Meta-analysis For The Superiority And Inferiority Of Different Drug Therapy After Conservative Surgery For Endometriosis

Objective:a systematic review of clinical adverse reactions and clinical application value of the conservative surgery with various types of drugs in the treatment of endometriosis.METHODS:A computer system evaluation method adopted to retrieve MEDLINE, PUBMED, VIP (VIP), China National Knowledge (CNKI), Articles database, retrieve relevant professional literature, retrieval time for the deadline to June 2014. To collect relevant randomized controlled trials of the conservative surgery with drugs in the treatment of endometriosis. To take gestrinone as the representative drug compared with other commonly used drugs in the treatment of endometriosis, and to meta-analysis the data in the aspect of pain relief, relapse, pregnancy and side effects. According to the Cochrane systematic review program to remove the literature which does not meet the research and the data is unreliable, and to meta-analysis with RevMan5.2 software process data.Result:Meta-analysis relevant literature data, and total included 68 cases randomized controlled trials.There are 13 RCT compared endometriosis after conservative surgery using gestrinone with conservative surgery alone. There are 20 RCT compared endometriosis after conservative surgery using gestrinone with efficacy of mifepristone. There are 18 RCT compared endometriosis after conservative surgery using gestrinone with efficacy of GnRH-a. There are 9 RCT compared endometriosis after conservative surgery using gestrinone with efficacy of danazol. There are 8 RCT compared efficacy of gestrinone with that of Marvelon. System Ratings Show:(1) Compared endometriosis after conservative surgery using gestrinone group with conservative surgery alone group:reducing the recurrence rate is better than surgery alone group (RR = 0.25,95% CI [0.16,0.39], P＜0.00001), pain relief is better than surgery alone group (RR = 1.57,95% CI [1.36,1.86], P＜0.00001), and improving the pregnancy rate is better than surgery alone group (RR = 1.58,95% CI [1.22,2.04], P = 0.0005).(2)Compared endometriosis after conservative surgery using gestrinone group with endometriosis after conservative surgery using GnRH-a group: reducing the recurrence rate is not as good as GnRH-a (RR = 2.29,95% CI [1.28,4.09], P = 0.005), pain relief is not as good as GnRH-a (RR = 0.90,95% CI [0.86,0.95], P＜0.00001), and improving the pregnancy rate is not as good as GnRH-a (RR = 0.77,95% CI [0.66,0.89], P = 0.00006).(3) There is similar efficacy in pain relief rate, pregnancy-improving rate, and relapse reduce rate after conservative surgery using gestrinone, Marvelon, mifepristone, and danazol. (4) GnRH-a and Marvelon are less likely to lead to liver injury in the course of treatment, whereas gestrinone, mifepristone and danazol commonly lead to liver injury. The most serious is danazol, the less is gestrinone, and the least is mifepristone.Conclusion:Endometriosis after conservative surgery using drug therapy can significantly relieve pain rate, improve pregnancy rate, and reduce relapse rate. Endometriosis after conservative surgery using GnRH-a is superior to gestrinone in relieving pain rate, improving pregnancy rate, and reducing relapse rate. There is similar efficacy in pain relief rate, pregnancy-improving rate, and relapse reduce rate after conservative surgery using gestrinone, Marvelon, mifepristone, and danazol. GnRH-a and Marvelon are less likely to lead to liver injury in the course of treatment, whereas gestrinone, mifepristone and danazol commonly lead to liver injury. The most serious is danazol, the less is gestrinone, and the least is mifepristone.