宫内干预的选择,以防止复发后透粘结溶解:一个系统的审查和随机对照试验的网络元分析
Ruonan Tang1,2, Wanlin Zhang2, Xifeng Xiao2
1Xi'an Medical University, Xi'an, Shaanxi, China.
Archives of gynecology and obstetrics
|March 17, 2024
概括
在手术后预防子宫内粘附至关重要. 一个网络元分析发现,与气球相结合的富血小板血 (PRP) 似乎是减少粘附复发的最有效方法.
科学领域:
- 生殖医学 生殖医学
- 妇科外科手术 妇科外科
- 基于证据的医学基于证据的医学.
背景情况:
- 宫内粘附 (IUAs) 可能在透粘附解后复发,这对临床构成挑战.
- 缺乏一个统一的管理策略来防止IAU的复发.
研究的目的:
- 进行全面的网络元分析,比较预防IUA复发的干预措施.
- 为了确定最优的策略,以最大限度地减少附着重塑后手术.
主要方法:
- 系统地搜索PubMed,Embase和Cochrane数据库,直到2023年7月为相关的随机对照试验.
- 包括2106名患者的21项试验,分析了诸如气球,羊膜,富血小板血 (PRP),宫内避孕装置 (IUD),氨酸 (HA),富血小板纤维素 (PRF) 和颗粒细胞殖民地刺激因子 (G-CSF) 等干预措施.
- 随机效应模型用于评估几率比率 (OR) 和平均差异 (MD) 的95%置信区间 (CI);不良事件也被评估.
主要成果:
- 富血小板血 (PRP) +气球在美国生育学会 (AFS) 评分中表现出最大的改善 (MD = 5.44;95% CI,2.63 - 8.25).
- 其他有效的组合包括Amnion + 气球,IUD + 气球,HA + 气球和G-CSF + 气球.
- 在干预之间没有观察到中度至严重的IUA复发率或临床怀孕率的显著差异;大多数干预被认为是安全的.
结论:
- 这一网络元分析代表了迄今为止关于预防IUA复发的干预措施的最广泛的审查.
- PRP和气球的组合似乎是改善AFS分数和潜在地减少粘附复发的最有效策略.
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