The Meta-analysis Of Endometriosis After Conservative Surgery Combined With The Treatment Of Levonorgestrel-releasing Intrauterine System

Objective: Evaluation of treatment efficacy and safety of endometriosis after conservative surgery combined with levonorgestrel releasing intrauterine system(LNG-IUS).Materials and methods:computer retrieval and manual retrieval: Ovid Medline 、 ACP Journal C1ub;Cochrane Central Register of Controlled Trials CENTRAL 、 CBM、 pubmed、controlled clinical trials database、 NCBI、 Chinese biomedical literature database、VIP Information Databasc、WAN FANG Data、CNKI database of relevant literature in English and Chinese(2003-2014)Controlled Clinical Trial iterature of surgery of endometriosis after conservative treatment combined with levonorgestrel releasing intrauterine system were collected and evaluated. The quality of the literature and data extraction were evaluated independently by the author and his assistant using Rev Man5.3 software for meta-analysis.Results: 12 Trials were included.including 728 patients.9 were randomized controlled trials,3 were Controlled Clinical Trial included, According to the standards of grading,score 7 points 1 piece, quality grade 6 points for 2, quality score 5 points for 2, quality score of 4 points for 2, they were the high quality papers. The remaining four papers,the quality score 3 points for 2,quality score 2 points for 2, low quality of literature.The controlled clinical trials was scored by methodological index for non-eandomized studies(MINORS),they were the high quality papers.1.Compared with surgery alone postoperative levonorgestrel-releasing intrauterine system, were incorporated into three study, a total of 166 patients.Postoperative levonorgestrel releasing intrauterine system can more effectively relieve pain, and the difference was statistically significant(P<005);can obviously decrease the recurrence rate, the difference was statistically significant(OR: 0.19, 95% CI:0.19, 0.19, P = 0.0004); Can significantly improve the quality of life, the difference was statistically significant(P = 0.014); there was no statistically significant difference in headache, bloating, oily skin, acne and breast tenderness and other similar incidence of adverse reactions.2.Levonorgestrel-releasing intrauterine system compared with application of Gn RH-a after postoperative including 5 trials 211 patients. No statistically significant differences between the two groups in terms of pain relief(P = 0.31, WMD = 0.31,95% CI(0.50, 0.57)]. No statistically significant differences in reducing ca- 125 level[P=0.12,WMD=﹣12.29,95%CI:(﹣27.9~3.32)]; there was no statistically significant difference In raising the quality of life in both groups, [P = 0.7, WMD =0.7, 95% CI(6.19, 9.19)]. the risk of cardiovascular may increase, and the difference was statistically significant[P=0.004,WMD=15.02,95%CI:(4.7~25.34)]In terms of the incidence of adverse events, the levonorgestrel-releasing intrauterine system group under irregular bleeding, simple ovarian cysts, the incidence of abdominal pain in higher risk compared with Gn RHa group(p < 0.03, while Gn RHa group in the aspect of vasomotor symptoms, the incidence of amenorrhea and levonorgestrel-releasing intrauterine system had a higher risk than LNG-IUS,p < 0.05;3. Compare with application gestrinone after postoperative, levonorgestrel releasing intrauterine system placed in intrauterine there were four studies,including 351 cases of patients. the difference was statistically significant[P<0.00001,WMD=-1.33,95%CI(-1.79,-0.87];in terms of reducing the recurrence rate is better than that of gestrinone group, the difference was statistically significant(P = 0.0007, OR = 0.21, 95% CI: 0.08 ~ 0.51)].Conclusion: Levonorgestrel can release intrauterine system compare with surgery alone after postoperative,can improve pain symptoms, reduce the relapse rate and improve the quality of life, no increase in adverse. Compared with postoperative Gn RH-a, in pain relief, ca-125 levels, improve the quality of life is quite short-term effects; there may be a potential cardiovascular risk, side effects in the near future LNG-IUS group in terms of irregular bleeding, ovarian cystic were increased and the risk of lower abdominal pain were also increased, p <0.03, Gn RH-a group had a higher rate of vasomotor symptoms, and the incidence of secondary amenorrhea p<0.05;contrast use gestrinone after postoperative, can significantly reduce relapse rates and pain relief.