Meta-analysis Of Two Surgical Methods In The Treatment Of The Previous Cesarean Scar Defect

Objective: The purpose of this study is to systematically evaluate the surgical effect of hysteroscopy-laparoscopic combined surgery and vaginal surgery in the treatment of the previous cesarean scar defect(PCSD)by Meta-analysis,and to provide a practical theoretical basis for clinical treatment.Research methods: By searching foreign language databases Pub Med,Web of Science,Embase,Medline,Library,Cochrane and CNKI,Wanfang Data,VIP and China Journal full-text Database,to collect the literatures published in various databases at home and abroad from January 2014 to November 2019 on the treatment of PCSD by hysteroscopylaparoscopic combined surgery and vaginal surgery.To select the literature that meets the inclusion criteria,extract the analytical indexes of this study(operation time,intraoperative blood loss,the length of hospital stay,hospitalization cost,postoperative menstrual recovery,postoperative anal exhaust time,postoperative scar diverticulum repair under B-ultrasound,postoperative complications).Review Manager 5.3 software was used to evaluate and analyze the extracted data by Meta.Research results: Finally,13 articles were included in this Meta-analysis,including 1 in English and 12 in Chinese.There were 914 cases,including 494 cases of hysteroscopy-laparoscopic combined surgery and 420 cases of vaginal surgery.The Meta-analysis results of the extracted indexes are shown by using Review Manager 5.3 software: comparison between hysteroscopy-laparoscopic combined surgery and vaginal surgery in the treatment of PCSD,the difference of operation time was statistically significant(MD=19.14,95%CI[17.59,20.69],P<0.00001);there was no significant difference in the amount of intraoperative blood loss(MD=4.56,95%CI[-9.73,18.84],P=0.53);there was a significant difference in the length of hospital stay(MD=-3.52,95%CI[-4.02,-3.03],P<0.00001);the difference of hospitalization expenses(MD=6.92,95%CI[4.56,9.28],P<0.00001)was statistically significant;there was no significant difference in the recovery of menstruation after operation(OR=1.37,95%CI[0.72,2.59],P=0.34);there was no significant difference in postoperative anal exhaust time(MD=-0.10,95%CI[-1.16,0.96],P=0.85);there was no significant difference in the repair of scar diverticulum under B-ultrasound after operation(OR=1.15,95%CI[0.52,2.55],P=0.73);there was a significant difference in the incidence of postoperative complications(OR=0.27,95%CI[0.13,0.56],P=0.0004).Research conclusion: 1.When hysteroscopy-laparoscopic combined surgery in the treatment of PCSD,the operation time is longer and the hospitalization cost is higher than that of vaginal operation;The hospital stay of hysteroscopy-laparoscopic combined surgery is shorter than that of vaginal surgery,and the incidence of postoperative complications is lower than that of vaginal surgery.2.There was no significant difference in intraoperative blood loss,postoperative menstrual recovery,postoperative anal exhaust time and postoperative scar diverticulum repair under B-ultrasound between hysteroscopy-laparoscopic combined surgery and vaginal surgery in the treatment of PCSD.Among them,the reliability of the results of intraoperative blood loss and postoperative anal exhaust time is poor,which needs to be further verified by a lot of literature.