子宫肌瘤的新治疗选择，如子宫动脉栓塞术（UAE），超声引导和磁共振引导高强度聚焦超声（USgHIFU和MRgHIFU），经颈射频消融（TFA）方法，广泛应用于临床实践。这项系统评价和荟萃分析（CRD42022297312）旨在评估和比较接受这些微创子宫肌瘤手术的女性的生殖和产科结局。搜索是在PubMed中进行的，谷歌学者，ScienceDirect,科克伦图书馆,Scopus,WebofScience和Embase。使用纽卡斯尔-渥太华量表（NOS）和Cochrane指南评估偏倚风险。选择的文章符合以下资格标准：（1）研究文章，(2)人体主体研究,（3）三种方法之一-UAE治疗子宫肌瘤后妊娠结局的研究，HIFU,TFA。对25篇符合条件的原始文章的分析表明，阿联酋的活产率相似，USgHIFU,MRgHIFU,和TFA(70.8%，73.5%,70%,75%,分别)。在这些研究中，怀孕的数量差异很大，以及孕妇的平均年龄。然而,TFA的妊娠结局结果不足以得出确切的结论，因为在这些研究中只有24名妇女怀孕，导致三个活产。阿联酋组的流产率最高（19.2％）。与阿联酋相比，USgHIFU与胎盘异常的发生率更高(2.8%vs.1.6%）。在阿联酋之后，怀孕的综合估计为17.31％至44.52％，HIFU后18.69%至78.53%，TFA后2.09%至7.63%。现有证据证实，这些子宫肌瘤的微创保留子宫治疗方案是希望保持生育能力的患者的好方法，不同技术的生殖和产科结局具有可比性。
Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (
USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic
review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE,
USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%).
USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.
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