A Systematic Review And Meta-analysis On The Safety And Effectiveness Of Uterine Artery Embolization Vs. Surgery For Symptomaticuterine Fibroids

Objective:To systematacially review the safety and effectiveness of Uterine Artery Embolization(UAE) vs. surgery for symptomatic uterine fibroids.Methods:The Cochrane Library、PubMed、EMbase、Web of Science、China National Knowledge Internet(CNKI) and Wan Fang Data ect. were searched from their inception to July, 2014 to collect the Randomized Controlled Trials(RCTs) about UAE versus surgery in treating patients with symptomatic uterine fibroids, and the references of the included studies were also retrieved. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality. The Meta-Analysis was conducted by meas of the Rev Man 5.2 software.Results:Totally of 6 RCTs involving 732 patients were adopted. The results of Meta-Analysis showed that UAE was lower compared to surgery in the length of stays [MD=-2.47,95%CI(-2.74,-2.20),P<0.00001] and recovery time [MD=-21.18,95%CI(-28.88,-13.49),P<0.00001].There were no significant differences in health-related quality of life, patients satisfaction within 1-2 years [OR=0.61,95%CI(0.32,1.16),P=0.13], patients satisfaction within 5 years [OR=0.93, 95%CI(0.46, 1.88), P=0.85], intra procedural complications [OR=1.15,95%CI(0.57,2.29),P=0.70], major complications within 1 year [OR=0.63,95%CI(0.35,1.15),P=0.13] and the regrowth of uterine fibroids. However UAE was higher compared to surgery in minor complications within 1 year [OR=1.98,95%CI(1.40,2.81),P=0.0001]、 further interventions within 2 years [OR=4.90,95%CI(2.60,9.24),P<0.00001] and further interventions within 5 years [OR=6.74,95%CI(1.11,40.92),P<0.0001], with a significant difference. And UAE was lower compared to surgery in pregnancy and live birth, with a significant difference.Conclusions:UAE has many advantages such as security,favorbale effect,easy operation,easy tending, little trauma and easy to be accepted by patients etc..However UAE has more risk of re-intervention.The effects on the pationts’ fertility 、different emboliaztion agents effects on UAE’ effectiveness and the effectiveness on the multiple uterine fibroids need for futher study.