| Endometriosis is refers to the endometrial tissue (glands and stroma) appeared outside uterine body parts. This disease is a kind of estrogen dependent disease, is a common and frequently-occurring disease of department of gynaecology, with strong aggressive, widely cultivated, easy relapse. With the development of the society, age at first menstruation, pregnancy, childbirth, and menopause aging, the incidence of the disease has a rising trend year by year. The disease pathogenesis is unclear. Although histologically benign lesions, but such as proliferation, infiltration and metastasis and recurrence of malignant behavior, is the disease of clinical refractory.The fundamental goal of treatment of endometriosis is "cut and remove lesions, relieve pain and control, treatment and promote fertility, prevent and reduce recurrence". At present western medicine in the treatment of endometriosis mainly include drug therapy, surgical treatment and expectant treatment. Surgery is the first choice for treatment of pelvic endometriosis, conservative surgical treatment can effectively relieve symptoms recently, but the postoperative recurrence rate is high and the recurrence time is short, the serious influence the patient’s quality of life, therefore to seek a can effectively inhibit the recurrence of endometriosis, and can improve the fertility, reduce adverse reactions medicine is a clinical problems to be solved.Objective:1 To assess the clinical effects and safety of Chinese herbal treatment compared with GnRH-a for preventing the post-operative recurrence of pelvic endometriosis.2 To observe and evaluate the clinical efficacy of Huoxuexiaoyi Decoction for preventing the post-operative recurrence of pelvic endometriosis.Methods:1 Network meta-analyses:The relative randomized controlled trials (RCTs) of Chinese herbal treatment GnRH-a and control groups were searched from PubMed (1966-2016.02), MEDLINE (-2016.02), EMBASE.com (1974-2016.02), Cochrane Library (-2016.02), China National Knowledge Infrastructure (1994-2016.02), Chinese Biomedical Literature Database(1978-2016.02) and Wan-Fang Database (1997-2016.02). The RCTs were screened according to the predefined inclusion and exclusion criteria. The related items were used to assess the quality of RCTs. Data were analyzed by STATA V.13.1 software.2 Clinical research:60 cases of patients after operation diagnosed as "endometriosis" were Collected from January 2013 to January 2015 in Guang’an Men Hospital, China Academy of Chinese medical sicience outpatient gynecological clinical.Referring to《the guideline for clinical research of new herbs and decoctions)) printed in 2002.Recurrence rate, pregnant rate,CA125 and CA199 before operation and after operation once every three months by the end of 1 year were recorded and made a comparison with the use of SPSS 21.0 statistical analysis software.Results:1 Network meta-analyses:Initially, we screened 2092 citations by reading the title and the abstract. Then we attained and screened full-text of potential included studies (90 studies). Finally, we included 41 studies including 45 references in our research. Among all included studies, there are 33 studies which was written in Chinese and 8 in English.2 Clinical research:(1)There are 8 patients recurred during 12 months after operation, the total recurrence rate is 13.3%. The recurrence rate of ovarian endometriosis is 12.0%; the recurrence rate of ovarian endometriosis combined deep infiltrating endometriosis type is 11.1%; the recurrence rate of ovarian endometriosis combined peritoneal endometriosis type is 100%; the recurrence rate of Ⅰ,Ⅱ stage patients is 0%, the recurrence rate of Ⅲ, Ⅳ stage patients is 17.8%; (2) 60 cases, there are a total of 26 patients with fertility requirements, the total pregnancy rate is 61.5% in 12 months after operation. The pregnancy rate of ovarian endometriosis is 64.0%. Ⅰ, Ⅱ period have fertility requirement, a total of 9 cases,4 cases were pregnancy in 12 months after operation, the pregnancy rate is 44.4%; Ⅲ,Ⅳ period have fertility requirement, a total of 17 cases,12 cases were pregnancy in 12 months after operation, the pregnancy rate is 70.6%; (3) Huoxuexiaoyi treatment could lower the value of CA125 and CA199; (4) The incidence of adverse events is 16.7%.Conclusions:1 Network meta-analyses:The results of network meta-analyses indicated:(1) Compared with the only surgery groups, GnRH-a and three kinds of Chinese herbal treatment (the medicine for activating blood circulation, the medicine for regulating the circulation of qi and blood, the medicine for strengthening kidney and promoting blood circulation) could significantly decrease the recurrence rate after operation. There was no significant difference among all interventions. (2) Compared with the only surgery groups, GnRH-a and four kinds of Chinese herbal treatment (the medicine for activating blood circulation, the medicine for regulating the circulation of qi and blood, the medicine for strengthening kidney and promoting blood circulation, the medicine for clearing heat and activating blood) could significantly increase the pregnant rate. Especially, huoxuehuayu and liqihuoxue treatment showed better effect in contrast to GnRH-a. (3) GnRH-a and four kinds of Chinese herbal treatment were relatively safe treatments.2 Clinical research:Clinical curative effect observation showed huoxuexiaoyi treatment could effectively decrease the recurrence rate after operation, increase the pregnant rate, lower the value of CA125 and CA199, had rare adverse events for preventing the post-operative recurrence of pelvic endometriosis. |
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