BACKGROUND Evidence supporting uterine artery embolisation (UAE) for giant fibroids (≥ 10 cm and/or uterine volume ≥ 700 CC) remains sparse. We performed a systemic review and meta-analysis of UAE outcomes for symptomatic giant versus non-giant fibroids. METHODS The literature was systematically reviewed. Research studies of UAE as an adjunct to surgery, and those not using peri-operative MRI were excluded. Primary outcomes were fibroid size and uterine volume reduction, procedure time, length of hospital stay, reinterventions, patient symptom improvement/satisfaction and complications. RESULTS We identified four observational studies (839 patients; giant = 163, non-giant = 676). Both groups demonstrated reduction in fibroid size and uterine volume after UAE, with equivocal difference in uterine volume reduction (Mean difference (MD) - 0.3 95% confidence interval (CI) - 3.8 to 3.1, p = 0.86) and greater reduction in non-giant dominant fibroid size (MD - 5.9 95% CI - 10.3 to - 1.5, p < 0.01). Giant fibroids were associated with 5.6 min longer mean operative time (MD 5.6 min 95% CI 2.6-8.6, p < 0.01) and 4.8 h longer mean hospital stay (MD 4.8 h 95% CI 1.1-8.6, p = 0.01). Patient symptoms/satisfaction outcomes were summarised, but too heterogeneous for meta-analysis. Major complication and reintervention rates were low, with a statistically higher rate of major complications (Odds ratio (OR) 4.7 95% CI 1.5-14.6, p < 0.01) and reinterventions (OR 3.6 95% CI 1.7-7.5, p < 0.01) in giant fibroids. CONCLUSIONS Current evidence shows UAE is a safe and effective option to treat giant fibroids. However, the limited available data indicate a relatively higher risk of complications and reinterventions when compared with non-giant fibroids. Patients should be selected, counselled and managed accordingly. LEVEL OF EVIDENCE Level III, Systematic review of retrospective cohort studies.

中文翻译：

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巨人与非巨人子宫肌瘤妇女的子宫动脉栓塞术：系统评价和荟萃分析。

背景技术巨大肌瘤（≥10 cm和/或子宫体积≥700 CC）的支持子宫动脉栓塞术（UAE）的证据仍然很少。我们对有症状的巨肌瘤和非巨肌瘤的阿联酋结局进行了系统评价和荟萃分析。方法对文献进行系统地回顾。阿联酋作为手术辅助的研究以及未使用围手术期MRI的研究均被排除在外。主要结局是肌瘤大小和子宫体积减少，手术时间，住院时间，再次干预，患者症状改善/满意和并发症。结果我们确定了四项观察性研究（839例；巨人= 163，非巨人= 676）。两组均显示阿联酋术后肌瘤大小和子宫体积减少，子宫体积减少明显差异（均值差异（MD）-0）。3 95％置信区间（CI）-3.8至3.1，p = 0.86）和更大的非巨人优势肌瘤大小减少（MD-5.9 95％CI-10.3至-1.5，p <0.01）。巨肌瘤平均手术时间延长5.6分钟（MD 5.6分钟95％CI 2.6-8.6，p <0.01）和平均住院时间延长4.8 h（MD 4.8 h 95％CI 1.1-8.6，p = 0.01）。总结了患者的症状/满意度结果，但对于荟萃分析而言太异类了。重大并发症和再干预率较低，重大并发症（赔率（OR）为4.7 95％CI 1.5-14.6，p <0.01）和再干预（OR 3.6 95％CI 1.7-7.5，p <0.01）在统计学上较高在巨大的肌瘤中。结论当前的证据表明，阿联酋是治疗巨大肌瘤的一种安全有效的选择。然而，有限的可用数据表明，与非巨肌瘤相比，并发症和再次干预的风险相对较高。应该对患者进行选择，咨询和管理。证据级别III级，回顾性队列研究的系统评价。