Department of Gynaecology and Obstetrics, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
Department of Pathology and Pathophysiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
Medicine (Baltimore). 2023 Aug 4;102(31):e34496. doi: 10.1097/MD.0000000000034496.
Endometriosis (EMT) is a benign and common estrogen-dependent disease. Hormonal therapy improves pain symptoms in most women with EMT. However, in many cases, laparoscopic fertility preservation surgery is considered a common treatment for EMT. The present study aimed to evaluate the efficacy and safety of dienogest, leuprolide, danazol, gestrinone, mifepristone and levonorgestrel intrauterine system (LNG-IUS) in relieving symptoms and delaying the recurrence of EMT cysts after fertility protection surgery.
We searched PubMed, the Cochrane Library, Web of Science, EMBase, China National Knowledge Infrastructure, VIP Database, China Biology Medicine disc, WanFang Data databases to collect randomized controlled trials (RCT) related to dienogest, leuprolide, danazol, gestrinone, mifepristone and LNG-IUS as a follow-up treatment after fertility preserving surgery for EMT. After literature screening, data extraction and quality evaluation, effective rate, recurrence rate, pregnancy rate and adverse reaction rate were used as outcome indicators to evaluate the efficacy and safety of drugs. Evidence networks included in the study were drawn and publication bias was assessed. The drugs most likely to be the best postoperative treatment were explored through mixed comparison of different drugs and efficacy ranking.
Effective rate: dienogest, leprerelin, gestrinone and LNG-IUS were better than placebo after EMT fertility preservation surgery; dienogest was superior to mifepristone and danazol. LNG-IUS is superior to danazol. LNG-IUS has the highest potential for improving the effectiveness of EMT symptoms. Recurrence rate: the application of dienogest, leuprolide, gestrinone, mifepristone and LNG-IUS after EMT fertility preservation surgery was lower than that of placebo; dienogest and LNG-IUS were lower than danazol. The recurrence rate of dinorgestrel was the last place with the highest performance. Pregnancy rate: in the cases with fertility requirements, dienogest and,leuprolide were better than placebo after EMT fertility preservation surgery; dienogest was superior to danazol, gestrinone and mifepristone. Leuprolide is superior to danazol and gestrinone. The first rank of dienogest pregnancy rate was the highest. Adverse reaction rate: the application of dienogest, leuprolide, danazol, gestrinone, mifepristone and LNG-IUS after EMT fertility preservation surgery was higher than that of placebo. After placebo, LNG-IUS had the highest adverse reaction rate.
For patients after fertility preserving surgery for EMT, the recurrence rate of dienogest was the last place with highest preference. The first rank of dienogest pregnancy was the highest.
子宫内膜异位症（EMT）是一种良性且常见的雌激素依赖性疾病。大多数 EMT 患者应用激素治疗可改善疼痛症状。然而，在许多情况下，腹腔镜生育保存手术被认为是 EMT 的常见治疗方法。本研究旨在评估地诺孕素、亮丙瑞林、丹那唑、孕三烯酮、米非司酮和左炔诺孕酮宫内缓释系统（LNG-IUS）在缓解症状和延迟 EMT 囊肿复发方面的疗效和安全性。
我们检索了 PubMed、Cochrane 图书馆、Web of Science、EMBase、中国知网、维普数据库、中国生物医学文献数据库、万方数据资源系统，收集了地诺孕素、亮丙瑞林、丹那唑、孕三烯酮、米非司酮和 LNG-IUS 作为 EMT 生育保存手术后的后续治疗的随机对照试验（RCT）。经过文献筛选、数据提取和质量评价，以有效率、复发率、妊娠率和不良反应率作为疗效指标，评估药物的疗效和安全性。研究纳入的证据网络绘制并评估发表偏倚。通过不同药物的混合比较和疗效排名，探讨最有可能成为术后最佳治疗药物的药物。
有效率：地诺孕素、亮丙瑞林、孕三烯酮和 LNG-IUS 在 EMT 生育保存手术后优于安慰剂；地诺孕素优于米非司酮和丹那唑。LNG-IUS 优于丹那唑。LNG-IUS 对 EMT 症状的疗效改善最具潜力。复发率：地诺孕素、亮丙瑞林、孕三烯酮、米非司酮和 LNG-IUS 应用于 EMT 生育保存手术后的复发率低于安慰剂；地诺孕素和 LNG-IUS 低于丹那唑。地诺孕素的复发率最低，表现最佳。妊娠率：在有生育要求的病例中，地诺孕素和亮丙瑞林在 EMT 生育保存手术后优于安慰剂；地诺孕素优于丹那唑、孕三烯酮和米非司酮。亮丙瑞林优于丹那唑和孕三烯酮。地诺孕素的妊娠率排名第一，最高。不良反应率：地诺孕素、亮丙瑞林、丹那唑、孕三烯酮、米非司酮和 LNG-IUS 应用于 EMT 生育保存手术后的不良反应率高于安慰剂。在安慰剂之后，LNG-IUS 的不良反应率最高。
对于 EMT 生育保存手术后的患者，地诺孕素的复发率最低，首选率最高。地诺孕素的妊娠率排名第一，最高。
