Conservative Treatment of Uterine Myomas: A Network Meta-Analysis of Randomized Controlled Studies

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-07-01 DOI:10.1016/j.jmig.2024.12.012

Mattia Dominoni MD, PhD, Barbara Gardella MD, Andrea Gritti MD, Marianna Francesca Pasquali MD, Arsenio Spinillo MD

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引用次数: 0

Abstract

Objective

To comparatively evaluate the effectiveness of uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), radiofrequency ablation treatment (RFT), and laparoscopic/laparotomic surgery in the conservative treatment of uterine fibroids.

Data Sources

The research was performed via electronic databases PubMed, Embase, and Cochrane Library, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.

Methods of Study Selection

The network included 10 randomized trials between 2000 and 2024 and 1002 randomized subjects.

Tabulation, Integrations, and Results

The network meta-analysis was conducted with subroutine netmeta on R. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The surface under the cumulative ranking curve (SUCRA) was computed by Bayesian network meta-analysis. Incidences of reintervention per 100 person/year of follow-up were 4.13 (range, 0–19.4), 16.1 (6.2–32.8), 14.3 (0–15.1), and 6 (4.3–6.7) for myomectomy, UAE, HIFU, and RFT, respectively. The incidence rate ratios compared with myomectomy were 2.45 (95% confidence interval [CI], 1.38–4.37), 5.23 (95% CI, 1.59–17.3), and 4.59 (95% CI, 0.77–27.3; p = .09) for UAE, HIFU, and RFT, respectively. RTF had the highest (SUCRA, 1.25% and 3%) whereas myomectomy had the lowest risk of reintervention (SUCRA, 98% and 95%) or hysterectomy during follow-up (median, 12 months; range, 3–24). The risk of major complications was significantly lower after UAE (odds ratio, 0.38; 95% CI, 0.17–0.85) than myomectomy. The procedure with the lowest likelihood of major complications was HIFU (SUCRA, 81.5%). Finally, in the evaluation of QoL at follow-up visits, there were no differences between the treatments studied, although the model was highly heterogeneous and inconsistent.

Conclusion

In the analysis of randomized trials, surgical myomectomy carried the least risk of reintervention and subsequent hysterectomy during a relatively short follow-up period. HIFU was the method with the lowest risk of major complications.

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子宫肌瘤的保守治疗：随机对照研究的网络荟萃分析。NMA在子宫肌瘤保守治疗中的应用。

目的：比较评价子宫动脉栓塞（UAE）、聚焦超声（HIFU）、射频消融（RFT）和腹腔镜/剖腹手术在子宫肌瘤保守治疗中的疗效。资料来源：本研究采用PRISMA标准，通过PubMed、EMBASE和Cochrane Library电子数据库进行。研究选择方法：该网络包括2000年至2024年间的10项随机试验和1002名随机受试者。表列：网络荟萃分析（NMA）采用子程序netmeta对r进行。使用随机试验的修订Cochrane风险-偏倚工具评估偏倚风险。利用贝叶斯NMA计算了累积排序曲线下的曲面。整合与结果：整合与结果：子宫肌瘤切除术、UAE、HIFU和RFT的再干预发生率分别为每100人/年随访4.13（范围0 - 19.4）、16.1（范围6.2 - 32.8）、14.3（范围0 - 15.1）和6（范围4.3 - 6.7）。与子宫肌瘤切除术相比，UAE、HIFU和RFT的发病率分别为2.45 （95% CI = 1.38-4.37）、5.23 （95% CI = 1.59,17.3）和4.59 （95% CI= 0.77-27.3, p=0.09）。随访期间（中位12个月，范围3-24），RTF患者再干预或子宫切除术的风险最高（SUCRA=1.25%和3%），而子宫肌瘤切除术患者再干预或子宫切除术的风险最低（SUCRA=98%和95%）。与子宫肌瘤切除术相比，UAE术后发生主要并发症的风险明显降低（OR=0.38,95%CI=0.17-0.85）。发生主要并发症可能性最低的手术是HIFU （SUCRA=81.5%）。最后，在随访时的生活质量评估中，尽管模型高度异质性和不一致性，但所研究的治疗之间没有差异。结论：在随机试验分析中，在相对较短的随访期内，手术子宫肌瘤切除术的再干预和后续子宫切除术的风险最小。HIFU是主要并发症风险最低的方法。

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

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.