Tang Ruonan, Zhang Wanlin, Xiao Xifeng, Li Wenyi, Chen Xinxin, Wang Xiaohong
Xi'an Medical University, Xi'an, Shaanxi, China.
Department of Gynecology and Obstetrics, Reproductive Medicine Center, Tangdu Hospital, Air Force Medical University, No. 1 Xinsi Road, Baqiao District, Xi'an, Shaanxi, China.
Arch Gynecol Obstet. 2024 May;309(5):1847-1861. doi: 10.1007/s00404-024-07460-y. Epub 2024 Mar 17.
Recurrence of adhesions after hysteroscopic adhesiolysis is a challenging clinical problem without a unified management approach. Therefore, we conducted a network meta-analysis that considered both direct and indirect comparisons between interventions to identify optimal strategies for preventing recurrence.
We searched for research trials published up to July 2023 from PubMed, Embase and the Cochrane Database. We selected randomized controlled trials comparing the use of different interventions for the prevention of adhesion recurrence, with no language or regional restrictions. We used random-effects models to assess odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI). Adverse events associated with the interventions were also assessed. This study was registered on PROSPERO, CRD42023449068.
Data from 21 randomized controlled trials involving 2406 patients were synthesized, including interventions with balloon, amnion, platelet-rich plasma (PRP), intrauterine device (IUD), hyaluronic acid (HA), platelet-rich fibrin (PRF), and granulocyte colony-stimulating factor (G-CSF). The top 5 interventions for change in AFS scores were: PRP + Balloon (MD = 5.44; 95% CI, 2.63-8.25), Amnion + Balloon (MD = 5.08; 95% CI, 2.71-7.44), IUD + Balloon (MD = 4.89; 95% CI, 2.49-7.30), HA + Balloon (MD = 3.80; 95% CI, 1.78-5.82), and G-CSF + Balloon (MD = 3.84; 95% CI, 1.05-6.63). There were no statistically significant differences between interventions in the recurrence rate of moderate-to-severe uterine adhesions and the clinical pregnancy rate. Most interventions were safe.
To our knowledge, this is the most comprehensive network meta-analysis to date of interventions for preventing postoperative intrauterine adhesion recurrence. Our results indicate that PRP + Balloon seems to be the most effective approach.
宫腔镜粘连松解术后粘连复发是一个具有挑战性的临床问题，目前尚无统一的管理方法。因此，我们进行了一项网络荟萃分析，该分析考虑了不同干预措施之间的直接和间接比较，以确定预防粘连复发的最佳策略。
我们检索了截至2023年7月在PubMed、Embase和Cochrane数据库上发表的研究试验。我们选择了比较不同干预措施预防粘连复发效果的随机对照试验，没有语言或地区限制。我们使用随机效应模型来评估比值比（OR）和平均差（MD）以及95%置信区间（CI）。还评估了与干预措施相关的不良事件。本研究已在PROSPERO注册，注册号为CRD42023449068。
综合了21项涉及2406例患者的随机对照试验的数据，包括使用球囊、羊膜、富血小板血浆（PRP）、宫内节育器（IUD）、透明质酸（HA）、富血小板纤维蛋白（PRF）和粒细胞集落刺激因子（G-CSF）的干预措施。在AFS评分变化方面，排名前5的干预措施分别为：PRP+球囊（MD = 5.44；95% CI，2.63 - 8.25）、羊膜+球囊（MD = 5.08；95% CI，2.71 -
