目的:评估医学管理对卵巢子宫内膜瘤大小的影响。
方法:从开始到2022年10月搜索在线数据库,包括OvidMEDLINE,OvidEmbase,PubMed,EBM评论-Cochrane中央对照试验登记册(CENTRAL),ClinicalTrials.gov,和WebofScience。
方法:遵循PRISMA(系统评价和荟萃分析的首选报告项目)指南,我们包括所有的英语,报道医学干预后子宫内膜瘤大小(直径或体积)变化的全文文章。排除评估手术干预或术后复发的研究。所有筛选和数据提取均由两名作者独立进行。使用Cochrane偏差风险工具进行随机对照试验,或使用改良的纽卡斯尔-渥太华量表进行观察性研究。
结果:删除重复项之后,筛选了9332项研究,33篇全文被认为有资格纳入。在荟萃分析中,Dienogest显示囊肿直径显着减小(减小1.32cm,95%CI,0.91-1.73,八项研究,n=418个囊肿)和体积(对数转换体积的平均差1.35,95%CI,0.87-1.83,七项研究,n=282个囊肿)。同样,口服避孕药(OCP)(1.06cm,95%CI,0.59-1.53,九项研究,n=455),促性腺激素释放激素(GnRH)激动剂(1.17厘米,95%CI,0.42-1.92,四项研究,n=128个囊肿),醋酸炔诺酮(0.6厘米,95%CI,0.27-0.94,两项研究,n=88个囊肿),和达那唑(1.95厘米,95%CI,1.18-2.73,两项研究,n=34个囊肿)。含芳香化酶抑制剂的醋酸Norethingrone也可有效减少子宫内膜瘤体积(对数转换体积的平均差异1.47,95%CI,0.16-2.78,两项研究,n=34个囊肿)。
结论:饮食管理,OCPs,GnRH激动剂,醋酸炔诺酮,含芳香化酶抑制剂的醋酸炔诺酮,或达那唑可以减少卵巢子宫内膜瘤的大小。
背景:PROSPERO,CRD42022363319。
OBJECTIVE: To estimate the effect of medical management on the size of ovarian endometriomas.
METHODS: Online databases were searched from inception to October 2022, including Ovid MEDLINE, Ovid EMBASE, PubMed, EBM Reviews-Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Web of Science.
METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we included all English-language, full-text articles that reported on change in endometrioma size (either diameter or volume) after medical interventions. Studies evaluating surgical interventions or postoperative recurrence were excluded. All screening and data extraction were performed independently by two authors. Risk of bias assessment was performed with either the Cochrane Risk of Bias Tool for randomized controlled trials or a modified Newcastle-Ottawa Scale for observational studies.
RESULTS: After removal of duplicates, 9,332 studies were screened, with 33 full-text articles deemed eligible for inclusion. In the meta-analysis, dienogest showed significant reduction in cyst diameter (reduction 1.32 cm, 95% CI, 0.91-1.73, eight studies, n=418 cysts) and volume (mean difference of log-transformed volume 1.35, 95% CI, 0.87-1.83, seven studies, n=282 cysts). Similarly, significant reductions were seen with the oral contraceptive pill (OCP) (1.06 cm, 95% CI, 0.59-1.53, nine studies, n=455), gonadotropin-releasing hormone (GnRH) agonists (1.17 cm, 95% CI, 0.42-1.92, four studies, n=128 cysts), norethindrone acetate (0.6 cm, 95% CI, 0.27-0.94, two studies, n=88 cysts), and
danazol (1.95 cm, 95% CI, 1.18-2.73, two studies, n=34 cysts). Norethindrone acetate with aromatase inhibitor was also effective in reducing endometrioma volume (mean difference of log-transformed volume 1.47, 95% CI, 0.16-2.78, two studies, n=34 cysts).
CONCLUSIONS: Medical management with dienogest, OCPs, GnRH agonists, norethindrone acetate, norethindrone acetate with aromatase inhibitor, or
danazol can reduce the size of ovarian endometriomas.
BACKGROUND: PROSPERO, CRD 42022363319.