The Clinical Efficacy And Pregnancy Outcome Between Hysteroscopic And Laparoscopic Myomectomy About Intramural Uterine Myoma:a Meta-analysis

Objective: To evaluate the clinical efficacy and pregnancy outcomes of transcervical resection of myoma(TCRM)and laparoscopic myomectomy(LM)in the treatment of intramural uterine myoma,,so as to provide decision-making basis for the clinical diagnosis and treatment of patients with reproductive hysteromyoma and the selection of appropriate surgical methods.Methods:CNKI database,Wanfang database,Vip,PubMed,Web of Science database were searched by computer.The searching time was from the establishment of the database to 2019.01.Randomized controlled trials(RCT)and cohort studies on the effect of hysteroscopy and laparoscopic hysteromyomectomy on the clinical efficacy and pregnancy outcomes were collected.Data were analyzed by RevMan 5.3 software.Results: A total of 10 RCTs and 11 cohort studies were included,including 3749 patients,1778 in hysteroscopy group and 1981 in laparoscopy group.The final Meta-analysis results showed that: 1.Pregnancy outcomes: there was no significant difference in pregnancy rate[OR=1.31,95%CI(0.93,1.86),P=0.13] between hysteroscopic and laparoscopic hysteromyomectomy;abortion rate [OR=0.18,95%CI(0.1,0.32),P<0.00001],cesarean section rate [OR=0.53,95%CI(0.39,0.71),P<0.0001] between hysteroscopic and laparoscopic hysteromyomectomy showed significant difference.The abortion rate,cesarean section rate and the distance from the first pregnancy time of hysteroscopy group were all less than laparoscopy group.2.1-Months Myometrial healing rate [OR=93.90,95%CI(20.71,425.69),P<0.00001],3-months myometrial healing rate [OR=11.45,95%CI(8.14,16.10),P<0.00001],6-months myometrial healing rate [OR=33.66,95%CI(12.54,89.69),P<0.00001],12-month myometrial healing rate [OR=12.68,95%CI(4.51,35.69),P<0.00001] had statistical significance.The myometrial healing rate of hysteroscopy group at 1,3,6 and 12 months was higher than that of LM group.3.Operation time: The operation time of hysteroscopy group was shorter than that of laparoscopy group [MD=-40.22,95%CI(-50.06,-30.38),P<0.00001];4.Intraoperative bleeding volume: The operation time of hysteroscopy group was shorter than that of Laparoscopic group [MD=-50.82,95%CI(-71.81,-29.83),P<0.00001];5.Postoperative hospital stay: Hysteroscopy group was less than laparoscopic group(OR=-1.95,95% CI(-2.18,-1.71),P < 0.00001);6.Recurrence rate: there was no significant difference in Recurrence rate between two operations [OR=0.63,95%CI(0.39,1.02),P=0.06];7.Menstrual recovery rate: hysteroscopy group was better than that of laparoscopy group [OR=2.12,95%CI(1.45,3.09),P=0.0001]。Conclusion: Hysteroscopy and laparoscopy are safe and feasible for the treatment of intramural hysteromyoma.The operation time,intraoperative bleeding volume,hospital stay and recurrence rate of hysteromyomectomy under hysteroscope were less than those in laparoscopy group.There was no significant difference in pregnancy rate and recurrence rate between the two groups after hysteroscopy,but the time from the first pregnancy time,abortion rate and cesarean section rate was lower in hysteroscopy group than that in laparoscopy group.Therefore,hysteroscopy is a better choice for women of childbearing age who have plans for pregnancy in the near future.