| ObjectiveTo explore the effectof laparoscopic and transabdominal surgery on pregnancy after momectomy.Through meta-analysis,the data of RCT from several small samples are combined to improve the statistical efficiency of the original results,and to provide scientific basis for patients with leiomyoma who spare fertility in choosing surgical approachs.MethodWe collected data on the pregnancy outcomes of multiple uterine leiomyoma patients with fertility-sparing from January 1,2015 to January 30,2018.JADAD score was used to evaluate the quality of randomized controlled trials included in the study,and Review Manager 5.3 software was used to conduct meta-analysis of the data.ResultA total of 8 domestic and foreign studies(5 Chinese studies and 3 English studies)were extracted.A total of 1130 patients underwent surgical treatment,including 567 laparoscopic minimally invasive operations and 563 laparotomy operations.Eight studies reported the pregnancy rate,mode of production,production process and neonatal quality respectively.Therefore,the literature research was analyzed from these four aspects.Eight studies included in the literature reported the pregnancy rate after operation.The statistics were made from four aspects: normal pregnancy rate after operation,abortion rate,pregnant uterine rupture and non-pregnancy rate after operation.The specific data(see table 2)showed that the heterogeneity test results were P=0.34,I2=0.03.With the help of fixed effect model analysis,(1)Postoperative normal pregnancy rate: The pregnancy rate in laparoscopic group was significantly higher than that in transabdominal operation group [RR=2.07,95% CI(1.73,2.61),P=0.02];(2)Postpartum abortion rate: The abortion rate in laparoscopic group was lower than that in transabdominal operation group [RR=0.35,95%CI(0.13,0.67),P=0.03];(3)Postpartum uterine rupture rate: There was no significant difference between the two groups [RR=1.12,95% CI(0.63,1.71),P=0.13];(4)Postoperative non-pregnancy rate: lumen.The mirror group was significantly lower than the transabdominal operation group [RR=0.39,95% CI(0.17,0.52),P=0.01];there was no significant bias in the published funnel plot analysis.Six articles reported the delivery mode of patients after laparoscopic operation group and transabdominal operation group respectively.The data were collected(see table 3).The results of heterogeneity test were P=0.03,I2=0.61.Fixed-effect model was used to analyze the following results:(1)There was no significant difference in the spontaneous delivery rate between the two groups [SMD=0.97,95% CI(-0.52,1.01),P=0.12];(2)The cesarean section rate: there was no significant difference between the two groups,[SMD=1.01,95% CI(-1.13,2.29),P=0.20],there were some publication bias between the two groups.Among the eight studies included in the literature,5 articles reported the time of delivery and the amount of bleeding after laparoscopic operation group and transabdominal operation group respectively.The extracted data(see table 4)showed that the results of heterogeneity test were P=0.02,I2=0.71.With the help of random effect model analysis,(1)Delivery time: There was no significant difference between the two groups [SMD=0.13,95% CI(-1.92,1.47),P = 0.34];(2)Blood loss: There was no significant difference between the two groups [SMD =-1.02,95% CI(-2.27,1.33),P=0.23].The analysis of publication bias funnel chart showed obvious asymmetry between left and right,and there was publication bias.It is concluded that there is no significant difference between laparoscopic operation group and transabdominal operation group in terms of delivery time and blood loss during the production process.Six articles reported the Apgar score(1 min)and NACS score(15 min)of neonates in laparoscopic operation group and transabdominal operation group respectively.The data were collated and extracted(see table 5).The results of heterogeneity test were P=0.28,I2=0.07.The fixed effect model was used to analyze the Apgar score(1 min).There was no significant difference between the two groups[RR=1.12,95%CI(0.34,1.92),P=0.15];NACS score(15 min): There was no significant difference between the two groups [RR=1.03,95%CI为(0.57,1.48),P=0.12];it was known that there was no effect on neonates born in laparoscopic and transabdominal groups.No significant bias tables were found in the published analysis of bias funnel maps.ConclusionThe results of this study showed that laparoscopic hysteromyomectomy could significantly improve the pregnancy rate of patients with hysteromyoma after hysteromyomectomy,and reduce the abortion rate or infertility rate(within 3 years)compared with open hysteromyomectomy.The risk of uterine rupture after laparoscopic myomectomy is higher than that after abdominal surgery,but there is no statistical significance because of the low incidence.There was no significant difference between the two methods in terms of delivery mode and neonatal quality. |
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