卡前列甲酯在子宫肌瘤剔除术及计划生育相关手术中的应用价值

The clinical value of carboprost suppositories in myomectomy and operations of family planning

目的系统评价卡前列甲酯(卡孕栓)在子宫肌瘤剔除术及计划生育相关手术中的应用价值。方法计算机检索中国生物医学文献光盘数据库、中国学术期刊全文数据库、中文科技期刊数据库、中文生物医学期刊文献数据库等电子数据库,查找卡孕栓在子宫肌瘤剔除术及药物流产、人工流产手术、取宫内节育器手术中的应用效果的随机对照试验和临床对照试验。由两位评价员独立进行资料提取后,采用Stata软件进行Meta分析。结果共纳入卡孕栓在子宫肌瘤剔除术中的应用文献3篇、绝经后取宫内节育器6篇、人工流产手术45篇、药物流产11篇。结果发现卡孕栓与缩宫素相比,可显著减少子宫肌瘤剔除术中出血量(均数差为-22.04,95%CI-27.85～16.23,P均﹤0.05)。对绝经后取宫内节育器效果,加用卡孕栓有利于扩张宫口和成功取器,对应RR值及其95%CI分别为2.07(1.66,2.57)和1.42(1.02,1.98),P均<0.05。人工流产术中,常规手术中加用卡孕栓可有效软化宫颈(RR3.19,95%CI 2.43～4.18,P﹤0.05)和镇痛(RR2.43,95%CI 1.19～4.96,P﹤0.05)。在药物流产中,卡孕栓与米索前列醇(米索)两组总成功率基本一致(RR1.00,95%CI 0.97～1.02,P=0.695),而卡孕栓组比米索组的流产时间更短[均数差为-1.42,95%CI(-2.47,-0.37),P﹤0.05]、阴道出血量更少[均数差-10.13,95%CI(-14.75,-5.51),P﹤0.05]。结论卡孕栓在子宫肌瘤剔除术中减少出血,在药物流产和手术流产中均能有效的软化宫颈、减少出血、缩短手术时间。但尚需更多高质量的随机对照试验来进一步验证相关结论。

Objective To systematically assess the effect of Carboprost Suppositories in myomectomy, taking intrauterine device and abortion. Methods Randomized controlled trials and clinical controlled trials of Carboprost Suppositories in prevention and treatment of myomectomy and operations of family planning were searched in Chinese Biomedical Literature Database, China National Knowledge Infrastructure, et al. The quality of the included studies was evaluated and the data were extracted by two assessors independently. Meta-analyses were performed with Stata software. Results Three studies on myomeetomy, 6 studies on taking intrauterine device, 45 studies on artificial abortion and 11 studies on drug abortion were identified. The Meta-analyses on myomeetomy showed that Carboprost Suppositories statistically decrease the amount of hemorrhage and the corresponding mean difference was - 22. 04 （95% CI - 27.85 - 16. 23 ）. For taking intrauterine device, Carboprost Suppositories could expand uterine orifice and help to take intrauterine device successfully, and the corresponding RR and 95% CI were 2. 07 （ 1.66,2. 57 ） and 1.42 （ 1.02,1.98 ）, respectively. In artificial abortion, adding Carboprost Suppositories is able to soften uterine orifice （ RR 3. 19,95% CI 2.43 - 4. 18 ） and reduce paining feeling （ RR 2.43,95% CI 1.19 - 4. 96）. Regarding drug abortion, the success rate of Carboprost Suppositories and misoprostol is almost identical （ RR 1.00, 95% CI 0. 97 - 1.02）, however Carboprost Suppositories is better than misoprostol in the time of abortion （mean difference and 95%CI - 1.42（ -2. 47, -0. 37） and the amount of vagina hemorrhage [ - 10. 13（ - 14. 75, -5.51 ） ]. Conclusion The present meta-analysis convinced that Carboprost Suppositories play significant role in the treatment of gynecological diseases and family planning working. Yet, more and higher level randomized controlled trials are also needed to further confirm the conclusion.