背景:尽管有手术和激素治疗等治疗方法,患有子宫内膜异位症的女性经常忍受慢性问题。本文旨在评估神经骨盆学的有效性和安全性。方法:在一项具有荟萃分析的系统评价中,我们搜索了三个电子数据库:MEDLINE(PubMed),Scopus,Embase,WebofScience(WOS)搜索于2024年1月进行,没有日期或语言限制,使用一组精心策划的关键字。我们进行了全面审查,包括所有关于子宫内膜异位症神经骨盆治疗方法的观察性和临床试验,无论地理位置。我们审查中包含的研究必须在同行评审的期刊上发表,并以任何语言提供。至少有一个英文摘要。所有纳入研究的数据汇总在Excel(19版)中,并通过综合Meta分析v3.3(Biostat)和STATA(17版)进行分析。对两组(干预和对照)的研究进行了多水平荟萃分析,以评估神经骨盆学治疗子宫内膜异位症妇女的疗效。结果:筛选476条记录后,30项研究,发表于1952年至2021年,被纳入这篇综述,每个人都采用不同的方法。研究分为以下三类:(a)神经切除术或神经切除术的疗效(n=20),(b)神经松解术(神经阻滞)的疗效(n=4),和(c)神经调节(n=6)在子宫内膜异位症治疗中的功效。在评估神经切除术或神经切除术疗效的研究中,10项研究(18组比较)纳入随机效应荟萃分析。神经切除术的治疗成功率(未发生疼痛)高于对照(RR=0.497,95%CI=0.236至1.04,p=0.06(对于实验研究)和RR=0.248,95%CI=0.14至0.43,p<0.001(对于观察性研究)),在实验和观察性研究中,疼痛复发的风险降低了50%和75.2%,分别。同样,神经溶解,特别是上腹下神经丛阻滞和子宫神经乙醇神经松解术,子宫内膜异位症患者在疼痛减轻和生活质量改善方面取得了令人鼓舞的结果.神经调节在治疗子宫内膜异位症症状中的功效似乎很有希望,但需要进一步研究。结论:总之,神经骨盆学方法,比如神经切除术,神经溶解,和神经调节,为子宫内膜异位症患者的疼痛减轻提供了巨大的潜力,尽管有并发症和高复发率的风险,需要仔细的患者选择和长期监测。
Background: Despite the availability of treatments such as surgery and hormonal therapy, women with endometriosis often endure chronic problems. This review aims to evaluate the effectiveness and safety of neuropelveology. Methods: In a systematic review with a meta-analysis, we searched three electronic databases: MEDLINE (PubMed), Scopus, Embase, and Web of Science (WOS). The search was conducted in January 2024 with no date or language restrictions using a carefully curated set of keywords. We conducted a comprehensive review, including all observational and clinical trials reporting data on neuropelveology approaches in the management of endometriosis, irrespective of geographical location. The studies included in our review were required to be published in peer-reviewed journals and be available in any language, with at least an abstract in English. The data of all included studies were summarized in excel (version 19) and were analyzed by Comprehensive Meta-analysis v3.3 (Biostat) and STATA (version 17). A multilevel meta-analysis was performed on studies with two arms (intervention and control) to evaluate the efficacy of neuropelveology in managing women with endometriosis. Results: After screening 476 records, 30 studies, published from 1952 to 2021, were included in this review, each employing various methodologies. The studies were divided into the following three categories: (a) efficacy of neurectomy or
nerve resection (n = 20), (b) efficacy of neurolysis (
nerve blocks) (n = 4), and (c) efficacy of neuromodulation (n = 6) in the management of endometriosis. Among the studies evaluating the efficacy of neurectomy or
nerve resection, 10 studies (with 18 group comparisons) were included in the random-effects meta-analysis. Treatment success (not occurrence of pain) was higher with neurectomy vs. controls (RR = 0.497, 95% CI = 0.236 to 1.04, p = 0.06 (for experimental studies) and RR = 0.248, 95% CI = 0.14 to 0.43, p < 0.001 (for observational studies)), representing a 50% and 75.2% risk reduction in the recurrence of pain in experimental and observational studies, respectively. Similarly, neurolysis, particularly superior hypogastric plexus blocks and uterine
nerve ethanol neurolysis, demonstrated encouraging outcomes in pain reduction and an improved quality of life for women with endometriosis. The efficacy of neuromodulation in managing endometriosis symptoms appears promising but requires further investigation. Conclusions: In conclusion, neuropelveology approaches, such as neurectomy, neurolysis, and neuromodulation, offer significant potential for pain reduction in endometriosis patients, albeit with risks of complications and high recurrence rates, necessitating careful patient selection and long-term monitoring.