LEEP刀疗法和微波疗法治疗慢性宫颈炎有效性的Meta分析

目的 评价LEEP刀疗法与微波疗法在治疗慢性宫颈炎中的疗效.方法 依据循证医学原则,采用Cochrane系统评价方法,检索2000-2015年期间Cochrane图书馆、PubMed、CNKI、中国医药文献数据库(CBM)、万方和重庆维普等数据库中公开发表的文献,将LEEP刀疗法与微波疗法在治疗慢性宫颈炎的随机对照试验(RCTs)纳入研究.采用RevMan5.0和R软件进行Meta分析.结果 ①共纳入7篇符合要求的RCTs文献,共计1 052例患者(LEEP刀组522例,微波组530例).②所纳入的研究根据随机方法、分配隐藏、盲法、失访、基线比较和等级描述等进行质量评估,结果质量均达到B.Meta分析结果:LEEP刀疗法组的总有效率高于微波疗法组(RR=1.06,95%CI:1.00~1.10,P=0.01);LEEP刀疗法组和微波疗法组在轻度和中度慢性宫颈炎的亚组中总有效率上并没有明显差别(轻度RR=1.00,95%CI:0.97~1.04,P=0.93;中度RR=1.07,95%CI:0.99~11.08,P=0.12);在重度的亚组中,LEEP刀疗法组的总有效率高于微波疗法组(重度RR=1.10,95%CI:1.04~1.16,P=0.002);LEEP刀疗法组的手术中出血量低于微波疗法组(WMD=-2.47,95%CI:-2.74~-2.20,P<0.000 01);LEEP刀疗法组的阴道流液时间短于微波疗法组(WMD=-2.00,95%CI:-2.22~-1.78,P<0.000 01).结论 LEEP刀疗法在治疗慢性宫颈炎的总有效率和围手术期指标均优于微波疗法.

Effectiveness of LEEP therapy and microwave therapy in the treatment of chronic cervicitis:a meta-analysis

Objective To evaluate the effectiveness of microwave therapy and loop eelectrosurgical excision procedure (LEEP) therapy in the treatment of chronic cervicitis. Methods Following the principles of evidence-based medicine and Cochrane systematic review method, we searched the Cochrane library, PubMed, CNKI, Chinese Biomedi-cal literature database (CBM), Wang Fang digital library and Chongqing VIP library for published literatures between 2000 and 2015. All randomized controlled trials (RCTs) that compared LEEP therapy with microwave therapy in the treatment of chronic cervicitis were included. We employed RevMan5.3 and R software to perform the meta-analysis. Results A total of 7 RCTs were included, including 1 052 patients (522 patients in LEEP group and 530 patients in mi-crowave group). Meta-analysis suggested that the overall effective rate of LEEP therapy was higher than that of micro-wave therapy (RR=1.06, 95%CI 1.00~1.10, P=0.01). LEEP therapy and microwave therapy showed no statistically sig-nificant difference in the treatment of mild and moderate chronic cervicitis (mild:RR=1.00, 95%CI:0.97~1.04, P=0.93;moderate:RR=1.07, 95%CI:0.99~11.08, P=0.12). In the severe chronic cervicitis subgroup, the effective rate of LEEP therapy was higher than that of microwave therapy (RR=1.10, 95%CI:1.04~1.16, P=0.002). Vaginal bleeding in LEEP therapy was less than that in microwave therapy (WMD=-2.47, 95%CI:-2.74~-2.20, P<0.000 01). The time of vagi-nal drainage in LEEP therapy was shorter than that in microwave therapy (WMD=-2.00, 95% CI: -2.22~-1.78, P<0.000 01). Conclusion From the perspective of the overall effective rate and preoperative period indicators, the LEEP therapy is superior to microwave therapy in the treatment of chronic cervicitis.