Department of Obstetrics and Gynecology, Sechenov First Moscow State Medical University (Sechenov University) 119991, 8-2 Trubetskaya St., Moscow, Russia.
Department of Obstetrics and Gynecology, Sechenov First Moscow State Medical University (Sechenov University) 119991, 8-2 Trubetskaya St., Moscow, Russia.
J Gynecol Obstet Hum Reprod. 2022 Apr;51(4):102334. doi: 10.1016/j.jogoh.2022.102334. Epub 2022 Feb 5.
Our study aims to compare the effects of using hyaluronan gel, an intrauterine device, and their combination to prevent intrauterine adhesions.
The systematic review was conducted according to the PRISMA 2020 checklist and has been registered in the PROSPERO.
randomized controlled trials (RCTs) in English, patients after intrauterine surgery were included. Patients with hypersensitivity and pelvic inflammatory disease were excluded.
PubMed, The Cochrane Library, ClinicalTrials.gov, Embase, and MEDLINE. The search was performed on studies published before February 1, 2021 to identify articles evaluating the effectiveness of hyaluronan gel, an intrauterine device, and their combination in the prevention of intrauterine adhesions.
8 RCTs were included for qualitative analysis reporting on 1226 participants. Five randomized trials compared recurrence rates between two groups: hyaluronan gel and control (RR = 0.53, 95% CI: 0.40 to 0.69, P < .00001). Hyaluronan gel had a significant role on reducing adhesion formation after surgical intervention. Meta-analysis of pregnancy rates compared hyaluronan gel usage and group with IUD or lack of treatment (RR = 1.58, 95% CI: 1.10 to 2.27, P = .01). Hyaluronan gel group had significantly higher pregnancy rates compared with another group in this meta-analysis.
Based on our study, it has become more evident that hyaluronic acid is an effective and safe method after adhesiolysis to prevent recurrence and lead to pregnancy in comparison with other techniques. Nevertheless, further research is needed to achieve more answers regarding adhesions prevention.
本研究旨在比较使用透明质酸凝胶、宫内节育器及其联合应用预防宫腔粘连的效果。
系统评价按照 PRISMA 2020 清单进行，并已在 PROSPERO 中注册。
纳入英语随机对照试验（RCT），患者为宫腔手术后。排除对透明质酸过敏和患有盆腔炎的患者。
PubMed、Cochrane 图书馆、ClinicalTrials.gov、Embase 和 MEDLINE。检索时间截至 2021 年 2 月 1 日，以确定评估透明质酸凝胶、宫内节育器及其联合应用预防宫腔粘连效果的文章。
定性分析纳入 8 项 RCT，共报告 1226 名参与者。5 项随机试验比较了两组之间的复发率：透明质酸凝胶和对照组（RR=0.53，95%CI：0.40 至 0.69，P<0.00001）。透明质酸凝胶在减少手术后粘连形成方面有显著作用。妊娠率的荟萃分析比较了透明质酸凝胶的使用与宫内节育器或缺乏治疗的组（RR=1.58，95%CI：1.10 至 2.27，P=0.01）。与另一组相比，透明质酸凝胶组在本荟萃分析中的妊娠率显著更高。
根据我们的研究，与其他技术相比，透明质酸凝胶在粘连松解术后预防复发和提高妊娠率方面是一种有效且安全的方法，这一点变得更加明显。然而，需要进一步的研究来获得更多关于预防粘连的答案。
