宫腔镜用于体外受精-胚胎移植失败患者改善妊娠结局的Meta分析

目的评价体外受精-胚胎移植(IVF-ET)失败患者行宫腔镜检查、治疗后妊娠结局的改善情况。方法计算机检索PubMed、ProQuest Medical Library、Medline外文生物医学期刊文献数据库、中国生物医学文献数据库(CBM)、中国知网(CNKI)、中国科技期刊数据库(VIP)、万方数据库和读秀学术搜索引擎等。收集2000年至2014年3月发表的论文,比较宫腔镜检查用于IVF-ET患者治疗的临床试验,按Cochrane系统评价方法提取有效数据,采用RevMan 5.2软件进行Meta分析。结果共纳入11篇文献,合计2 078例患者,其中宫腔镜干预组1 304例,未行宫腔镜检查组774例,Meta分析结果显示:IVF-ET失败患者中宫腔镜干预组临床妊娠率明显高于未检查组(RR=1.56,95%CI(1.35,1.81),P0.00001)。宫腔镜干预组内,宫腔异常组临床妊娠率高于宫腔正常组(RR=0.81,95%CI(0.70,0.94),P0.01)。结论对于IVF-ET失败患者,宫腔镜干预有助于提高临床妊娠率。IVF-ET失败患者再次行IVF-ET/卵胞浆内单精子注射(ICSI)助孕治疗前可考虑行宫腔镜探查,并对异常情况进行适当处理。

Clinical outcome of hysteroscope used in the failed in vitro fertilization-embryo transfer patients:a Meta-analysis

Objective： To evaluate the clinical outcome of hysteroscopy used in the failed in vitro fertilization- embryo transfer（IVF-ET） patients. Methods： All references were retrieved from databases including PubMed,ProQuest Medical Library, Medline, CBM, CNKI, VIP, Wanfang Databases, VIP and Reading. Data were collected from 2000 to March 2014. The references included in the eligible studies with clinical efficacy of hysteroscopy in failed IVF-ET patients. All the data were extracted in the same way as Cochrane system Analysis, Meta-analysis were performed by two reviewers independently with the software of RevmMan 5.2. Results： Eleven articles included a total of 2 078 patients who met all inclusion criteria. The patients were divided to two groups： 1 304 patients in hysteroscopy examination and treatment group, and 774 patients in no hysteroscopy group. The Meta-analysis showed that the clinical pregnancy rate in hysteroscopy group was significantly higher than that in no-hysteroscopy group for the failed IVF-ET patients（RR= 1.56,95% CI （1.35,1.81）, P〈0. 00001）. The clinical pregnancy rate of abnormal uterine cavity patients was significantly higher than that of normal uterine cavity patients in the hysteroscopy group（RR=0.81,95% CI （0.70,0.94）,P〈0.01）.