Abstract
Objective:To asscess the efficacy of the hysteroscopy combined with lapa-roscopy versus the vaginal operation for previous cesarean scar defect ( PCSD ) . Method:The databases such as The Cochrane Central Register of Controlled Trials ( CENTRAL )、Pubmed、SCIE、EMbase、CNKI、VIP and WanFang Data were searched to collecting the randomized con-trol trials( RCTs) about the hysteroscopy combined with laparoscopy and vaginal operation for PCSD. The retrieval time was from inception to Dec. 2015. Two reviewers independently screened the literature and assessed the quality of included studies. Then, the meta-analysis were performed by using the RevMan 5. 1 software according to Cochrane Handbook. Results:A total of Fourteen RCTs involving 884 patients were included. The meta-analysis showed that the hysteroscopy combined with laparoscopy operation had longer operation time compared with the vaginal operation[MD=13. 99,95%CI(4. 76,23. 23),P=0. 003],lesser amount of intraoper-ative bleeding[MD=-13. 08,95%CI(-22. 98,-3. 18),P=0. 01],shorter hospital stay time [MD=-2. 10,95%CI(-3. 45,-0. 75),P=0. 002],lower rate of postoperative complications [RR=0. 38,95%CI(0. 19,0. 75),P=0. 006],shorter postoperative vaginal bleeding time. [MD=-3. 16,95%CI(-5. 26,-1. 05),P=0. 003],better menstruation recovery[OR=1. 89, 95%CI ( 1 . 11 , 3 . 20 ) , P=0 . 02 ] , more effective uterine incision diverticulum repair [ OR=2. 16,95%CI(1. 20,3. 88),P=0. 010],more expensive treatment cost[SMD=6. 93,95%CI (4. 50,9. 35),P<0. 00001]. Additionaly,there was no significance difference in postoperative anal exhaust[MD=0. 26,95%CI(-0. 22,0. 75,P=0. 29)]. Conclusion:The current evidence indicates that the hysteroscopy combined with laparoscopy surgery is similar to the vaginal oper-ation in postoperative anal exhaust, and lesser intraoperative bleeding than the vaginal opera-tion,longer than the vaginal operation in operation time,more expensive than the vaginal opera-tion in treatment cost, can shorten the postoperative vaginal bleeding time, improve the total postoperative complications and the total remission rate,increase the repair rate of uterine inci-sion diverticulum. For quality limitation and low methodological quality of included studies,this conclusion still need to be further proved by performing more high-quality and large scales RCTs.关键词
剖宫产切口憩室/宫腔镜/腹腔镜/阴式手术/Meta分析/随机对照试验Key words
Previous cesarean scar defect/Hysteroscopy/Laparoscopy/Transvaginal/Meta-analysis/Randomized controlled trial分类
医药卫生
