Balachandran Amrita, Mishra R K, Effie A Ouma, Raghunathan Akshay, Mathew Anoopa, Archana S
Department of Minimal Access Surgery, World Laparoscopy Hospital, Gurgaon, Haryana, India.
Department of Obstetrics and Gynaecology, Nairobi Regional Hospital, Nairobi, Kenya.
J Minim Access Surg. 2024 Oct 1;20(4):363-372. doi: 10.4103/jmas.jmas_272_23. Epub 2024 Oct 9.
Laparoscopic myomectomy is a commonly performed operation with fast recovery and excellent results. However, haemorrhagic nature of the operation mandates us to use variety of vasoconstrictive and uterotonic agents. Amongst which, one of them is vasopressin. It is a synthetic antidiuretic hormone analogue which has been in common use as a vasoconstrictive agent in various surgical procedures including laparoscopic myomectomy.
A meta-analysis of randomised controlled trials published from 2013 to 2023 (10 years) comparing the use of vasopressin against other drug or placebo or different doses of vasopressin was performed. The outcome measures were intraoperative blood loss, need for blood transfusion, difference in the haemoglobin (Hb) and haematocrit (Hct).
We identified 176 articles through the study search, amongst which 12 articles were included for the meta-analysis. There was a significant heterogeneity in the studies with moderate risk of bias in eight studies and low risk of bias in four studies. Compared to placebo, vasopressin showed significantly lower odds need of blood transfusion (odds ratio [OR] 0.28, 95% confidence interval [CI]: 0.13-0.61, P = 0.002) and significantly lower pre-post fall in Hb (OR -3.12, 95% CI: -4.63--1.60, P < 0.0001). However, there was no statistically significant difference in intraoperative blood loss (OR -0.56 (95% CI: -2.04-0.92, P = 0.46) and pre-post fall in Hct (OR -0.94, 95% CI: -1.96-0.07, P > 0.05). Compared to other drug (epinephrine, misoprostol and octreotide acetate), vasopressin showed no significant superiority in controlling blood loss ( P > 0.05). Even the two doses of vasopressin (dilute vs. concentrated) showed no statistically significant difference between surgical blood loss and need for blood transfusion ( P > 0.05).
Vasopressin is an efficacious drug to be used for controlling blood loss, decreasing blood transfusion requirement and maintaining Hb and Hct during laparoscopic myomectomy.
腹腔镜子宫肌瘤切除术是一种常见的手术，恢复快且效果良好。然而，该手术的出血性质要求我们使用多种血管收缩剂和宫缩剂。其中之一是血管加压素。它是一种合成抗利尿激素类似物，在包括腹腔镜子宫肌瘤切除术在内的各种外科手术中作为血管收缩剂广泛使用。
对2013年至2023年（10年）发表的比较血管加压素与其他药物或安慰剂或不同剂量血管加压素使用的随机对照试验进行荟萃分析。结局指标为术中失血、输血需求、血红蛋白（Hb）和血细胞比容（Hct）的变化。
通过研究检索我们识别出176篇文章，其中12篇文章纳入荟萃分析。研究存在显著异质性，八项研究存在中度偏倚风险，四项研究存在低度偏倚风险。与安慰剂相比，血管加压素显示输血需求的比值比显著更低（比值比[OR]0.28，95%置信区间[CI]：0.13 - 0.61，P = 0.002），且Hb术前术后下降幅度显著更低（OR -3.12，95% CI：-4.63 - -1.60，P < 0.0001）。然而，术中失血（OR -0.56（95% CI：-2.04 - 0.92，P = 0.46））和Hct术前术后下降幅度（OR -0.94，95% CI：-1.96 - 0.07，P > 0.05）无统计学显著差异。与其他药物（肾上腺素、米索前列醇和醋酸奥曲肽）相比，血管加压素在控制失血方面无显著优势（P > 0.05）。即使两种剂量的血管加压素（稀释剂与浓缩剂）在手术失血量和输血需求方面也无统计学显著差异（P > 0.05）。
血管加压素是一种有效的药物，可用于在腹腔镜子宫肌瘤切除术中控制失血、减少输血需求并维持Hb和Hct水平。
