A Meta-Analysis Of The Efficacy Of Hysteroscopic Electrotomy And Vaginal Surgery In The Treatment Of Previous Caesarean Scar Defect

Objective:The meta-analysis was carried out with Stata 15.1 software to compare the efficacy and safety of hysteroscopic electrotomy and vaginal surgery for previous caesarean scar defect(PCSD)in non-pregnant patients.Hoping that it could provide a decision-making basis for the choice of clinical surgical procedures.Method:According to the purpose of this study,the retrieval strategies were formulated.The databases were searched including CNKI,CBM,Wanfang,VIP,Pubmed,Embase,Cochrane.Baidu Academic and Google Academic were used to assist the retrieval.The retrieval period is from the establishment of databases to February 2019.All the relevant documents retrieved are imported into EndNote X7 software to eliminate duplicate documents.After that,according to the title,abstract and full-text of the literatures,all the non-conforming documents were excluded,and finally the randomized controlled trials(RCT)of hysteroscopy and vaginal surgery for previous caesarean scar defect(PCSD)in non-pregnant patients were included.According to the Cochrane Collaborative Network Manual,the literatures were evaluated.A meta-analysis evaluates theeffecacy and safety of hysteroscopic electrotomy and vaginal surgery for previous caesarean scar defect(PCSD)in non-pregnant patients by Stata 15.1software.Results: 799 literatures were retrieved firstly and 14 literatures were included finally according to inclusion criteria and exclusion criteria.All of them were RCT literatures,totaling 1193 patients.Meta-analysis showed that hysteroscopic electrotomy had worse curative effect of menstrual improvement whether in short-term or in long-term than vaginal surgery for previous caesarean scar defect(PCSD)in non-pregnant patients with abnormal menstruation than vaginal surgery(RR merger and 95% CI were 0.908(0.838,1.984)within 3 months after operation,RR merger and 95% CI were 0.774(0.717,0.835)at 6 months and above after operation).There was no difference in the postoperative exhausting time(SMD merger and 95% CI were 0.174(-0.419,0.766)))and the operative hospitalization time(WMD combined with95% CI 0.017(-1.806,1.841))between the two operations.There were no significant differences(P > 0.05)in postoperative pregnancy rate(RR merger and 95% CI were 0.925(0.688,1.243)),intraoperative blood loss(WMD merger and 95% CI were-9.633(-23.312,4.046)),operative time(WMD merger and95% CI were-12.478(-25.749,0.792)),overall complications rate(RR merger and 95% CI were 2.059(0.577,7.347)),hospitalization cost(WMD merger and95% CI were-22817.318(-59278.992,13644.356))and treatment satisfaction(RR merger and 95% CI were 0.904(0.740,7.104)))between hysteroscopic electrotomy and vaginal surgery for previous caesarean scar defect(PCSD)in non-pregnant patients,but the above meta-analysis results include too few samples or the stability of meta-analysis results were poor.Conclusion: Hysteroscopic electrotomy is less effective whether in shortterm or in long-term than vaginal surgery in the treatment of PCSD patients with abnormal menstruation.It is not considered that there is no significant difference in the postoperative exhausting time and the perative hospitalization time between the two operations.However,there is no sufficient evidence to suggest that there are no differences between the two methods in terms of postoperative pregnancy rate,intraoperative blood loss,operation time,overall complications rate,hospitalization expenses and treatment satisfaction,etc.More large sample and multi-center randomized controlled trials are needed for further comparative analysis,so as to evaluate more objectively and systematically the clinical efficacy of Hysteroscopic electrotomy and transvaginal surgery in the treatment of non-pregnant PCSD.