| Objective:The clinical efficacy transvaginal surgery(TS)versus laparoscope surgery(LS)were compared,including success rate of the operation,operation time,intraoperative blood loss,postoperative pain score,postoperative hospital stay,the decrease of postoperative β-HCG value to normal time,menstrual rehydration time and so on,to provide evidence-based medical evidence for clinical scar pregnancy treatment.Methods: Pubmed,Embase,Cochrane,CNKI,Wan fang,VIP,CBM were searched comprehensively.From the date of self-bulit database to March 31,2020,the randomized controlled trial of clinical efficacy of TS and LS in the treatment of type Ⅲ cesarean scar pregnancy was conducted.Review Manager 5.3 software was used for meta-analysis to evaluate the safety and effectiveness of the two surgical methods in the treatment of scar pregnancy.Results: A total of 32 articles were included in the study.On the analysis of related indexes between TS group and LS group,the comparison results of the success rates of the two operations showed:[RR=1.00,95%CI=[0.98,1.01],Z=0.71(P=0.48)],with no statistical difference,indicating that the success rates of the two operations were not significantly different.The comparison results of operation time showed:[MD=-17.87,95%CI=[-23.48,-12.26],Z=6.24(P<0.00001)],with statistical difference.The operation time in TS group was shorter than that in LS group.Analysis of intraoperative blood loss showed that: [MD=-49.14,95%CI=[-61.23,-37.05],Z=7.97(P<0.00001)],the difference was statistically significant,suggesting that the blood loss in LS group was more than that in LS group.The comparison results of postoperative pain scores showed: [MD=-1.63,95%CI=[-2.5,-0.76],Z=3.67(P=0.0002)],the comparison results showed that the pain in TS was significantly lower than in LS group.The comparison results of hospitalization time after operation showed:[MD=-0.51,95%CI=[-0.91,-0.11],Z=2.52(P=0.01)],with statistical difference,suggesting that the operation time of LS group is longer than that of TS group.The comparison results of the blood β-HCG value decreased to the normal time after operation showed that: [MD=0.86,95%CI=[-1.81,3.53],Z=0.63(P=0.53)],there was no statistical difference between the two groups.The results of menstruation relapse time showed: [MD=-0.83,95%CI=[-2.52,0.85],Z=0.97(P=0.33)],there was no significant difference between the two groups.Conclusion: The results of comparative study show that TS group and LS group have no obvious difference in the success rate of operation,the decrease of β-HCG value to normal time after operation,postoperative hospital stay and menstrual recurrence time,but TS group has obvious advantages over LS group in terms of operation time,intraoperative blood loss,postoperative hospital stay,postoperative pain score,etc.However,due to the low quality of the documents included in this study,in order to evaluate the safety and effectiveness of TS and LS groups in treating scar pregnancy more comprehensively and truly,large-sample and high-quality clinical randomized controlled experiments are needed for verification in the future.The postoperative pain score is a small-sample study,and more randomized controlled experiments and large samples are needed for verification. |
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