| Objective: 1.To evaluate the safety and effectiveness of electronic endometrial resection combined with progesterone for fertility preservation in patients with endometrial atypical hyperplasia and early endometrial cancer by systematically reviewing published studies;2.To compare the clinical and pregnancy outcomes of electronic endometrial resection combined with progesterone and other measures to preserve fertility function.Method: The Chinese and English databases were searched by computer from the establishment of the database to January 2023 to screen out the studies that met the inclusion criteria for patients with endometrial atypical hyperplasia and early endometrial cancer who used electronic endometrial resection combined with progesterone to preserve fertility function,extract the original effective data,and evaluate the quality of the included studies.Meta analysis of complete response rate,recurrence rate,pregnancy rate,full-term delivery rate and adverse pregnancy rate after treatment was performed using Stata 16.0 software.Results: In this study,43 literatures were included,including a total of 1311 patients,406 patients with endometrial atypical hyperplasia,893 patients with early endometrial cancer,and 12 patients with undifferentiated pathological types,including 14 control group articles.The results of meta-analysis showed that: 1.Complete response rate of 83%,95%CI[77%-89%],recurrence rate 11%,95%CI[8%-14%],pregnancy rate 64%,95%CI[52%-75%],full term delivery rate49%,95%CI[35%-64%] and adverse pregnancy rate was 10%,95%CI[6%-15%] for endometrial atypical hyperplasia and early endometrial carcinoma treated with electronic endometrial resection combined with oral progesterone;2.Complete response rate was 92%,95%CI[85-97%],recurrence rate was 5%,95%CI[2%-8%],pregnancy rate was 85%,95%CI[75%-93%],term delivery rate was70%,95%CI[60%-79%] and adverse pregnancy rate was 13%,95%CI[10%-17%]for endometrial atypical hyperplasia and early endometrial carcinoma treated with electronic endometrial resection combined with levonorgestrel intrauterine sustained release system;3.Electronic endometrial resection combined with progesterone compared with other interventions,complete response rate(RR=1.31,P<0.05),pregnancy rate(RR=1.43,P<0.05),full-term delivery rate(RR=2.10,P<0.05),recurrence rate(RR=0.33,P<0.05)and adverse pregnancy rate(RR=0.43,P<0.05)for endometrial atypical hyperplasia and early endometrial carcinoma.Conclusions: 1.electronic endometrial resection combined with progesterone therapy is safe and effective for fertility preservation in patients with endometrial atypical hyperplasia and early endometrial cancer;2.The complete remission rate,pregnancy rate,full-term delivery rate and adverse pregnancy rate of electronic endometrial resection combined with levonorgestrel intrauterine sustained release system for endometrial atypical hyperplasia and early endometrial carcinoma were higher than those of electronic endometrial resection combined with oral progesterone.The recurrence rate was lower than that of electronic endometrial resection combined with oral progesterone;3.The complete remission rate,pregnancy rate,and full-term delivery rate of electronic endometrial resection combined with progesterone for endometrial atypical hyperplasia and early endometrial carcinoma were higher than those in other intervention groups.The recurrence rate and adverse pregnancy rate were lower than those in other intervention groups. |
