宫颈锥形切除术后不同时间间隔对子宫切除术影响的系统评价与Meta分析

A systematic review and meta-analysis of the effect of different time intervals after cervical conization on hysterectomy

目的 探讨宫颈锥形切除术后不同时间间隔行子宫切除术的影响。方法 系统检索PubMed、Embase、Web of Science、Cochrane Library、CNKI、万方、VIP和CBM数据库。检索研究宫颈锥形切除术后不同时间间隔对子宫切除术影响的相关文献,按照纳入与排除标准筛选合格文献,对文献进行质量评价与数据提取。检索时间截至2020年7月24日,语言限定为中文或英文。结果 本研究分析了涉及3 323例患者的22项研究。评估48 h的时间间隔,≤48 h组的术后住院时间较短[MD=-0.30,95%CI(-0.58,-0.02),P=0.04]。评估4周的时间间隔时,>4周组的手术时间更短[MD=7.37,95%CI(0.44,14.30),P=0.04],术后住院天数更少[MD=0.90,95%CI(0.37,1.42),P=0.0008],并发症发生率更低[OR=2.80,95%CI(1.46,5.34),P=0.002]。评估6周的时间间隔,>6周组的术中失血量较少[MD=77.11,95%CI(38.92,115.30),P<0.001]。其余指标在各组之间差异无统计学意义。结论 宫颈锥切术后子宫切除术的最佳时机不是随意的;宫颈锥切术后4/6周以上进行子宫切除术疗效更佳,符合目前临床推荐。

Objective To explore the effect of different time intervals after cervical conization on hysterectomy.MethodsA systematic search of PubMed,Embase,Web of Science,Cochrane Library,CNKI,Wanfang,VIP,and CBM databases was performed.We searched the relevant literatures on the influence of different time intervals after cervical conization on hysterectomy,screened the qualified literatures according to the inclusion and exclusion criteria,and evaluated the quality of the literatures and extracted the data.The search was performed through July 242020,and the language was limited to Chinese or English.Results 22 Studies involving 3323 patients were analyzed.Evaluating the time interval of 48 hours,the postoperative hospital stay of the≤48 hours group was shorter[MD=-0.30,95%CI(-0.58,-0.02),P=0.04].Evaluating the time interval of 4 weeks,the>4 weeks group had a shorter operation time[MD=7.37,95%CI(0.44,14.30),P=0.04],fewer days of postoperative hospital stay[MD=0.90,95%CI(0.37,1.42),P=0.0008],and a lower complication rate[0R=2.80,95%CI(1.46,5.34),P=0.002].Evaluating the time interval of 6 weeks,the>6 weeks group had less intraoperative blood loss[MD=77.11,95%CI(38.92,115.30),P<0.0001].There was no significant difference in other indexes among the groups.Conclusion The optimal timing of hysterectomy after cervical conization is not random.Hysterectomy performed more than 4/6 weeks after cervical conization is more effective and in line with current clinical recommendations.