中国循证医学杂志

中国循证医学杂志

腹腔镜与开腹子宫肌瘤切除术对术后妊娠结局影响的 Meta 分析

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目的系统评价腹腔镜与开腹子宫肌瘤切除术对术后妊娠结局的影响。方法计算机检索 PubMed、Web of Science、Elsevier、The Cochrane Library、CNKI、VIP 和 WanFang Data 数据库,搜集腹腔镜与开腹子宫肌瘤切除术对术后妊娠结局影响的随机对照试验(RCT)和队列研究,检索时限均从建库截至 2017 年 7 月。由 2 位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 8 个 RCT 和 21 个队列研究,包括 4 357 例患者。Meta 分析结果显示:腹腔镜术组的早产率低于开腹组[OR=0.60,95%CI(0.38,0.95)P=0.03];但腹腔镜术组在妊娠期间子宫破裂的发生率高于开腹组[OR=3.19,95%CI(1.29,7.89),P=0.01]。在子宫肌瘤残留[OR=1.00,95%CI(0.37,2.65),P=0.99]、子宫肌瘤复发[OR=0.92,95%CI(0.68,1.25),P=0.60]、术后流产[OR=0.90,95%CI(0.63,1.28),P=0.56]、异位妊娠[OR=1.11,95%CI(0.54,2.26),P=0.78]、妊娠率[OR=1.06,95%CI(0.89,1.27),P=0.52]、剖宫产率[OR=0.82,95%CI(0.57,1.19),P=0.31]和妊娠并发症[OR=0.84,95%CI(0.45,1.59),P=0.60]方面,两组差异均无统计学意义。结论当前证据显示,腹腔镜与开腹子宫肌瘤切除术在肌瘤残留、肌瘤复发、术后流产、异位妊娠、妊娠距手术时间、妊娠率、剖宫产发生率、妊娠并发症等方面无明显差异。腹腔镜术后早产率更低,但妊娠期间发生子宫破裂的可能性更大。受纳入研究质量和数量的限制,本研究结论尚需更多高质量研究予以验证。

ObjectivesTo systematically review the perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy.MethodsPubMed, Web of Science, Elsevier, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched from inception to July 2017, to collect randomized controlled trials or cohort studies comparing the perinatal outcomes after laparoscopic myomectomy and transabdominal myomectomy. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsEight randomized controlled trials, twenty-one cohort studies involving 4357 patients were included. The results of meta-analysis showed that: the premature birth rate (OR=0.60, 95%CI 0.38 to 0.95, P=0.03) in the laparoscopic myomectomy was lower than that in the laparotomy group. However, the rate of uterine rupture during pregnancy (OR=3.19, 95%CI 1.29 to 7.89, P=0.01) in the laparoscopic myomectomy was higher than that in the laparotomy group. There were no significant differences between two groups in the myoma residual (OR=1.00, 95%CI 0.37 to 2.65, P=0.99), recurrence (OR=0.92, 95%CI 0.68 to 1.25, P=0.60), abortion (OR=0.90, 95%CI 0.63 to 1.28, P=0.56), ectopic pregnancy (OR=1.11, 95%CI 0.54 to 2.26, P=0.78), pregnancy rate (OR=1.06, 95%CI 0.89 to 1.27, P=0.52), cesarean (OR=0.82, 95%CI 0.57 to 1.19, P=0.31), and pregnancy complications (OR=0.84, 95%CI 0.45 to 1.59, P=0.60).ConclusionsCurrent evidence shows that there are no significant differences between two groups in the myoma residual, myoma recurrence, abortion, ectopic pregnancy, pregnancy rate, cesarean and pregnancy complications. While the rate of uterine rupture during pregnancy in the laparoscopic myomectomy is higher than that in the laparotomy group, the premature birth rate after operation in the laparoscopic myomectomy is lower and shorter than that in the laparotomy group. Due to the limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.

关键词: 子宫肌瘤切除术; 妊娠; 腹腔镜; 开腹; 子宫破裂; 随机对照试验; 队列研究

Key words: Myomectomy; Pregnancy; Laparoscopy; Laparotomy; Uterine rupture; Randomized controlled trial; Cohort study

引用本文: 刘唯庆, 胡丽娜, 熊汉. 腹腔镜与开腹子宫肌瘤切除术对术后妊娠结局影响的 Meta 分析. 中国循证医学杂志, 2018, 18(8): 831-839. doi: 10.7507/1672-2531.201710049 复制

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