硬化疗法治疗的子宫内膜异位症患者结局的研究。对复发、疼痛缓解、妊娠、技术成功率和并发症发生率进行荟萃分析。对硬化治疗留置时间（≤10 分钟与>10 分钟）进行亚组分析。
纳入 28 项研究（1301 例患者）。汇总的技术有效率为 98.3%。汇总的复发率、疼痛缓解率和妊娠率分别为 13.8%、85.9%和 37.6%。汇总的主要并发症发生率为 1.7%。硬化治疗时间>10 分钟的复发率低于时间≤10 分钟（11.2%比 20.9%；p=0.106）。直接比较显示，硬化治疗时间>10 分钟的复发率显著低于时间≤10 分钟（OR，0.2；p=0.015）。关于妊娠率，硬化治疗时间>10 分钟与时间≤10 分钟之间无显著差异（35.9%比 38.8%；p=0.664）。与手术的直接比较显示，与手术相比，硬化治疗增加了妊娠率（OR，2.0；p=0.042）。硬化治疗前后 AMH 水平无显著差异（p=0.951）。硬化治疗时间>10 分钟与时间≤10 分钟的主要并发症发生率无显著差异（p=0.837）。
超声引导下硬化疗法似乎是治疗卵巢子宫内膜异位症患者的一种有效且安全的治疗选择，可降低复发率、缓解疼痛和提高妊娠率。
• 超声引导下硬化疗法似乎是治疗卵巢子宫内膜异位症患者的一种有效且安全的治疗选择，可降低复发率、缓解疼痛和提高妊娠率。• 硬化治疗时间>10 分钟的复发率低于时间≤10 分钟。硬化治疗时间>10 分钟与时间≤10 分钟的主要并发症发生率无显著差异。• 需要进行未来的随机对照试验，以比较超声引导下硬化疗法与手术的治疗结果。
