透明质酸钠凝胶预防人工流产术后宫腔粘连有效性及安全性的Meta分析

Clinical efficacy and safety of sodium hyaluronate gel in the prevention of intrauterine adhesions after induced abortion: a Meta-analysis

目的系统评价透明质酸钠凝胶预防人工流产术后宫腔粘连(IUA)的有效性及安全性。方法检索PubMed数据库、Springer电子期刊数据库、Cochrane图书馆、Elsevier ScienceDirect数据库、CNKI数据库、万方数据库、维普数据库,查找关于透明质酸钠凝胶预防人工流产术后IUA的有效性及安全性的随机对照试验(randomized controlled trial, RCT)文献,检索时限自各数据库建库至2017年12月。按纳入和排除标准进行文献筛选、资料提取和质量评价后,采用ReVman5.3软件进行Meta分析。结果最终共纳入14篇RCT文章。Meta分析结果显示:试验组术后IUA以及粘连严重程度的发生率均较对照组低,差异均有统计学意义(P<0.000 01);与对照组相比,试验组术后阴道流血时间短,量少,月经复潮时间短,且月经经量减少、闭经、周期性下腹痛等发生率更低,差异有统计学意义(P<0.000 01)。结论人工流产术后应用透明质酸钠凝胶可降低IUA的发生率,减轻粘连严重程度,促进子宫恢复以及减少术后并发症的发生。

Objective To investigate the clinical effectiveness and safety of sodium hyaluronate gel in preventing intrauterine adhesion (IUA) after surgical abortion.Methods The databases including Pubmed database, Springer database, Cochrane library, Elsevier ScienceDirect database, CNKI database, Wanfang database, VIP database were systematically searched to collect the randomized control trail (RCT) about sodium hyaluronate gel in preventing IUA after artificial abortion, the retrieval time is from the building of each database to December 2017. According to the inclusion and exclusion criteria to search studies, data extraction and quality assessments were performed. RevMan 5.3 software was used for Meta-analysis.Results Fourteen RCTs were included. Meta-analysis showed that compared with control group, the incidence of IUA and the 3 stages (mild, moderate and severe) of adhesion in experimental group were statistically lower (P<0.00001). In experimental group, the lasting time and the amount of vaginal bleeding after operation were less, the time of menstruation turnover was shorter, the incidence of hypomenorrhea, amenorrhea and the periodic hypogastralgia was lower, and all the differences were statistically significant (P<0.00001).Conclusion Application of sodium hyaluronate gel after induced abortion can reduce the incidence of IUA, moderate the severity of adhesions, promote the recovery of the uterus and reduce postoperative complications.