Objective To systematically review the effectiveness and safety of high intensity focused ultrasound (HIFU) for myoma of uterus fibroid. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 10, 2012), CBM, CNKI, and WanFang Data were electronically searched from inception to November 2012 for randomized controlled trials on HIFU for myoma of uterus fibroid. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software, and the quality levels of evidence were graded using GRADEpro 3.2 software. Results A total of 6 trials were included, involving 643 patients. The results of meta-analysis showed that, HIFU was similar to surgery in complete and partial fibroid ablation, with no significant difference; HIFU and radiofrequency were different in complete and partial fibroid ablation, with significant differences; and HIFU was superior to mifepristone in complete fibroid ablation, with a significant difference. Conclusion HIFU is an alternative, non-invasive, safe and effective treatment for myoma of uterus fibroid.
ObjectiveTo evaluate the efficacy of myomectomy via transumbilical laparoendompic single-site surgery (TU-LESS) and traditional multiport laparoscopy.MethodsThe study was conducted at Chengdu Western Hospital from June 2019 to June 2020. Fifty patients underwent TU-LESS myomectomy (TU-LESS group), while another 50 patients underwent traditional multiport laparoscopic myomectmy (multiport laparoscopy group). The conditions of operation, extra analgetic usage, VAS grade, and patients’ satisfaction degree were compared between two groups.ResultsPatients in both groups had similar age, BMI, fibroma volume, operative time, expelling gas day, blood loss, complication rate, and hospitalized costs (P>0.05). Compared with traditional multiport laparoscopy, the TU-LESS group resulted in significantly shorter hospitalization day, lower VAS score of the 1st/3nd/7th days after surgery, less use of analgetic after surgery, and higher satisfaction degree.ConclusionsTU-LESS is safe and feasible for myomectomy, and it is associated with less pain, shorter hospitalization day, and higher satisfaction degree.
(1)子宫肌瘤的单独药物治疗:①单独应用促性腺激素释放激素类似物:RCT发现,与安慰剂相比,GnRHa(gonadorelin analogues)可改善子宫肌瘤的症状,但副作用较大.其中1个研究表明,与安慰剂相比,达菲林在治疗12周时能明显增加闭经;另1个系统性回顾研究显示,无充分证据证实达菲林和布舍瑞林疗效的优劣.1个RCT发现,达菲林高剂量治疗较低剂量治疗在治疗16周时显著增加闭经.两个RCT发现,达菲林与安慰剂相比,在治疗16周后能显著减少骨密度,但治疗停止6个月后,骨密度可以回升到治疗前水平.两个RCT发现,与安慰剂和布舍瑞林相比,达菲林引起的潮热显著增加.②GnRHa联合雌/孕激素:1个小样本RCT比较了GnRHa+雌/孕激素和GnRHa+孕酮改善子宫肌瘤症状的效果的差异,但这些证据很不充分.③GnRHa+孕酮:1小样本RCT发现,与单独使用醋酸亮丙瑞林治疗相比,醋酸亮丙瑞林加孕酮能显著减少出血过多.两个小样本RCT发现,与单独应用GnRHa相比,GnRHa+孕酮能显著减少潮热.④GnRHa+7-甲异炔诺酮:小样本RCT发现,在子宫、子宫肌瘤大小及症状改善方面,单独使用GnRHa和GnRHa+7-甲异炔诺酮比较,无显著差异.⑤非类固醇抗炎药物:两个小样本RCT发现,无充分证据显示非类固醇抗炎药物对子宫肌瘤引起的月经过多有效果.⑥孕三烯酮、左炔诺孕酮宫内系统、米非司酮:无RCT.(2)子宫肌瘤的手术前药物治疗:GnRHa:1项系统回顾研究和1个RCT发现,与安慰剂或不治疗相比,术前使用GnRH-a 3个月以上能增加患者血红蛋白和红细胞压积,减轻子宫和盆腔症状及术中出血.术前应用GnRHa后,更适合经阴道而不是经腹子宫切除.然而术前用药妇女往往会有低雌激素所带来的副效应.(3)子宫肌瘤的手术治疗效果:①经腹子宫切除:无RCT.但一致认为子宫切除对改善子宫肌瘤症状有效.②腹腔镜协助下经阴道子宫切除:无RCT比较此方法与其他方法的长期效果.1个小样本RCT发现,仅有限的证据表明此种方法比经腹子宫切除恢复快、术后疼痛轻.③腹腔镜下肌瘤切除(对比经腹肌瘤切除):1项RCT表明,前者比后者的术后疼痛轻、恢复快.④热球子宫内膜切除术:无RCT比较此方法与非手术治疗及子宫切除之间的效果.有1个RCT比较了术前应用GnRHa,且子宫肌瘤小于孕12周子宫大小的病例中此方法与滚珠子宫内膜去除方法.在子宫切除率、闭经率、流血图表估计得分或治疗12个月时的血红蛋白方面,二者没有差别.与滚珠子宫内膜去除相比,热球子宫内膜去除术减少了操作时间及术中并发症.据报道,大约有1/3的妇女不十分满意滚珠子宫内膜去除术和热球子宫内膜去除术二者中的任何一种方法.
ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To analysis the safety of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids and provide references for clinical practice and prevention of complications of gynecological diseases. Methods Databases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, CBM, CNKI, and VIP were searched to collect studies concerning the complications of HIFU for uterine fibroids from March 1st 2005 to February 15th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using R software. Results A total of twenty studies involving 2 405 patients were included. The results of meta-analysis showed that complications rate of gynecological system induced by HIFU was 6.63% (95%CI 3.58% to 12.28%); among them, the incidence of vaginal bleeding was 5.82% (95%CI 3.22% to 10.53%), and the incidence of abdominal pain was 10.02% (95%CI 4.77% to 21.05%). Conclusion The current evidence shows that there is a certain amount of complications of HIFU for uterine fibroids. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more studies.
Objective To assess the efficacy and safety of Guizhifuling capsule versus western medicine in the treatment of uterine myoma. Methods Randomized controlled trials (RCTs) involving Guizhifuling capsule versus western medicine in the treatment of uterine myoma were identified from CBM (1978 to 2009), VIP (1989 to 2009), WANFANG Database (1998 to 2009), CNKI (1979 to 2009). We also manually searched relevant journals from Tianjin University of Traditional Chinese Medicine. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaboration’s RevMan 5.0.22 software was used for data analyses. Results A total of 8 trials involving 798 patients were included. The results of meta-analyses showed that, a) the mean uterine myoma volume in the experimental group was different when compared with the mifepristone group (WMD= 0.64, 95%CI 0.56 to 0.71); b) no difference was found between the experimental group and the mifepristone group in serums hormone level, such as, follicle-stimulating hormone (WMD= 2.40, 95%CI –?3.09 to 7.89), luteinizing hormone (WMD= 1.22, 95%CI –?1.05 to 3.49), estriol (WMD= 11.07, 95%CI –?7.70 to 29.84), and P (WMD= 0.52, 95%CI –?0.33 to 1.37); c) As for clinical symptoms effective rate, significant difference was noted between the experimental group and the mifepristone group, such as, menorrhagia (RR= 0.49, 95%CI 0.25 to 0.94), dysmenorrheal (RR= 0.12, 95%CI 0.04 to 0.38), and bellyache and abdominal distension (RR= 0.28, 95%CI 0.12 to 0.62); d) In terms of the total effective rate, significant differences were noted between the experimental group and the mifepristone group (RR= 1.16, 95%CI 1.02 to 1.32); and e) Four trials reported the long-term follow-up results in which the experimental group was better than that in the control group.Conclusion The treatment of uterine myoma by Guizhifuling capsule plus mifepristone is superior to that by mifepristone alone in reducing uterine myoma volume, clinical symptom, and long-term follow-up results. Singly using Guizhifuling capsule is not inferior to western medicine. Further large-scale trials are required to define the role of Guizhifuling capsule in the treatment of uterine myoma.
Objective To evaluate and select essential medicine for uterine neoplasms using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Six guidelines were included, three of which were evidence-based. (2) Retrieved guidelines related to nine medicines (of three classes) for uterine neoplasms and five adjuvant drugs (of three classes) used after relevant surgery. (3) According to WHOEML (2011), NEML (2009), CNF (2010), other guideline and the quantity and quality of evidence, we offered a b recommendation for medroxyprogesterone acetate, oxytocin, ergometrine and a weak recommendation for testosterone propionate, methyltestosterone, tamoxifen, mifepristone, tranexamic acid, leonurus heterophyllus used in the treatment of uterine neoplasms. We offered a recommendation against danazol and aromatase inhibitors. (4) We found relevant domestic literature on mifepristone, methyltestosterone, tamoxifen, oxytocin and leonurus heterophyllus. Mifepriston combined with methyltestosterone or tamoxifen was recommended to use as a conservative therapy for uterine neoplasms. Oxytocin,and leonurus heterophyllus were used to reduce bleeding after the surgery of uterine neoplasms. As to daily expense, mifepriston (25 mg/d) cost 13.0 to 27.5 yuan, methyltestosterone (5 mg/d) 0.074 yuan, tamoxifen (20 mg/d) 0.6 to 1.4 yuan, leonurus heterophyllus (injection, 1 mL) 15 yuan and oxytocin (injection, 20 U) 1.5 yuan. (5) Results of domestic studies indicated that mifepristone, mifepristone plus methyltestosterone, and mifepristone plus tamoxifen were proved to be safe and applicable for the treatment of uterine neoplasms. Oxytocin and leonurus heterophyllus are effective in preventing postoperative bleeding and the combination of two effectively and safely promoted uterine contraction. Conclusion (1) We offer a recommendation for three medication plans used in the treatment uterine neoplasms during perimenopause, including: a) Mifepristone (25 mg/ tablet, once daily); b) Mifepristone (25 mg/ tablet, once daily) plus methyltestosterone (5 mg/tablet, once daily); c) Mifepristone (25 mg/ tablet, once daily) plus tamoxifen (10 mg/tablet, twice daily). The three plans mentioned above should be used from first day of menstrual cycle, continuously for three months. (2) Adjuvant drugs such as oxytocin (injection, 1 to 2 mL) and leonurus heterophyllus (injection, 10 U) can be applied to reduce vaginal bleeding flow after the surgery of uterine neoplasms. (3) Personnel in elementary healthcare institution should stick to drug indication, carefully make follow-up, and dynamically monitor the change of uterine neoplasms and menstruation so as to adjust medication plan according to patients’ situation.
【摘要】 目的 比较腹腔镜和开腹子宫肌瘤切除术在术后第1周的临床效果。 方法 将2008年1月-2009年12月收治的34例子宫肌瘤患者随机分为腹腔镜组17例，开腹组17例。所有患者均为肌壁间肌瘤或浆膜下肌瘤，肌瘤直径在5~15 cm之间且数目≤3个。 结果 两组患者手术时间相近；腹腔镜组术后体温恢复正常时间、肛门排气时间、排尿时间均短于开腹组（Plt;0.05）；腹腔镜组、开腹组术后血红蛋白下降更为明显（Plt;0.05）；术后7 d，开腹组腹痛视觉模拟评分明显高于腹腔镜组（Plt;0.05）。 结论 腹腔镜下子宫肌瘤切除术具有创伤小、恢复快、疼痛轻等优点,是一种安全有效的手术方法。【Abstract】 Objective To compare the outcome of myomectomy performed by laparotomy and laparoscopy in the first 7 days after surgery. Methods Thirty-four patients with myoma less than three and in diameter of 5-15 cm from January 2008 to December 2009 were randomly divided into laparotomy group and laparoscopy group. Results Operation lengths were similar in the two groups. Time of paralytic ileus (Plt;0.05) and discharge (Plt;0.05) were longer in laparotomy group than laparoscopy group. Compared with laparoscopy group, laparotomy group had a greater hemoglobin decline (Plt;0.05). Time of post-operation fever were longer in laparotomy group than laparoscopy group (Plt;0.05). Seven days after surgery, the visual analogue scores of abdominal pain were higher in laparotomy group than in laparoscopy group (Plt;0.05). Conclusion Compared with the laparotomy myomectomy, laparoscopy myomectomy have mini trauma, quicker post operative recovery, and less pain. This method is safe and effective.
ObjectivesTo systematically review the perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy.MethodsPubMed, Web of Science, Elsevier, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched from inception to July 2017, to collect randomized controlled trials or cohort studies comparing the perinatal outcomes after laparoscopic myomectomy and transabdominal myomectomy. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsEight randomized controlled trials, twenty-one cohort studies involving 4357 patients were included. The results of meta-analysis showed that: the premature birth rate (OR=0.60, 95%CI 0.38 to 0.95, P=0.03) in the laparoscopic myomectomy was lower than that in the laparotomy group. However, the rate of uterine rupture during pregnancy (OR=3.19, 95%CI 1.29 to 7.89, P=0.01) in the laparoscopic myomectomy was higher than that in the laparotomy group. There were no significant differences between two groups in the myoma residual (OR=1.00, 95%CI 0.37 to 2.65, P=0.99), recurrence (OR=0.92, 95%CI 0.68 to 1.25, P=0.60), abortion (OR=0.90, 95%CI 0.63 to 1.28, P=0.56), ectopic pregnancy (OR=1.11, 95%CI 0.54 to 2.26, P=0.78), pregnancy rate (OR=1.06, 95%CI 0.89 to 1.27, P=0.52), cesarean (OR=0.82, 95%CI 0.57 to 1.19, P=0.31), and pregnancy complications (OR=0.84, 95%CI 0.45 to 1.59, P=0.60).ConclusionsCurrent evidence shows that there are no significant differences between two groups in the myoma residual, myoma recurrence, abortion, ectopic pregnancy, pregnancy rate, cesarean and pregnancy complications. While the rate of uterine rupture during pregnancy in the laparoscopic myomectomy is higher than that in the laparotomy group, the premature birth rate after operation in the laparoscopic myomectomy is lower and shorter than that in the laparotomy group. Due to the limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.