Meta-analysis Of Combined Traditional Chinese And Western Medicine In Treating Intrauterine Adhesions

Objective: By using the meta-analysis method,multiple outcome indicators were summarized,and the advantages and effects of combined traditional Chinese and western medicine in the treatment of intrauterine adhesions were summarized.It provided evidence-based medical evidence for combined traditional Chinese and western medicine in the treatment of intrauterine adhesions and provided a scientific basis for clinical medication.Methods: Search CNKI,Wanfang Date,Vip Electronic Periodical Full-text Database(VIP),China Biomedical Literature Service System(CBM),Pubmed,Embase,Cochrane Library,the database of the China Clinical Trial Registration Center,collects randomized controlled trials of integrated Western medicine treatment of intrauterine adhesions,the search terms are "uterine adhesions" "less menstruation" "integrated Chinese and Western medicine" "Chinese medicine" "random" Subject keywords and their corresponding free words,the search time is set to build the database to December 31,2019,two reviewers independently choose research and independently conduct quality evaluation,extract data according to the previously designed table,if the opinions are inconsistent,the two sides discuss Solve or judge by the third party.Literatures were screened according to inclusion criteria and exclusion criteria,and eligible studies after screening used Cochrane risk bias assessment tools to evaluate the quality of the included research literatures.The collected data was analyzed using Rev Man5.3 software provided by Cochrane Library.Result: A total of 21 randomized controlled studies were included in the study,a total of 1738 cases,869 cases in the experimental group,869 cases in the control group,including 5 cases,including 3 cases in the control group and 2 cases in the experimental group.Meta analysis results suggest that integrated traditional Chinese and western medicine treatment can improve the overall efficacy(OR = 3.42,95% CI = [2.33,5.01],Z = 6.29,P <0.05),and improve menstrual recovery rate(OR = 4.25,95% CI = [2.42,7.48],Z = 5.02,P <0.05),improve the recovery rate of intrauterine adhesions(OR = 4.14,95% CI = [2.11,8.12],Z = 4.13,P <0.05),can effectively reduce the uterus Spiral artery and uterine artery PI,RI,uterine spiral artery PI(MD =-0.11,95% CI = [-0.16,-0.06],Z = 4.66,P <0.05),uterine spiral artery RI(MD =-0.04,95% CI = [-0.06,-0.02],Z = 3.65,P <0.05);Uterine artery PI(MD =-0.28,95% CI = [-0.31,-0.24],Z = 14.18,P <0.05),Uterine artery RI(MD =-0.09,95% CI = [-0.11,-0.07],Z = 8.17,P <0.05),reduce the level I distribution of endometrial perforator blood flow,increase endometrial perforator blood Flow Class II and Class III distribution Class I(OR = 0.25,95% CI = [0.16,0.39],Z = 6.01,P <0.05);Class II(OR = 1.56,95% CI = [1.03,2.35],Z = 2.11,P <0.05);Grade III(OR = 2.44,95% CI = [1.59,3.75],Z = 4.10,P <0.05),accelerate the repair of endometrium(MD= 0.95,95%CI= [0.84,1.06],Z=16.57,P<0.05),can increase the postoperative pregnancy rate(OR = 2.61,95% CI = [1.84,3.68],Z = 5.43,P <0.05),reduce the occurrence of re-adhesion in the uterine cavity after surgery(OR = 0.29,95% CI = [0.15,0.58],Z = 3.53,P <0.05),lower the intrauterine adhesion score(SMD =-0.63,95% CI = [-0.84,-0.42],Z = 5.80,P <0.05),reduce peripheral blood TGF-?(MD =-12.82,95% CI = [-16.52,-9.13],Z = 6.81,P <0.05),but the combination of traditional Chinese and Western medicine has no obvious pregnancy outcome compared with Western medicine Difference(OR = 0.70,95% CI = [0.27,1.81],Z = 0.74,P = 0.46> 0.05).Conclusions : The following conclusions were reached in this study:(1)Integrated Chinese and Western medicine can significantly improve the clinical comprehensive efficacy of IUA,improve menstrual abnormalities and intrauterine adhesions,promote endometrial repair,increase endometrial thickness,increase pregnancy rate,and reduce endometrial spiral Uterine artery PI,RI,improve uterine blood supply,can also improve the prognosis of IUA,reduce the recurrence of IUA by promoting endometrial repair and reducing TGF-? and other methods,and it is more effective than Western medicine treatment alone.(2)Integrated Chinese and Western medicine for IUA has no statistically significant difference in pregnancy outcomes compared with Western medicine treatment alone.However,due to the lack of relevant prospective studies,whether Integrated Chinese and Western medicine has an impact on pregnancy outcomes still needs further study.(3)Integrated Chinese and Western medicine therapy can accelerate endometrial growth and promote endometrial recovery,and is more effective than simple Western medicine treatment,however,in this Meta analysis,the quantitative relationship between endometrium and estrogen dose could not be obtained,neither the best estrogen dosage after intrauterine adhesions.Large sample size,multi-center clinical experiments are still needed to study and confirm.(4)There are still deficiencies in this study.For example,the included randomized controlled studies are all small sample studies,the low quality of the literature leads to unstable conclusions and lack of reliability,therefore,a large sample,multi-center,high-quality randomized controlled study is still needed to confirm the results.