阴式手术和腹腔镜手术治疗Ⅲ型剖宫产瘢痕妊娠Meta分析

Meta Analysis of type Ⅲ caesarean scar pregnancy treated by vaginal operation and laparoscopic surgery

目的系统评价阴式手术与腹腔镜手术在治疗Ⅲ型剖宫产瘢痕妊娠(CSP)中的有效性、安全性和经济性。方法检索中国知网(CNIKI)、万方、维普(VIP)、Cochrane Library、Pub Med等数据库,纳入阴式手术与腹腔镜手术治疗Ⅲ型CSP的随机对照试验(RCT),评价文献质量,采用Rev Man5.3软件进行Meta分析。结果共纳入10篇文献,Meta分析结果显示:阴式手术治疗Ⅲ型CSP与腹腔镜手术比较,阴式手术治愈率高、术中出血少、手术时间短、术后血β-HCG降至正常时间短、不良反应及并发症发生率低、住院费用低,差异均有显著性(P<0.05);而住院时间、术后月经复潮时间比较,差异无显著性(P>0.05)。结论阴式手术治疗Ⅲ型CSP较腹腔镜手术更加有效、安全、经济,值得推广。

Objective To systematically evaluate the efficacy,safety and economy of vaginal surgery and laparoscopic surgery in the treatment of type Ⅲ cesarean scar pregnancy. Methods The datebases in CNIKI,Wan Fang,VIP,Cochrane Library and Pub Med,etc were searched,including the randomized controlled trials of vaginal surgery and laparoscopic surgery for type CSP III,then the quality of the literature was evaluated,and Meta analysis was carried out by using Rev Man5. 3 software. Results A total of 10 articles were included. The results of the Meta analysis showed that in the treatment of type Ⅲ CSP,compared with laparoscopic surgery,the cure rate of vaginal surgery was higher,with less intraoperative blood loss,shorter operation time,shorter blood β-HCG reduction to normal time,lower incidence of adverse reactions and complications,and lower hospitalization costs. All the above differences were statistically significant（P 〈0. 05）. There was no significant difference in hospitalization time and menstruation returned to normal time（P 〉0. 05）. Conclusion The treatment of type ⅢCSP by vaginal operation is more effective,safer and more economical than laparoscopic surgery,so it is worth promoting.