剖宫产瘢痕妊娠治疗方法的Meta分析

发布时间：2018-04-30 21:06

本文选题：剖宫产瘢痕妊娠 + 治疗　；参考：《吉林大学》2017年硕士论文

【摘要】：研究背景:剖宫产瘢痕妊娠是一种较少见的异位妊娠类型,发生率在1/2216~1/1800之间,但近年来临床发病率呈上升趋势,CSP患者如果不能及时诊断及妥善治疗,将会出现大出血、子宫破裂、子宫切除甚至危及患者的生命。但由于国内外对剖宫产瘢痕妊娠的治疗缺乏足够有力的循证医学依据,目前CSP尚无规范统一的治疗指南。因此,通过循证医学探寻一种创伤小、恢复快、安全有效的治疗方式对于最大限度的保护患者的健康、提高患者的生活质量有重要意义。目的:研究子宫瘢痕妊娠的治疗方法,对临床应用较多、创伤较小、患者接受度高的子宫动脉化疗栓塞术联合清宫术、甲氨蝶呤联合清宫术、阴式病灶切除术及腹腔镜下病灶切除术等四种治疗方式从治愈率、术中出血量、血β-h CG降至正常的时间、住院时间、住院费用、月经复潮的时间等多个观察指标进行系统评价、荟萃分析。方法:依据《Systematic Review in Heath Care:Meta-analysis in Context》制作步骤,针对要评价的问题,确定纳入和排除标准。制定检索策略,利用计算机在线检索Pubmed,Embase,Cochrane Library,Medline,OVID,Web of science;相关期刊论文(CNKI)、万方数据库、中国生物医学文献服务系统(Sino Med)、重庆维普中文期刊全文数据库(VIP)等,人工检索吉林大学医学图书馆相关杂志,全面搜集2012年1月至2016年12月中英文发表及未发表的剖宫产瘢痕妊娠治疗方法的有关文献。由两位评价员独立选择研究、评估研究的质量及提取数据,使用Review Manager5.3软件完成纳入文献的Meta分析。结果:两位评价员依据纳入及排除标准共纳入文献19篇,有关子宫动脉化疗栓塞术联合清宫术及甲氨蝶呤联合清宫术治疗CSP的文献15篇,有关阴式病灶切除术及腹腔镜下病灶切除术治疗CSP的文献4篇。其中,533例患者行子宫动脉化疗栓塞术联合清宫术治疗,383例患者行甲氨蝶呤联合清宫术治疗,114例患者行阴式病灶切除术,125例患者行腹腔镜下病灶切除术。使用Review Manager5.3软件进行Meta分析,结果显示:⑴子宫动脉化疗栓塞术联合清宫术与甲氨蝶呤联合清宫术治愈率对比,纳入15篇文献,合并分析结果示:OR=2.5,95%CI为(1.43,4.38),Z=3.20,P=0.001,P0.05,两组数据差异有统计学意义;子宫动脉化疗栓塞术联合清宫术与甲氨蝶呤联合清宫术术中出血量、血β-HCG降至正常的时间及住院费用对比,因纳入研究异质性大,无法合并分析。⑵阴式病灶切除术与腹腔镜下病灶切除术治愈率对比,纳入4篇文献,合并分析结果示:RR=1.00,95%CI为(0.97,1.03),且Z=0.20,P=0.84,P0.05,两组数据差异无统计学意义;术中出血量对比,纳入3篇文献,合并分析结果示:SMD=1.17,95%CI为(0.82,1.51),且Z=6.68,P0.00001,P0.05,两组数据差异有统计学意义;手术时间对比,纳入文献3篇,合并分析结果示:MD=25.23,95%CI为(20.08,30.38),且Z=9.61,P0.00001,P0.05,两组数据差异有统计学意义;月经复潮时间对比,纳入文献4篇,合并分析结果示:MD=0.76,95%CI为(-0.96,2.48),且Z=0.87,P=0.39,P0.05,两组数据差异无统计学意义;血β-HCG降至正常的时间、住院费用对比,因纳入研究异质性大,无法合并分析。结论:1.UAEC联合清宫术治疗CSP比MTX联合清宫术治疗CSP治愈率高,术中大出血及进一步治疗的概率低,为更安全有效的治疗方式。2.阴式病灶切除术与腹腔镜下病灶切除术,治愈率无明显差异,且治愈率均较高。3.阴式病灶切除术治疗CSP比腹腔镜下病灶切除术治疗CSP术中出血量少,手术时间短,两种方式治疗CSP后,月经复潮时间无明显差异。
[Abstract]:Background: cesarean scar pregnancy is a rare type of ectopic pregnancy. The incidence rate is between 1/2216~1/1800, but in recent years the incidence of cicatricial pregnancy is rising. If CSP patients can not be diagnosed and treated properly, there will be massive hemorrhage, rupture of uterus, hysterectomy and even endanger the patient's life. The treatment of uterine cicatricial pregnancy lacks sufficient evidence of evidence-based medicine. At present, there is no standardized and unified guide for treatment in CSP. Therefore, it is of great significance to explore a kind of small trauma, quick recovery, safe and effective treatment through evidence-based medicine for the maximum protection of the health of the patients and the improvement of the quality of life of the patients. The treatment of cicatricial pregnancy has more clinical application and less trauma. Patients with high acceptability of uterine artery chemoembolization combined with uterine artery embolization, methotrexate combined with uterine resection, vaginal lesion excision and laparoscopic focus resection are four treatment methods from the cure rate, the amount of intraoperative bleeding, the time of blood beta -h CG to the normal time, hospitalization A systematic evaluation and meta analysis of several observation indexes, such as between the cost of hospitalization, the time of menstruation and tide, etc. methods: according to the steps of , the inclusion and exclusion criteria are determined for the problems to be evaluated. The retrieval strategy is formulated and the computer is used to retrieve Pubmed, Embase, Cochrane Li on the computer. Brary, Medline, OVID, Web of science; Chinese journal full text database (CNKI), Wanfang database, Chinese biomedical literature service system (Sino Med), Chongqing VP Chinese journal full text database (VIP), etc., manually retrieving the related miscellaneous records of the medical library of Jilin University, and collecting and unpublished in English from January 2012 to 12 2016. The literature on the treatment of caesarean scar pregnancy. Two evaluators independently selected the study to evaluate the quality and data of the study, and use the Review Manager5.3 software to complete the Meta analysis in the literature. Results: two evaluators included 19 articles in the literature according to the inclusion and exclusion criteria, and the uterine artery chemoembolization combined with the palace of Qing palace. 15 literature for the treatment of CSP with methotrexate combined with methotrexate, 4 articles about the treatment of CSP with vaginal lesion resection and laparoscopic lesion excision, of which 533 patients were treated with uterine artery chemoembolization combined with hysterectomy, 383 patients treated with methotrexate combined with hysterectomy, 114 patients with vaginal excision, 125 Patients underwent laparoscopic lesion excision. Meta analysis was performed using Review Manager5.3 software. The results showed: (1) the comparison of the curative rate of uterine artery chemoembolization combined with methotrexate combined with methotrexate was included in 15 articles. The combined analysis showed that OR=2.5,95%CI was (1.43,4.38), Z=3.20, P=0.001, P0.05, and the data of the two groups were different. Statistical significance: uterine artery chemoembolization combined with uterine artery embolization and methotrexate combined with the amount of bleeding, blood beta -HCG to normal time and hospital cost comparison, because of the large heterogeneity of the study, can not be combined analysis. (2) the comparison of the cure rate of vaginal lesion resection and laparoscopic resection, including 4 literature, merge points The results showed that: RR=1.00,95%CI was (0.97,1.03), and Z=0.20, P=0.84, P0.05, two groups of data differences were not statistically significant; the amount of bleeding in the operation was included in 3 articles, and the combined analysis results showed that SMD=1.17,95%CI was (0.82,1.51), and Z=6.68, P0.00001, P0.05, two groups of data differences were statistically significant; operation time comparison, included 3 articles, merge points. The results showed: MD=25.23,95%CI (20.08,30.38), and Z=9.61, P0.00001, P0.05, two groups of data differences were statistically significant; menstrual cycle time comparison, included in the literature 4, the combined analysis showed that MD=0.76,95%CI was (-0.96,2.48), and Z=0.87, P=0.39, P0.05, two groups of data differences without statistical significance; blood beta -HCG to normal time, hospitalization fee Conclusion: 1.UAEC combined with CSP is more effective in treating CSP than MTX, and the probability of large bleeding and further treatment is low, and there is no significant difference in the cure rate between.2. vaginal focus resection and laparoscopic focus resection. The cure rate was higher than that of.3. negative resection for the treatment of CSP compared with laparoscopic focus resection for the treatment of CSP with less bleeding and shorter operation time. There was no significant difference in the period of menstrual recovery after two ways of treating CSP.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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