The Therapeutic Efficacy Of The Hysteroscopic Cold Knife Resection Versus Electrocision For IUA:A Meta-analysis And Trial Sequential Analysis

Objective:To compare the therapeutic efficacy of the hysteroscopic cold knife resection and electrocision in the treatment of IUA.Methods:The Pubmed,Sinomed,Embase,The Cochrane Library,CNKI,CBM,Wanfang,Vip and other databases were searched through computer to collect all prospective randomized controlled studies on the comparison between the therapeutic efficacy of the hysteroscopic cold knife resection and electrocision in the treatment of Intrauterine adhesions from January 2000 to January 2021.Through selected qualified literature,evaluated the quality of the literature and extracted relevant data,we performed meta-analysis with Rev Man5.3.In addition,in order to evaluate the reliability and stability of the conclusions,we conducted experimental TSA.Results:After screening,a total of 19 Chinese studies were included.There are 1707 patients with IUA were diagnosed,including 850 patients in the hysteroscopic cold knife resection group and 857 patients in the hysteroscopic electrocision group.The results of this meta-analysis show that: 1.In the transcervical resection of adhesion of IUA,compared with electrocision,cold knife resection has shorter operative time,less intraoperative blood loss and absorbed dose of distending medium,higher recurrence rate,the total effective rate of separation of adhesion and menstrual improvement;2.However,in terms of improving postoperative pregnancy rate,no conclusion can be drawn as to which surgical method is better,and more studies are needed to participate in the analysis;3.Through the stratified analysis of the above studies with high heterogeneity and TSA of major clinical indicators were conducted to further verify the reliability and stability of the conclusions of this meta-analysis.Conclusion:In the process of hysteroscopic diagnosis and treatment of IUA,cold knife resection shows obvious superiority.Compared to electrocision,cold knife resection can not only shorten operation time,reduce intraoperative blood loss and the absorbed dose of distending medium,but also increase the total effective rate of separation of adhesion and menstrual improvement.However,in terms of improving postoperative pregnancy rate,no conclusion can be drawn as to which surgical method is better,and more studies are needed to participate in the analysis.