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Endometrial ablation or resection versus levonorgestrel intra-uterine system for the treatment of women with heavy menstrual bleeding and a normal uterine cavity: a systematic review with meta-analysis.
Human Reproduction Update ( IF 13.3 ) Pub Date : 2020-01-28 , DOI: 10.1093/humupd/dmz051 Catherine Bergeron 1, 2 , Philippe Y Laberge 1, 2 , Amélie Boutin 3 , Marie-Anne Thériault 1, 2 , Florence Valcourt 1, 2 , Madeleine Lemyre 1, 2 , Sarah Maheux-Lacroix 1, 2
Human Reproduction Update ( IF 13.3 ) Pub Date : 2020-01-28 , DOI: 10.1093/humupd/dmz051 Catherine Bergeron 1, 2 , Philippe Y Laberge 1, 2 , Amélie Boutin 3 , Marie-Anne Thériault 1, 2 , Florence Valcourt 1, 2 , Madeleine Lemyre 1, 2 , Sarah Maheux-Lacroix 1, 2
Affiliation
BACKGROUND
Endometrial ablation/resection and the levonorgestrel intra-uterine system (LNG-IUS) are well-established treatment options for heavy menstrual bleeding to avoid more invasive alternatives, such as hysterectomy.
OBJECTIVE
The aim was to compare the efficacy and safety of endometrial ablation or resection with the LNG-IUS in the treatment of premenopausal women with heavy menstrual bleeding and to investigate sources of heterogeneity between studies.
SEARCH METHODS
We searched the databases MEDLINE, EMBASE, CENTRAL, Web of Science, Biosis and Google Scholar as well as citations and reference lists published up to August 2019. Two authors independently screened 3701 citations for eligibility. We included randomized controlled trials published in any language, comparing endometrial ablation or resection to the LNG-IUS in the treatment of premenopausal women with heavy menstrual bleeding and a normal uterine cavity.
OUTCOMES
Thirteen studies (N = 884) were eligible. Two independent authors extracted data and assessed the quality of included studies. Random effect models were used to compare the modalities and evaluate sources of heterogeneity. No significant differences were observed between endometrial ablation/resection and the LNG-IUS in terms of subsequent hysterectomy (primary outcome, risk ratio (RR) = 1.13, 95% CI 0.60 to 2.11, P = 0.71, I2 = 14%, 12 studies, 726 women), satisfaction, quality of life, amenorrhea and treatment failure. However, side effects were less common in women treated with endometrial ablation/resection compared to the LNG-IUS (RR = 0.52, 95% CI 0.37 to 0.71, P < 0.001, I2 = 0%, 10 studies, 580 women). Three complications were reported in the endometrial ablation/resection group and none in the LNG-IUS group (P = 0.25). Mean age of the studied populations was identified as a significant source of heterogeneity between studies in subgroup analysis (P = 0.01). In fact, endometrial ablation/resection was associated with a higher risk of subsequent hysterectomy compared to the LNG-IUS in younger populations (mean age ≤ 42 years old, RR = 5.26, 95% CI 1.21 to 22.91, P = 0.03, I2 = 0%, 3 studies, 189 women). On the contrary, subsequent hysterectomy seemed to be less likely with endometrial ablation/resection compared to the LNG-IUS in older populations (mean age > 42 years old), although the reduction did not reach statistical significance (RR = 0.51, 95% CI 0.21 to 1.24, P = 0.14, I2 = 0%, 5 studies, 297 women). Finally, sensitivity analysis taking into account the risk of bias of included studies and type of surgical devices (first and second generation) did not modify the results. Most of the included studies reported outcomes at up to 3 years, and the relative performance of endometrial ablation/resection and LNG-IUS remains unknown in the longer term.
WIDER IMPLICATIONS
Endometrial ablation/resection and the LNG-IUS are two excellent treatment options for heavy menstrual bleeding, although women treated with the LNG-IUS are at higher risk of experiencing side effects compared to endometrial ablation/resection. Otherwise, younger women seem to present a lower risk of eventually requiring hysterectomy when treated with the LNG-IUS compared to endometrial ablation/resection.
中文翻译:
子宫内膜切除或切除术与左炔诺孕酮子宫内系统治疗严重月经出血和子宫腔正常的妇女:荟萃分析的系统评价。
背景技术子宫内膜消融/切除术和左炔诺孕酮子宫内系统(LNG-IUS)是针对月经大量出血以避免其他侵入性方法(例如子宫切除术)的行之有效的治疗选择。目的比较子宫内膜消融或切除术与LNG-IUS治疗经期大出血的绝经前妇女的疗效和安全性,并研究两次研究之间异质性的来源。搜索方法我们搜索了MEDLINE,EMBASE,CENTRAL,Web of Science,Biosis和Google Scholar数据库,以及截至2019年8月发布的引文和参考文献清单。两位作者独立筛选了3701篇引文的资格。我们纳入了以任何语言发布的随机对照试验,比较子宫内膜切除术或切除术与LNG-IUS在治疗月经出血大,子宫腔正常的绝经前妇女中的作用。结果十三项研究(N = 884)符合条件。两名独立作者提取了数据并评估了纳入研究的质量。随机效应模型用于比较模式并评估异质性的来源。在随后的子宫切除术方面,子宫内膜消融/切除术与LNG-IUS之间无显着差异(主要结局,风险比(RR)= 1.13,95%CI 0.60至2.11,P = 0.71,I2 = 14%,12项研究) (726名女性),满意度,生活质量,闭经和治疗失败。但是,与LNG-IUS相比,接受子宫内膜切除/切除术的女性副作用较少(RR = 0.52,95%CI 0.37至0.71,P <0.001,I2 = 0%,10个研究,580位女性)。子宫内膜切除/切除组报告了3种并发症,LNG-IUS组没有报告(P = 0.25)。在亚组分析中,研究人群的平均年龄被确定为研究之间异质性的重要来源(P = 0.01)。实际上,与LNG-IUS相比,较年轻的人群(平均年龄≤42岁,RR = 5.26,95%CI 1.21至22.91,P = 0.03,I2 = 0%,3个研究,189名女性)。相反,在老年人群(平均年龄> 42岁)中,与LNG-IUS相比,进行子宫内膜切除/切除术的子宫切除术的可能性似乎较小(尽管降低并未达到统计学意义(RR = 0.51,95%CI) 0.21至1.24,P = 0.14,I2 = 0%,5个研究,297位女性)。最后,考虑纳入研究的偏倚风险和手术器械类型(第一代和第二代)的敏感性分析并没有改变结果。纳入的大多数研究报告了长达3年的结局,从长期来看,子宫内膜消融/切除术和LNG-IUS的相对表现仍然未知。子宫内膜消融/切除术和LNG-IUS是经期大量出血的两种极好的治疗选择,尽管与子宫内膜消融/切除术相比,接受LNG-IUS治疗的女性发生副作用的风险更高。否则,与子宫内膜消融/切除术相比,年轻妇女在接受LNG-IUS治疗时最终需要行子宫切除术的风险似乎较低。考虑纳入研究的偏倚风险和手术器械类型(第一代和第二代)的敏感性分析并没有改变结果。纳入的大多数研究报告了长达3年的结局,从长期来看,子宫内膜消融/切除术和LNG-IUS的相对表现仍然未知。子宫内膜消融/切除术和LNG-IUS是经期大量出血的两种极好的治疗选择,尽管与子宫内膜消融/切除术相比,接受LNG-IUS治疗的女性发生副作用的风险更高。否则,与子宫内膜消融/切除术相比,年轻妇女在接受LNG-IUS治疗时最终需要行子宫切除术的风险似乎较低。考虑纳入研究的偏倚风险和手术器械类型(第一代和第二代)的敏感性分析并没有改变结果。纳入的大多数研究报告了长达3年的结局,从长期来看,子宫内膜消融/切除术和LNG-IUS的相对表现仍然未知。子宫内膜消融/切除术和LNG-IUS是经期大量出血的两种极好的治疗选择,尽管与子宫内膜消融/切除术相比,接受LNG-IUS治疗的女性发生副作用的风险更高。否则,与子宫内膜消融/切除术相比,年轻妇女在接受LNG-IUS治疗时最终需要行子宫切除术的风险似乎较低。
更新日期:2020-03-06
中文翻译:
子宫内膜切除或切除术与左炔诺孕酮子宫内系统治疗严重月经出血和子宫腔正常的妇女:荟萃分析的系统评价。
背景技术子宫内膜消融/切除术和左炔诺孕酮子宫内系统(LNG-IUS)是针对月经大量出血以避免其他侵入性方法(例如子宫切除术)的行之有效的治疗选择。目的比较子宫内膜消融或切除术与LNG-IUS治疗经期大出血的绝经前妇女的疗效和安全性,并研究两次研究之间异质性的来源。搜索方法我们搜索了MEDLINE,EMBASE,CENTRAL,Web of Science,Biosis和Google Scholar数据库,以及截至2019年8月发布的引文和参考文献清单。两位作者独立筛选了3701篇引文的资格。我们纳入了以任何语言发布的随机对照试验,比较子宫内膜切除术或切除术与LNG-IUS在治疗月经出血大,子宫腔正常的绝经前妇女中的作用。结果十三项研究(N = 884)符合条件。两名独立作者提取了数据并评估了纳入研究的质量。随机效应模型用于比较模式并评估异质性的来源。在随后的子宫切除术方面,子宫内膜消融/切除术与LNG-IUS之间无显着差异(主要结局,风险比(RR)= 1.13,95%CI 0.60至2.11,P = 0.71,I2 = 14%,12项研究) (726名女性),满意度,生活质量,闭经和治疗失败。但是,与LNG-IUS相比,接受子宫内膜切除/切除术的女性副作用较少(RR = 0.52,95%CI 0.37至0.71,P <0.001,I2 = 0%,10个研究,580位女性)。子宫内膜切除/切除组报告了3种并发症,LNG-IUS组没有报告(P = 0.25)。在亚组分析中,研究人群的平均年龄被确定为研究之间异质性的重要来源(P = 0.01)。实际上,与LNG-IUS相比,较年轻的人群(平均年龄≤42岁,RR = 5.26,95%CI 1.21至22.91,P = 0.03,I2 = 0%,3个研究,189名女性)。相反,在老年人群(平均年龄> 42岁)中,与LNG-IUS相比,进行子宫内膜切除/切除术的子宫切除术的可能性似乎较小(尽管降低并未达到统计学意义(RR = 0.51,95%CI) 0.21至1.24,P = 0.14,I2 = 0%,5个研究,297位女性)。最后,考虑纳入研究的偏倚风险和手术器械类型(第一代和第二代)的敏感性分析并没有改变结果。纳入的大多数研究报告了长达3年的结局,从长期来看,子宫内膜消融/切除术和LNG-IUS的相对表现仍然未知。子宫内膜消融/切除术和LNG-IUS是经期大量出血的两种极好的治疗选择,尽管与子宫内膜消融/切除术相比,接受LNG-IUS治疗的女性发生副作用的风险更高。否则,与子宫内膜消融/切除术相比,年轻妇女在接受LNG-IUS治疗时最终需要行子宫切除术的风险似乎较低。考虑纳入研究的偏倚风险和手术器械类型(第一代和第二代)的敏感性分析并没有改变结果。纳入的大多数研究报告了长达3年的结局,从长期来看,子宫内膜消融/切除术和LNG-IUS的相对表现仍然未知。子宫内膜消融/切除术和LNG-IUS是经期大量出血的两种极好的治疗选择,尽管与子宫内膜消融/切除术相比,接受LNG-IUS治疗的女性发生副作用的风险更高。否则,与子宫内膜消融/切除术相比,年轻妇女在接受LNG-IUS治疗时最终需要行子宫切除术的风险似乎较低。考虑纳入研究的偏倚风险和手术器械类型(第一代和第二代)的敏感性分析并没有改变结果。纳入的大多数研究报告了长达3年的结局,从长期来看,子宫内膜消融/切除术和LNG-IUS的相对表现仍然未知。子宫内膜消融/切除术和LNG-IUS是经期大量出血的两种极好的治疗选择,尽管与子宫内膜消融/切除术相比,接受LNG-IUS治疗的女性发生副作用的风险更高。否则,与子宫内膜消融/切除术相比,年轻妇女在接受LNG-IUS治疗时最终需要行子宫切除术的风险似乎较低。