经宫颈粘连切除术治疗中重度宫腔粘连妇女的生殖结局：系统评价和荟萃分析。

Reproductive outcomes of women with moderate to severe intrauterine adhesions after transcervical resection of adhesion: A systematic review and meta-analysis.

机构信息

Department of Gynecology, Women and Children Healthcare Hospital of Zhuzhou, Zhuzhou, Hunan, China.

Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, Zhejiang, China.

出版信息

Medicine (Baltimore). 2023 Mar 17;102(11):e33258. doi: 10.1097/MD.0000000000033258.

DOI:10.1097/MD.0000000000033258

PMID:36930133

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10019229/

Abstract

BACKGROUND

Intrauterine adhesions (IUA) refers to the adhesion of the inner wall of the uterus, resulting in complete or partial occlusion of the uterine cavity, which causes a series of symptoms. Transcervical resection of adhesion (TCRA) is the standard surgical method for patients with IUA. However, the recurrence rate of women with moderate to severe IUA is high and it has raised a big concern about the reproductive outcomes.

METHODS

We conducted a scoping review by using 4 databases, including Google Scholar, PubMed, Scopus, Embase, and web of science, to retrieve relevant literature from September 1, 2001, to February 1, 2023, and to explore the reproductive outcomes in women with moderate to severe IUA after TCRA treatment. Following defined guidelines, data extraction was carried out by 2 researchers, and the findings were examined by 2 senior academics. The papers were evaluated by 2 reviewers using the inclusion and exclusion criteria. Using a form developed especially for this study, pertinent information was retrieved, including the first author, research design, study duration, age, intervention measurement, pregnancy rate, techniques of conception, and live birth rate. Two researchers conducted a quality assessment to determine any potential bias using the Cochrane technique and the Newcastle-Ottawa scale. RevMan 5.4.1 (The Cochrane Collaboration, London, United Kingdom) was used for data analysis, while I2 was used to evaluate heterogeneity.

RESULTS

In total, this study included 2099 participants. After a detailed systematic review and meta-analyses, the results showed that pregnancy and live birth rates were increased significantly after TCRA, and the risk difference of the pregnancy rate was 1.75 [1.17, 2.62]. Besides, in 2 retrospective studies, the risk difference of live birth rate was 2.26, with a 95% confidence interval of 1.99 to 2.58. Moreover, the menstrual status of women also was improved, and the risk difference of hypermenorrhoea and amenorrhea were -0.28 [-0.37, -0.19] and -0.06 [0.26, 0.13], respectively.

CONCLUSIONS

Taken together, TCRA is the useful strategy for the treatment of moderate to severe IUA to enhance the reproductive outcomes in women.

摘要

背景

宫腔粘连（IUA）是指子宫内膜的粘连，导致宫腔完全或部分闭塞，引起一系列症状。经宫颈粘连切除术（TCRA）是治疗 IUA 患者的标准手术方法。然而，中重度 IUA 患者的复发率较高，这引起了人们对其生殖结局的极大关注。

方法

我们使用 4 个数据库（包括 Google Scholar、PubMed、Scopus、Embase 和 Web of Science）进行了范围综述，从 2001 年 9 月 1 日至 2023 年 2 月 1 日检索了相关文献，以探讨 TCRA 治疗后中重度 IUA 患者的生殖结局。根据既定指南，由 2 名研究人员进行数据提取，并由 2 名资深学者进行检查。使用专门为此研究制定的表格，检索了相关信息，包括第一作者、研究设计、研究持续时间、年龄、干预措施、妊娠率、受孕技术和活产率。两名评审员使用纳入和排除标准评估论文。使用 RevMan 5.4.1（Cochrane 协作网，英国伦敦）进行数据分析，同时使用 I2 评估异质性。

结果

共有 2099 名参与者纳入本研究。经过详细的系统评价和荟萃分析，结果显示 TCRA 后妊娠率和活产率显著增加，妊娠率的风险差异为 1.75 [1.17, 2.62]。此外，在 2 项回顾性研究中，活产率的风险差异为 2.26，95%置信区间为 1.99 至 2.58。此外，患者的月经状况也得到改善，月经过多和闭经的风险差异分别为-0.28[-0.37, -0.19]和-0.06[0.26, 0.13]。