聚焦超声治疗有症状宫颈柱状上皮异位疗效和安全性的Meta分析  

Efficacy and Safety of Focused Ultrasound for Cervical Ectopy:A Meta-analysis

作　　者：唐雪莉[1] 高霑[2] 李幼平[1] 喻佳洁[1] 李向莲[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]四川绵阳404医院,绵阳621000

出　　处：《中国循证医学杂志》2015年第4期425-438,共14页Chinese Journal of Evidence-based Medicine

基　　金：国家科技支撑计划"物理治疗类产品应用示范评价与技术提升"(编号:2011BAI14B01)

摘　　要：目的系统评价聚焦超声与微波比较治疗有症状宫颈柱状上皮异位的疗效和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library、CBM、CNKI、VIP和Wan Fang Data,同时追溯纳入文献的参考文献,查找聚焦超声与微波比较治疗有症状宫颈柱状上皮异位的随机对照试验(RCT),检索时限均为建库至2014年8月30日。由2位评价员按纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2.0软件进行Meta分析。结果共纳入33个RCT,包括11 759例患者,纳入研究方法学质量均较低。Meta分析结果显示:与微波组相比,聚焦超声治疗宫颈柱状上皮异位在阴道出血率[RR=0.09,95%CI(0.05,0.17),P<0.000 01]、阴道排液率[RR=0.10,95%CI(0.04,0.24),P<0.000 01]、治愈率[RR=1.10,95%CI(1.05,1.15),P<0.000 1]、总有效率[RR=1.04,95%CI(1.02,1.06),P=0.000 5]方面优于微波,两组差异有统计学意义。但在复发率[RR=0.13,95%CI(0.02,1.00),P=0.05]方面,两组相当。结论现有证据显示,聚焦超声治疗有症状宫颈柱状上皮异位的疗效及安全性优于微波。受纳入研究质量限制,上述结论仍需要更多高质量的RCT予以验证。Objective To assess the efficacy and safety of focused ultrasound（FU） and microwave therapy（MW） for cervical ectopy（CE）. Methods We searched the following databases： Pub Med, EMbase, The Cochrane Library, CBM, VIP, CNKI and Wan Fang Data from inception to 30 th August 2014. Two reviewers（Tang XL and Gao Z） independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using Rev Man 5.2.0 software. Results A total of 33 randomized controlled trials（RCTs） involving 1 759 patients were included. All the included studies were considered to be at high risk of bias. The results of meta-analysis showed that： compared with MW, FU could significantly reduce the risk of vaginal bleeding（RR=0.09, 95%CI 0.05 to 0.17, P〈0.000 01） and vaginal discharge（RR=0.10, 95%CI 0.04 to 0.24, P〈0.000 01）, increase cure rate（RR=1.10, 95%CI 1.05 to 1.15, P〈0.000 1） and total effective rate（RR=1.04, 95%CI 1.02 to 1.06, P=0.000 5）. However, there was no difference in decreasing recurrence rate（RR=0.13, 95%CI 0.02 to 1.00, P=0.05）. Conclusion Current available evidence suggest that FU is safer and more effective than MW for treating CE. Due to the limitation of quality of included studies, more high quality RCTs are needed to verify the above conclusion.

关 键 词：宫颈柱状上皮异位 聚焦超声 微波 META分析 随机对照试验 

分 类 号：R737.33[医药卫生—肿瘤]