目的:第一代和第二代子宫内膜消融(EA)技术,以及医疗和侵入性手术,被认为是异常子宫出血(AUB)的成功治疗路线。我们着手确定第一代和第二代消融技术与药物治疗相比的疗效,侵入性手术和EA技术本身的不同模式。
方法:使用频率网络的系统评价和网络荟萃分析。
方法:我们搜索了Medline(Ovid),PubMed,ClinicalTrials.gov,科克伦中部,WebofScience,EBSCO和Scopus使用相关关键字获取截至2021年3月1日的所有已发表研究。
方法:我们纳入了所有接受第二代EA技术干预的绝经前妇女与AUB的随机对照试验(RCT)。
方法:纳入49份高质量随机对照试验,其中8038名女性。我们提取并汇集了数据,然后在频率论框架内进行分析以估计网络元分析模型。我们在R(V.3.6.1)和“Meta-Insight”网站中使用了netmeta包的随机效应模型。
结果:我们的网络荟萃分析根据具体结果显示了许多不同的结果。子宫球囊消融术的闭经率明显高于其他技术的短期(热液消融术(风险比(RR)=0.51,95%CI0.37;0.72),微波消融(RR=0.43,95%CI0.31;0.59),第一代技术(RR=0.44,95%CI0.33;0.59),子宫内膜激光宫内治疗(RR=0.18,95%CI0.10;0.32)和双极射频治疗(RR=0.22,95%CI0.15;0.31))和长期随访(微波消融(RR=0.11,95%CI0.01;0.86),双极射频消融(RR=0.12,95%CI0.02;0.90),第一代(RR=0.12,95%CI0.02;0.90)和子宫内膜激光宫内热治疗(RR=0.04,95%CI0.01;0.36)。当仅根据计算的出血评分计算疗效时,冷冻消融系统得分最高(p-score=0.98).
结论:大多数第二代EA系统优于第一代系统,设备之间的统计优势取决于测量的特征(继发性闭经率,AUB的治疗,患者满意度或痛经治疗)。尽管我们的研究受到大量设备比较数据匮乏的限制,我们得出的结论是,目前没有证据表明任何一种经过检查的第二代系统明显优于所有其他系统。
OBJECTIVE: First-generation and second-generation endometrial ablation (EA) techniques, along with medical treatment and invasive surgery, are considered successful lines of management for abnormal uterine bleeding (AUB). We set out to determine the efficacy of first and second-generation ablation techniques compared with medical treatment, invasive surgery and different modalities of the EA techniques themselves.
METHODS: Systematic review and network meta-analysis using a frequentist network.
METHODS: We searched Medline (Ovid), PubMed, ClinicalTrials.gov, Cochrane CENTRAL, Web of Science, EBSCO and Scopus for all published studies up to 1 March 2021 using relevant keywords.
METHODS: We included all randomised controlled trials (RCTs) that compared premenopausal women with AUB receiving the intervention of second-generation EA techniques.
METHODS: 49 high-quality RCTs with 8038 women were included. We extracted and pooled the data and then analysed to estimate the network meta-analysis models within a frequentist framework. We used the random-effects model of the netmeta package in R (V.3.6.1) and the \'Meta-Insight\' website.
RESULTS: Our network meta-analysis showed many varying results according to specific outcomes. The uterine balloon ablation had significantly higher amenorrhoea rates than other techniques in both short (hydrothermal ablation (risk ratio (RR)=0.51, 95% CI 0.37; 0.72), microwave ablation (RR=0.43, 95% CI 0.31; 0.59), first-generation techniques (RR=0.44, 95% CI 0.33; 0.59), endometrial laser intrauterine therapy (RR=0.18, 95% CI 0.10; 0.32) and bipolar radio frequency treatments (RR=0.22, 95% CI 0.15; 0.31)) and long-term follow-up (microwave ablation (RR=0.11, 95% CI 0.01; 0.86), bipolar radio frequency ablation (RR=0.12, 95% CI 0.02; 0.90), first generation (RR=0.12, 95% CI 0.02; 0.90) and endometrial laser intrauterine thermal therapy (RR=0.04, 95% CI 0.01; 0.36)). When calculating efficacy based only on calculated bleeding scores, the highest scores were achieved by cryoablation systems (p-score=0.98).
CONCLUSIONS: Most second-generation EA systems were superior to first-generation systems, and statistical superiority between devices depended on which characteristic was measured (secondary amenorrhoea rate, treatment of AUB, patient satisfaction or treatment of dysmenorrhoea). Although our study was limited by a paucity of data comparing large numbers of devices, we conclude that there is no evidence at this time that any one of the examined second-generation systems is clearly superior to all others.