Meta-analysis of the effectiveness of UACE and systematic MTX in the treatment of CSP

doi:10.3969/j.issn.1006-7795.2013.02.021

Abstract

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

CLC Number:

R714.2

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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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2013.02.021

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2013/V34/I2/275

References

[1] Jurkovic D, Hillaby K, Woelfer B, et al. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar[J]. Ultra-sound Obstet Gynecol, 2003,21(3):220-227.

[2] Seow K M, Huang L W, Lin Y H, et al. Cesarean scar pregnancy: Issues in manage-ment[J]. Ultrasound Obstet Gynecol, 2004,23(3):247-253.

[3] Ravina J H, Herbreteau D, Ciraru-Vigneron N, et al. Merland.Arterial embolisation to treat uterine myomata[J]. Lancet, 1995,346(8976):671-672.

[4] Li C, Li C, Feng D, et al. Transcatheter arterial chemoembolization versus systemic methotrexate for the management of cesarean scar pregnancy[J]. Int J Gynaecol Obstet, 2011,113(3):178-182.

[5] Lian F, Wang Y, Chen W, et al. Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern[J]. Cardiovasc Intervent Radiol, 2012,35(2):286-291.

[6] Wu X, Zhang X, Zhu J, et al. Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection[J]. Eur J Obstet Gynecol Reprod Biol, 2012,161(1):75-79.

[7] Yang X Y, Yu H, Li Km, et al. Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy[J]. BJOG, 2010,117(8):990-996.

[8] Zhuang Y, Huang Lili. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar[J]. Am J Obstet Gynecol, 2009,201(2):152e1-152e3.

[9] 陈丽平,刘曼华.剖宫产瘢痕部位妊娠介入治疗临床分析[J].南通大学学报:医学版,2007(5):426-427.

[10] 郭久柏,张琦.子宫动脉栓塞与甲氨蝶呤治疗子宫切口妊娠的比较研究[J].天津医药,2010(5):429-430.

[11] 赖肖娟.清宫术联合子宫动脉化疗栓塞治疗剖宫产瘢痕部位妊娠的临床研究[J].中国医学工程,2011(12):98-99.

[12] 李青华,张军署,李自瑜.对35例子宫切口妊娠临床治疗分析[J].中外医疗,2011(20):22-23.

[13] 刘海艳,杨俊红.子宫切口瘢痕妊娠治疗方法临床观察[J].河北医药,2011(4):547-548.

[14] 冉建淑.甲氨蝶呤联合米非司酮治疗切口妊娠与介入治疗的疗效对比研究[J].中国医药指南,2011,9(36):320-321.

[15] 王耀恒,胡宏伟,陈掌元,等.子宫动脉栓塞术在终止切口妊娠中的作用[J].中国现代手术学杂志,2011,15(4):294-296.

[16] 王朕华,王悦,张菊新.剖宫产术后子宫切口部位妊娠治疗方法的探讨[J].中国实用医刊,2011,38(12):49-51.

[17] 王芝英.两种不同方法治疗剖宫产瘢痕妊娠临床分析[J].现代实用医学,2011(1):87-88,93.

[18] 许燕军,张群锋.子宫动脉化疗栓塞术治疗子宫切口妊娠的临床效果分析[J].海南医学院学报,2011,17(05):664-666.

[19] 张朝辉.子宫动脉栓塞联合宫腔镜治疗子宫切口妊娠36例临床分析[J].中国医药指南,2011(15):251-252.

[20] 张英,陈义松,王佳佳,等.剖宫产术后子宫瘢痕部位妊娠96例临床分析[J].中华妇产科杂志,2010,45(9):664-668.

[21] 赵淑芬,柳怡,付稼虹.甲氨喋呤与子宫动脉栓塞治疗剖宫产切口妊娠疗效比较[J].内蒙古中医药,2008(18):50-52.

[22] 朱俊彦,狄文.剖宫产术后瘢痕妊娠不同治疗方法的疗效分析[J].上海交通大学学报,2011,31(11):1621-1624.

[23] Lam P M, Lo K W, Lau T K. Unsucceasful mrdical treatment of cesareat scarectopic pregnancy with systemic methotrexate: a report of two cases[J]. Acta Obstet Cynecol Scand, 2004,83(1):108.

[24] Ghezzi F, Lagana D, Franchi M, et al. Conservative treatment by chemotherapy and uterine arteries embolization of a cesarean scar pregnancy[J]. Eur J Obstet Gynecol Reprod Biol, 2002,103(1):88-91.

[25] 廖红荔,王维,罗贤明,等.经子宫动脉介入治疗剖宫产疤痕妊娠价值探讨[J].医学临床研究,2007,24(6):980-981.

[26] 毕建蕾,杨清,毕芳芳.剖宫产瘢痕妊娠的临床特点及不同临床类型治疗结果的回顾性分析[J].中国医科大学学报,2012,41(5):465-468.

[27] 孙艳,刘玲玲,底建敏,等.药物联合治疗在剖宫产子宫切口瘢痕妊娠保守治疗中的价值[J].中国煤炭工业医学杂志,2012,15(11):1676-1678.

[28] 张彩红,马秋英.子宫瘢痕妊娠两例报告并文献复习[J].解放军医药杂志,2012,24(1):72-75.

[29] Timor-Tritsch I E A, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review[J]. Am J Obstet Gynecol, 2012,207(1):14-29.

[30] Timor-Tritsch I E, Monteagudo A, Santos R, et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy[J]. Am J Obstetrics Gynecol, 2012,207(1):44.

[31] Yan C M. A report of four cases of caesarean scar pregnancy in a period of 12 months[J]. Hong Kong Med J, 2007,13(2):141-143.

[32] 刘鸣.系统评价、meta分析设计与实施方法[M].北京:人民卫生出版社,2011:71.

[33] Pyra K, Wozniak S, Szkodziak P, et al. Szczerbo-Trojanowska, uterine artery embolisation in massive vaginal bleeding in ectopic pregnancy case report[J]. Przegl Lek, 2012,69(7):399-401.

[34] Polat I, Alkis I, Sahbaz A, et al. Diagnosis and management of cesarean scar pregnancy[J]. Clin Exp Obstetrics & Gynecology, 2012,39(3):365-368.

[35] Frishman G N, Melzer K E, Bhagavath B. Ectopic pregnancy in a cesarean-section scar: the patient >6 weeks into an ectopic pregnancy, underwent local treatment[J]. Am J Obstet Gynecol, 2012,207(3):238.e231-232.

[36] Al-Hashimi S, Maiti S, Macfoy D. Successful conservative management of ectopic pregnancy in caesarean section scar[J]. BMJ Case Rep, 2012,23:2012.