介入栓塞术、手术及高强度聚焦超声治疗子宫肌瘤的网状Meta分析

目的运用网状评价方法评价子宫动脉栓塞术(uterine artery embolization,UAE)、手术及高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗子宫肌瘤的安全性和有效性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、WanFang Data和CNKI数据库,搜集有关UAE、外科手术、HIFU治疗子宫肌瘤的安全性和有效性评价的研究,检索时限均从2000年1月至2019年8月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,运用ADDIS 1.16.8软件和Stata 14软件进行网状Meta分析。结果共纳入11个研究(22篇文献),包括3469例患者。定性分析结果显示:与手术相比,UAE和HIFU患者术后1年生存质量较高,且UAE高于HIFU。网状Meta分析结果显示HIFU治疗子宫肌瘤术后1年内主要并发症发生率最低,UAE治疗次之,手术治疗最高;使用HIFU和UAE治疗患者住院时间及恢复时间较手术治疗短;但手术治疗后进一步干预率均低于UAE和HIFU治疗。结论UAE治疗子宫肌瘤术后1年生存质量最高。与手术相比,HIFU和UAE具有安全性好、住院时间短、康复快等优点,但两者有需要再次接受治疗的风险。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Interventional embolization,surgery and high intensity focused ultrasound for the treatment of uterine fibroids:a network meta-analysis

Objectives To systematically review the safety and effectiveness of uterine artery embolization(UAE),surgery and high intensity focused ultrasound(HIFU)in the treatment of uterine fibroids.Methods PubMed,EMbase,The Cochrane Library,Web of Science,WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE,surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019.Two reviewers independently screened the literature,extracted the data and evaluated the risk of bias of included studies,network meta-analysis was performed by ADDIS 1.16.8 software and Stata14.0 software.Results A total of 11 trials(22 references)involving 3469 patients were included.Compared with surgery,UAE and HIFU patients had higher quality of life(1-year follow-up)improvement,and UAE was higher than HIFU.Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year,followed by UAE,and surgery.Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery.The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.Conclusions UAE has the highest quality of life improvement(1-year follow-up)for uterine fibroids.HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery.However,both UAE and HIFU have the risk of re-treatment.However,limited by the number and quality of included studies,the above conclusions are needed to be verified by more high-quality studies.