A Systematic Review Of Adjuvant Mirena Therapy After Conservative Surgery For Endometriosis

Objective:To evaluate the efficacy of Mirena as an adjuvant treatment after conservative surgery for endometriosis.Resources and methods:All accessed related information was from MEDLINE, PUBMED, CNKI, VIP Information Database and WANFANG Data. Languages was only English and Chinese. All the collected published documents were related to the efficacy of Mirena as an adjuvant treatment after conservative surgery and those which were different from the purpose of this issue were excluded. The author independently assessed the qualities of the papers and extracted the data, and executes Meta-analysis with RevMan4.2software.Results:8trials involving423patients were accessed. Among the8inclusive trials,7were randomized clinical trials,1was the controlled clinical trial.7RCTs were evaluated by Jadad scale,4were considered as high quality trials and3were considered as low quality trials. The controlled clinical trial was scored by Non-randomized controlled clinical trial quality evaluation criteria and scoring sheet.The results are as follows:1. Compare the efficacy of using Mirena as an adjuvant treatment after surgery with the effect of surgery alone, including2trials and95patients.(1) Mirena as an adjuvant treatment after surgery could more effectively relieve pain, P<0.05.(2) Mirena could significantly reduce the recurrence rate, P=0.003, RR=0.21,95%CI (0.08,0.58).2. Compare the efficacy of using Mirena as an adjuvant treatment after surgery with the effect of using GnRH-a after surgery, including4trials and184patients. (1) There were no significant differences between the two groups in the relief of pain, P=0.31, WMD=-0.28,95%CI (-0.83,0.26).(2) There were no significant differences between the two groups on quality of life, P=0.56, WMD=1.50,95%CI (-3.56,6.56).3. Compare the efficacy of using Mirena as an adjuvant treatment after surgery with the effect of using Gestrinone after surgery, including2researches and155patients.(1) There were no significant differences between the two groups in the relief of pain, P>0.05.(2) The recurrence rate of Mirena was lower than that of Gestrinone and there were significant differences, P=0.02, RR=0.47,95%CI (0.25,0.90).Conclusions:Using Mirena as an adjuvant treatment after surgery could significantly relief the pain, reduce the recurrence rate and improve the quality of life. Mirena had a similar short-term efficacy to GnRH-a or Gestrinone in the relief of pain. Now only the data of short-term efficacy was available; there was no basis to evaluate the long-term efficacy. For the further research, more high quality randomized clinical trials were expected.