Eberle Alexa, Nguyen Dong Bach, Smith Jessica Papillon, Mansour Fady W, Krishnamurthy Srinivasan, Zakhari Andrew
Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada.
Obstet Gynecol. 2024 Jan 1;143(1):53-66. doi: 10.1097/AOG.0000000000005444. Epub 2023 Nov 9.
To estimate the effect of medical management on the size of ovarian endometriomas.
Online databases were searched from inception to October 2022, including Ovid MEDLINE, Ovid EMBASE, PubMed, EBM Reviews-Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Web of Science.
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we included all English-language, full-text articles that reported on change in endometrioma size (either diameter or volume) after medical interventions. Studies evaluating surgical interventions or postoperative recurrence were excluded. All screening and data extraction were performed independently by two authors. Risk of bias assessment was performed with either the Cochrane Risk of Bias Tool for randomized controlled trials or a modified Newcastle-Ottawa Scale for observational studies.
TABULATION, INTEGRATION, AND RESULTS: After removal of duplicates, 9,332 studies were screened, with 33 full-text articles deemed eligible for inclusion. In the meta-analysis, dienogest showed significant reduction in cyst diameter (reduction 1.32 cm, 95% CI, 0.91-1.73, eight studies, n=418 cysts) and volume (mean difference of log-transformed volume 1.35, 95% CI, 0.87-1.83, seven studies, n=282 cysts). Similarly, significant reductions were seen with the oral contraceptive pill (OCP) (1.06 cm, 95% CI, 0.59-1.53, nine studies, n=455), gonadotropin-releasing hormone (GnRH) agonists (1.17 cm, 95% CI, 0.42-1.92, four studies, n=128 cysts), norethindrone acetate (0.6 cm, 95% CI, 0.27-0.94, two studies, n=88 cysts), and danazol (1.95 cm, 95% CI, 1.18-2.73, two studies, n=34 cysts). Norethindrone acetate with aromatase inhibitor was also effective in reducing endometrioma volume (mean difference of log-transformed volume 1.47, 95% CI, 0.16-2.78, two studies, n=34 cysts).
Medical management with dienogest, OCPs, GnRH agonists, norethindrone acetate, norethindrone acetate with aromatase inhibitor, or danazol can reduce the size of ovarian endometriomas.
PROSPERO, CRD 42022363319.
评估药物治疗对卵巢子宫内膜异位囊肿大小的影响。
从数据库创建至2022年10月检索在线数据库，包括Ovid MEDLINE、Ovid EMBASE、PubMed、循证医学评价-考克兰对照试验中央注册库（CENTRAL）、ClinicalTrials.gov和科学网。
遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，纳入所有报告药物干预后子宫内膜异位囊肿大小变化（直径或体积）的英文全文文章。排除评估手术干预或术后复发的研究。所有筛选和数据提取均由两名作者独立进行。采用考克兰随机对照试验偏倚风险工具或改良的纽卡斯尔-渥太华量表对观察性研究进行偏倚风险评估。
制表、整合与结果：去除重复项后，筛选了9332项研究，33篇全文文章被认为符合纳入标准。在Meta分析中，地诺孕素使囊肿直径显著减小（减小1.32 cm，95%CI为0.91 - 1.73，八项研究，n = 418个囊肿），体积也显著减小（对数转换体积的平均差值为1.35，95%CI为0.87 - 1.83，七项研究，n = 282个囊肿）。同样，口服避孕药（OCP）（1.06 cm，95%CI为0.59 - 1.53，九项研究，n = 455）、促性腺激素释放激素（GnRH）激动剂（1.17 cm，95%CI为0.42 - 1.92，四项研究，n = 128个囊肿）、醋酸炔诺酮（0.6 cm，95%CI为0.27 - 0.94，两项研究，n = 88个囊肿）和达那唑（1.95 cm，95%CI为1.18 - 2.73，两项研究，n = 34个囊肿）也显示出显著减小。醋酸炔诺酮联合芳香化酶抑制剂在减小子宫内膜异位囊肿体积方面也有效（对数转换体积的平均差值为1.47，95%CI为0.16 - 2.78，两项研究，n = 34个囊肿）。
地诺孕素、OCPs、GnRH激动剂、醋酸炔诺酮、醋酸炔诺酮联合芳香化酶抑制剂或达那唑的药物治疗可减小卵巢子宫内膜异位囊肿的大小。
PROSPERO，CRD 42022363319
