子宫内膜异位症腹腔镜术后治疗网络Meta分析

A network Meta-analysis of the treatments for endometriosis after laparoscopy

目的系统评价子宫内膜异位症腹腔镜术后不同治疗方法的临床疗效。方法检索PubMed、CNKI、CBM、维普和万方数据库,搜集2007~2017年近十年来有关子宫内膜异位症腹腔镜术后治疗的随机对照试验(RCT)。对纳入符合标准的RCT并进行质量评价,提取数据后使用Stata 14.0和RevMan 5.3软件对腹腔镜术后治疗的临床效果进行Meta分析,并按治疗的有效率、复发率以及妊娠率分别进行网络Meta排序。结果总共纳入13篇RCT,包括1263例子宫内膜异位症患者。中西结合疗法在子宫内膜异位症腹腔镜术后治疗中的有效率高于单纯中药疗法以及西药疗法,差异均有统计学意义(P<0.05)。单纯西药和中药疗法治疗的有效率比较,差异无统计学意义(P>0.05)。按治疗的有效率、复发率以及妊娠率优劣排序均为中西结合、中药、西药、安慰剂。结论子宫内膜异位症患者腹腔镜术后应用中西结合疗法的临床疗效最为突出,可以有效提高子宫内膜异位症的治疗效果,降低复发率和不孕率。但本研究在纳入研究时可能存在一定的选择性偏倚,还需要更多高质量的RCT提供更准确的依据。

Objective To systematically evaluate the clinical efficacy of different treatment methods for endometriosis after laparoscopic surgery. Methods RCTs about endometriosis after laparoscopic surgery from 2007 to 2017 nearly ten years were searched in the database of Pub Med, CNKI, CBM, VIP and Wanfang. Eligible RCTs were included and the quality of RCTs were evaluated. The data were extracted and the clinical efficacy of after laparoscopic surgery was Meta analyzed by Stata 14.0 and Rev Man 5.3 software. And according to the effective rate of treatment, recurrence rate and pregnancy rate, the network Meta sequencing was ranked. Results A total of 13 RCTs were included in, including 1263 patients with endometriosis. The effective rate of laparoscopy combined with Chinese and Western medicine was higher than that of traditional Chinese medicine therapy and Western medicine therapy, the differences were statistically significant（P〈0.05）. There was no significant difference in the effective rate between simple western medicine and traditional Chinese medicine（P〈0.05）. According to the treatment efficiency, recurrence rate and pregnancy rate ranking order was the combination of Chinese and western, traditional Chinese medicine, western medicine and placebo.Conclusion The clinical curative effect of combined therapy of Chinese and Western in patients with endometriosis after the uterus is most prominent, can effectively improve the treatment efficiency of patients with endometriosis, reduce the recurrence rate and infertility rate. But there may be some selective bias to be included in the study, also need to provide more accurate basis to more high quality RCT.