子宫内膜异位症腹腔镜下保留生育功能手术后不同药物治疗临床疗效及安全性:一项更新的网状meta分析  

Clinical efficacy and safety of different drugs after laparoscopic fertility preservation surgery for endometriosis:an updated network meta-analysis

作　　者：庹俊 邵燕霞[1] 钟晓梅 Tuo Jun;Shao Yanxia;Zhong Xiaomei(Department of Obstetrics and Gynecology,the First People's Hospital of Neijiang,Neijiang 641000)

机构地区：[1]四川省内江市第一人民医院妇产科,内江641000

出　　处：《现代妇产科进展》2024年第2期92-103,共12页Progress in Obstetrics and Gynecology

摘　　要：目的:采用网状meta分析评价腹腔镜下保留生育功能术后联合不同药物治疗子宫内膜异位症(EMs)的临床疗效及安全性。方法:计算机全面检索PubMed、OVID、Cochrane Library、Embase、中国知网及万方数据库,检索时限为建库至2023年6月30日。搜集行腹腔镜保留生育功能手术联合药物治疗EMs患者的RCT。2位研究者独立筛选文献、质量评价、提取并分析数据,采用Stata 17.0软件对所得数据进行网状meta分析及图形绘制。结果:共纳入94项RCT,共9620例患者,对照组采用单纯腹腔镜手术,试验组采用腹腔镜手术联合曲普瑞林、亮丙瑞林、戈舍瑞林、孕三烯酮、米非司酮、左炔诺孕酮宫内节育系统(LNG-IUS)、达那唑、地屈孕酮、妈富隆及地诺孕素。纳入的94篇文献均为高质量RCT,质量等级B级及以上,其中英文文献17篇,中文文献77篇。网状meta分析结果:有效率由高到低排序:LNG-IUS(92.7%)、曲普瑞林(77%)、妈富隆(63.7%)、戈舍瑞林(63.6%)、地屈孕酮(51.1%)、亮丙瑞林(50.4%)、米非司酮(49.4%)、地诺孕素(44.5%)、孕三烯酮(33.3%)、达那唑(16.4%)、安慰剂(7.8%);复发率由高到低排序:安慰剂(98.1%)、孕三烯酮(74.7%)、达那唑(70.2%)、妈富隆(61.0%)、地屈孕酮(55.9%)、米非司酮(55.6%)、亮丙瑞林(54.3%)、戈舍瑞林(31.8%)、曲普瑞林(28.5%)、地诺孕素(15.1%)、LNG-IUS(4.9%);临床妊娠率由高到低排序:地屈孕酮(87.8%)、曲普瑞林(87.3%)、戈舍瑞林(58.3%)、米非司酮(55.8%)、亮丙瑞林(44.9%)、达那唑(43.4%)、地诺孕素(40.1%)、孕三烯酮(30%)、安慰剂(2.5%);不良反应发生率由低到高排序:地诺孕素(90.8%)、LNG-IUS(83.2%)、安慰剂(80.6%)、妈富隆(68.7%)、孕三烯酮(61.2%)、戈舍瑞林(50.4%)、亮丙瑞林(36.5%)、曲普瑞林(36.1%)、达那唑(19.8%)、地屈孕酮(15.6%)、米非司酮(7.1%)。结论:腹腔镜下保留生育功能手术联合左炔诺孕酮宫内节育系统治疗EMs患者的有效率最Objective:To evaluate the clinical efficacy and safety of laparoscopic fertility preservation surgery combined with different drugs in the treatment of endometriosis by network meta-analysis.Methods:PubMed,OVID,Cochrane Library,Embase,CNKI database and Wanfang database were searched by computer to seek relevant literatures until June 30,2023.All RCTs of patients with endometriosis who underwent laparoscopic fertility preservation surgery combined with medication were collected.Two researchers independently screened the literature,evaluated the quality,extracted and analyzed the data,and used Stata 17.0 software to perform network meta-analysis and graph drawing on the obtained data.Results:A total of 94 RCTS were included,with a total of 9620 patients.The control group received laparoscopy alone,and the experimental group received laparoscopy combined with triprerelin,leuprorrelin,goserelin,gestrinone,mifepristone,levonorgestrel intrauterine system(LNG-IUS),danazol,dydrogesterone,mawelon and dienogest.All the 94 literatures included were high quality RCTS with quality grade B or above,including 17 English literatures and 77 Chinese literatures.Network meta-analysis results showed that:The effective rate was ranked from high to low:LNG-IUS(92.7%),triprerelin(77%),mawelon(63.7%),goserelin(63.6%),dydrogesterone(51.1%),leuprorrelin(50.4%),mifepristone(49.4%),dienogest(44.5%),getrienone(33.3%),danazol(16.4%),placebo(7.8%).In order of recurrence rate from high to low:placebo(98.1%),getrienone(74.7%),danazol(70.2%),mawelon(61.0%),dydrogesterone(55.9%),mifepristone(55.6%),leuprorrelin(54.3%),goserrelin(31.8%),triprerelin(28.5%),dienogest(15.1%),LNG-IUS(4.9%).Pregnancy rate ranked from high to low:dydrogesterone(87.8%),triprerelin(87.3%),goserrelin(58.3%),mifepristone(55.8%),leuprorrelin(44.9%),danazol(43.4%),dienogest(40.1%),getrienone(30%),placebo(2.5%).Incidence of adverse reactions ranked from low to high:dienogest(90.8%),LNG-IUS(83.2%),placebo(80.6%),mawelon(68.7%),gestrenone(61.2%),goserrelin(50.4%),leuprorrelin(36.

关 键 词：子宫内膜异位症 手术 药物 网状meta分析 随机对照试验 

分 类 号：R713.4[医药卫生—妇产科学]