The impact of bilateral transient occlusion of uterine and utero-ovarian arteries on surgical blood loss during laparoscopic myomectomy: A systematic review and meta-analysis of randomized controlled trials

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-02-01 DOI:10.1016/j.ejogrb.2024.12.033

Saeed Baradwan , Bandr Hafedh , Samah Himayda , Bayan Albouq , Ehab Badghish , Neveen Awadh , Afnan Baradwan , Mohammed Mamdouh Saleh , Aziza Hussein Nassef , Elghamry E. Elghamry , Mahmoud Moustafa Alshareef , Alhassan M. Hassan , Ahmed Mohamed Abdelhakim , Eman M. Mojahed

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引用次数: 0

Abstract

Background

The primary perioperative concern during laparoscopic myomectomy is the risk of significant intraoperative blood loss, which can lead to hypovolemia, necessitate blood transfusion, and result in postoperative anemia. To address this issue, we conducted a systematic review and meta-analysis to assess the impact of temporarily clamping the uterine and utero-ovarian arteries on operative blood loss during laparoscopic myomectomy.

Methods

We conducted a comprehensive search across various databases to identify eligible clinical trials from inception to May 2024, focusing on randomized controlled trials (RCTs). In the intervention group, temporary bilateral clamping of the uterine and utero-ovarian arteries was performed during laparoscopic myomectomy, while the control group underwent laparoscopic myomectomy without arterial clamping. A meta-analysis was carried out on the gathered data using Revman software. The primary outcomes examined were blood loss and change in hemoglobin, with secondary outcomes including operation time and length of hospital stay.

Results

Three RCTs, involving a total of 275 patients, met our inclusion criteria. The intervention group showed significantly lower operative blood loss and a smaller reduction in hemoglobin compared to the control group. There was no notable difference in operation time between the two groups. Moreover, patients in the experimental group experienced a significantly shorter hospitalization duration than those in the control group.

Conclusions

The temporary bilateral occlusion of the uterine and utero-ovarian arteries is an effective method for reducing surgical blood loss, hemoglobin decline, and hospital stay duration during laparoscopic myomectomy. However, additional studies are needed to validate these findings.

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腹腔镜子宫肌瘤切除术中双侧子宫和子宫卵巢动脉短暂闭塞对手术出血量的影响：随机对照试验的系统回顾和荟萃分析。

背景：腹腔镜子宫肌瘤切除术围手术期的主要问题是术中大量失血的风险，这可能导致低血容量，需要输血，并导致术后贫血。为了解决这个问题，我们进行了一项系统回顾和荟萃分析，以评估腹腔镜子宫肌瘤切除术中暂时夹紧子宫和子宫卵巢动脉对手术出血量的影响。方法：我们对各种数据库进行了全面检索，以确定从成立到2024年5月的符合条件的临床试验，重点是随机对照试验（rct）。干预组在腹腔镜子宫肌瘤切除术中行双侧子宫动脉和子宫卵巢动脉临时夹持术，对照组行腹腔镜子宫肌瘤切除术，不夹持动脉。采用Revman软件对收集的数据进行meta分析。检查的主要结果是失血量和血红蛋白的变化，次要结果包括手术时间和住院时间。结果：3项随机对照试验，共涉及275例患者，符合我们的纳入标准。与对照组相比，干预组手术出血量明显减少，血红蛋白减少幅度较小。两组手术时间差异无统计学意义。实验组患者住院时间明显短于对照组。结论：双侧子宫及子宫卵巢动脉暂时闭塞是腹腔镜子宫肌瘤切除术中减少手术出血量、血红蛋白下降和缩短住院时间的有效方法。然而，需要进一步的研究来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.