子宫动脉化疗栓塞治疗瘢痕妊娠的Meta分析

doi:10.3969/j.issn.1006-7795.2013.02.021

摘要/Abstract

摘要：

目的评价子宫动脉化疗栓塞术(uterine artery chemoembolization,UACE)与甲氨蝶呤肌内注射(methotrexate,MTX)系统治疗相比,在治疗剖宫产子宫瘢痕部位妊娠(cesarean scar,CSP)方面的有效性和安全性。方法检索国内外的数据库Cochrane图书馆、PubMed、EMBASE、中国生物医学文献数据库、CNKI、维普中文科技期刊数据库和万方数据库,纳入有关子宫动脉化疗栓塞术治疗瘢痕妊娠的随机对照试验(randomized controlled trial,RCT),评价文献的方法学质量,并采用Revman 5.0软件进行Meta分析。结果共纳入19项研究,913名病例。Meta分析结果显示:UACE与MTX全身治疗相比,成功率、术中出血量、血β-HCG降到正常时间、住院时间、严重合并症,差异均具有统计学意义(P<0.05);而轻度不良反应、住院费用的比较,差异无统计学意义(P>0.05)。结论 UACE治疗CSP的疗效优于系统MTX治疗,且UACE联合清宫具有术中出血量、严重合并症少,血β-HCG降到正常时间短,住院时间短的优点,值得临床推广。由于综合分析的试验数量较少、质量不高,影响了结果的可靠性,仍需大样本,多中心的临床随机对照试验来进一步完善,才能更好地客观评价UACE技术。

关键词: 瘢痕妊娠, 子宫动脉化疗栓塞, 系统MTX治疗, Meta分析

Abstract:

Objective The objective of the study was to evaluate the efficacy and safety of uterine artery chemoembolization(UACE) vs systemic methotrexate(MTX) for pregnancy within a cesarean scar(CSP). Methods A database was constructed for the articles on relevant clinical trials on UACE treated with CSP, which were searched from PubMed, EMBASE, Cochrane Library, China Biological Medicine Database, CNKI,VIP, WanFang, and through contact with experts in the field from January 1995 to March 2012. The Revman 5.0 software was used for Meta-analysis according to Cochrane system evaluation method. Results Nineteen studies involving 913 patients were included. Meta-analysis showed that there were significant differences in success rate, bleeding volumes during uterine curettage, recovered β-hCG to normal values, hospitalization time, and severe adverse effects(P<0.05); there were no significant differences in mild side effects and hospitalization costs(P>0.05). Conclusion Compared with systematic MTX, UACE followed by suction curettage for CSP appeared to have more advantages and may be a priority option. But the study is limited to the original quality, quantity as well as the differences between the treatment programs of the study, the above conclusion only for clinicians to reference. Nevertheless, more multicenter, large-scale randomized controlled trials(RCTs) are still needed to get more high-quality evidence that to update this system.

Key words: cesarean scar pregnancy, uterine artery chemoembolization, systematic methotrexate, Meta-analysis

中图分类号:

R714.2

何鑫, 陈薇, 张震宇, 王淑珍, 翟妍, 李金凤, 桑翠琴. 子宫动脉化疗栓塞治疗瘢痕妊娠的Meta分析[J]. 首都医科大学学报, 2013, 34(2): 275-281.

HE Xin, CHEN Wei, ZHANG Zhenyu, WANG Shuzhen, ZHAI Yan, LI Jinfeng, SANG Cuiqin. Meta-analysis of the effectiveness of UACE and systematic MTX in the treatment of CSP[J]. Journal of Capital Medical University, 2013, 34(2): 275-281.

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