宫腔镜电切术联合曼月乐治疗早期子宫内膜癌保留生育功能疗效的Meta分析
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摘要
目的:综合分析宫腔镜电切术联合曼月乐对年轻早期子宫内膜癌患者保留生育功能治疗的疗效。方法:检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库(VIP)、Pubmed、Embase等数据库,搜索年限为建库至2018年11月,获取宫腔镜电切术联合曼月乐治疗早期子宫内膜癌疗效的文献,运用R3.5.1软件进行Meta分析。结果:共纳入14篇文献,Meta分析结果显示,年轻子宫内膜癌患者行宫腔镜电切术联合曼月乐治疗的完全缓解率为94%(95%CI:84%～98%),复发率为6%(95%CI:3%～10%),妊娠率为70%(95%CI:58%～80%),分娩率为55%(95%CI:41%～68%)。结论:年轻早期子宫内膜癌患者行宫腔镜电切术联合曼月乐治疗可获得满意的缓解率、生育率及较低的复发率。
Objective:To systematically analyze the effect of hysteroscopic electrotomy combined with Mirena on the clinical outcomes of young patients with early endometrial cancer after hysteroscopic electrotomy.Methods:We searched the major online databases(CNKI,CBM,Wanfang,VIP,PubMed,and Embase etc.)and retrieved all the research on hysteroscopic electrotomy combined with Mirena treatment for young,early endometrial cancer patients from the establishment of the databases to November 2018.The Meta analysis was performed with R3.5.1 software.Results:A total of 14 articles were included.The complete remission rate was 94%(95%CI:84%-98%),recurrence rate was 6%(95% CI:3%-10%),pregnancy rate was70%(95% CI:58%-80%),delivery rate was 55%(95% CI:41%-68%).Conclusion:Hysteroscopic resection combined with mirena could achieve satisfactory remission rate,fertility rate and low recurrence rate in young patients with early endometrial cancer.
Objective:To systematically analyze the effect of hysteroscopic electrotomy combined with Mirena on the clinical outcomes of young patients with early endometrial cancer after hysteroscopic electrotomy.Methods:We searched the major online databases(CNKI,CBM,Wanfang,VIP,PubMed,and Embase etc.)and retrieved all the research on hysteroscopic electrotomy combined with Mirena treatment for young,early endometrial cancer patients from the establishment of the databases to November 2018.The Meta analysis was performed with R3.5.1 software.Results:A total of 14 articles were included.The complete remission rate was 94%(95%CI:84%-98%),recurrence rate was 6%(95% CI:3%-10%),pregnancy rate was70%(95% CI:58%-80%),delivery rate was 55%(95% CI:41%-68%).Conclusion:Hysteroscopic resection combined with mirena could achieve satisfactory remission rate,fertility rate and low recurrence rate in young patients with early endometrial cancer.
引文
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[18]周琦,吴小华,刘继红,等.子宫内膜癌诊断与治疗指南(4版)[J].中国实用妇科与产科杂志,2018,34(8):880-886.
[19]沈艳,罗攀,肖诚蠫,等.宫腔镜检查诊断子宫内膜癌的价值及其与腹腔冲洗液细胞学、预后关系的Meta分析[J].现代妇产科进展,2018,27(7):526-530.
[20]杨莉.宫腔镜辅助分段诊刮术诊断子宫内膜癌及预测子宫颈浸润的临床意义[J].实用妇科内分泌杂志(电子版),2018,5(19):141-142,149.
[21]FAN Z P,LI H,HU R,et al.Fertility-preserving treatment in young women with grade 1presumed stage IA endometrial adenocarcinoma a Meta-Analysis[J].International Journal of Gynecological Cancer,2018,28(2):385-393.
[22]MARNACH M L,BUTLER K A,HENRY M R,et al.Oral progestogens versus Levonorgestrel-Releasing intrauterine system for treatment of endometrial intraepithelial neoplasia[J].Journal of Women’s Health,2017,26(4):368-373.
[23]PARK J Y,KIM D Y,KIM J H,et al.Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer(KGOG 2002)[J].European Journal of Cancer(Oxford,England:1990),2013,49(4):868-874.
[24]GALLOS I D,YAP J,RAJKHOWA M,et al.Regression,relapse,and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia:a systematic review and Metaanalysis[J].Am J Obstet Gynecol,2012,207(4):266.
[25]张悦.宫腔镜保守性手术联合孕激素对早期子宫内膜癌保留生育功能治疗的Meta分析[D].南宁:广西医科大学,2017.
[26]LA RUSSA M,ZAPARDIEL I,HALASKA M J,et al.Conservative management of endometrial cancer:a survey amongst European clinicians[J].Arch Gynecol Obstet,2018,298(2):373-380.
[2]COLOMBO N,CREUTZBERG C,AMANT F,et al.ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer:diagnosis,treatment and follow-up[J].Annals of Oncology:Official Journal of the European Society for Medical Oncology/ESMO,2016,27(1):16-41.
[3]李春梅,罗颖,毛邱娴,等.宫腔镜电切术联合孕激素对早期子宫内膜癌保留生育功能治疗8例分析[J].实用妇产科杂志,2013,29(3):224-226.
[4]曾敏.宫腔镜电切术联合孕激素对早期子宫内膜癌患者生育功能的影响[J].中国医药指南,2014,12(36):123-124.
[5]周剑.宫腔镜电切术联合左炔诺孕酮对早期子宫内膜癌患者保留生育功能的治疗效果和可行性观察[J].中国当代医药,2014,21(35):48-50.
[6]罗敏.宫腔镜电切术联合孕激素治疗早期子宫内膜癌患者5例临床分析[J].齐齐哈尔医学院学报,2015,36(13):1902-1903.
[7]俞玫君,刘巧英.采用宫腔镜电切术联合孕激素对早期子宫内膜癌保留生育功能治疗患者5例观察[J].中华肿瘤防治杂志,2016,23(S2):258-259.
[8]周勤英.宫腔镜电切术联合孕激素对早期子宫内膜癌患者生育功能的影响[J].长治医学院学报,2016,30(6):455-457.
[9]胡春艳,田燕妮,刘晨,等.宫腔镜电切术联合孕激素对早期子宫内膜癌患者保持生育功能的可行性分析[J].医学综述,2016,22(10):1981-1983.
[10]杨斯钠,刘罛,王宁.早期子宫内膜癌手术联合孕激素保留患者生育功能探讨[J].现代仪器与医疗,2016,22(3):86-88.
[11]颜艳.宫腔镜电切术联合孕激素对早期子宫内膜癌患者生育功能的保护作用[J].北方药学,2017,14(1):182-183.
[12]陶美霞.早期子宫内膜癌患者保留生育功能治疗的适应证和临床疗效[J].中国现代药物应用,2017,11(10):73-75.
[13]程秀萍.早期子宫内膜癌患者保留生育功能治疗的适应证和治疗观察[J].世界最新医学信息文摘,2017,17(79):265.
[14]杨莉.宫腔镜电切术联合孕激素对早期子宫内膜癌保留生育功能的疗效观察[J].现代诊断与治疗,2017,28(21):4039-4041.
[15]LAURELLI G,DI VAGNO G,SCAFFA C,et al.Conservative treatment of early endometrial cancer:preliminary results of a pilot study[J].Gynecol Oncol,2011,120(1):43-46.
[16]FALCONE F,LAURELLI G,LOSITO S,et al.Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer[J].J Gynecol Oncol,2017,28(1):e2.
[17]FIGO.International Federation of Gynecology and Obstetrics.FIGO Cancer Report 2018[J].Int J Gynaecol Obstet,2018,143(Suppl):2-3.
[18]周琦,吴小华,刘继红,等.子宫内膜癌诊断与治疗指南(4版)[J].中国实用妇科与产科杂志,2018,34(8):880-886.
[19]沈艳,罗攀,肖诚蠫,等.宫腔镜检查诊断子宫内膜癌的价值及其与腹腔冲洗液细胞学、预后关系的Meta分析[J].现代妇产科进展,2018,27(7):526-530.
[20]杨莉.宫腔镜辅助分段诊刮术诊断子宫内膜癌及预测子宫颈浸润的临床意义[J].实用妇科内分泌杂志(电子版),2018,5(19):141-142,149.
[21]FAN Z P,LI H,HU R,et al.Fertility-preserving treatment in young women with grade 1presumed stage IA endometrial adenocarcinoma a Meta-Analysis[J].International Journal of Gynecological Cancer,2018,28(2):385-393.
[22]MARNACH M L,BUTLER K A,HENRY M R,et al.Oral progestogens versus Levonorgestrel-Releasing intrauterine system for treatment of endometrial intraepithelial neoplasia[J].Journal of Women’s Health,2017,26(4):368-373.
[23]PARK J Y,KIM D Y,KIM J H,et al.Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer(KGOG 2002)[J].European Journal of Cancer(Oxford,England:1990),2013,49(4):868-874.
[24]GALLOS I D,YAP J,RAJKHOWA M,et al.Regression,relapse,and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia:a systematic review and Metaanalysis[J].Am J Obstet Gynecol,2012,207(4):266.
[25]张悦.宫腔镜保守性手术联合孕激素对早期子宫内膜癌保留生育功能治疗的Meta分析[D].南宁:广西医科大学,2017.
[26]LA RUSSA M,ZAPARDIEL I,HALASKA M J,et al.Conservative management of endometrial cancer:a survey amongst European clinicians[J].Arch Gynecol Obstet,2018,298(2):373-380.