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目的评价传统分段诊刮术与宫腔镜下分段诊刮术诊断子宫内膜病变的临床疗效。方法检索了CBM、CNKI、万方数据库、VIP、Cochrane Library、OVID、PubMed、Embase等数据库,手工检索了百度和谷歌等网络数据。纳入对比传统分段诊刮与宫腔镜下分段诊刮术诊断子宫内膜病变的随机对照试验(RCT)。由2名研究者独立按照纳入标准筛选文献、提取资料并交叉核对,而后采用Cochrane评价员手册5.1.0文献质量评价标准评价纳入研究质量,用Rev Man5.1软件进行Meta分析。结果共纳入11篇随机对照试验,共2 588例患者。Meta分析表明:宫腔镜诊刮组与传统诊刮组比较,术后标本送检率、子宫内膜癌确诊率、不典型增生确诊率和术后腹水肿瘤细胞阳性率均存在统计学差异,分别为[MD=0.31,95%CI(0.11,0.90),P=0.03]、[MD=0.40,95%CI(0.29,0.53),P<0.000 01]、[MD=0.30,95%CI(0.10,0.90),P=0.03]和[MD=0.38,95%CI(0.19,0.77),P=0.008];然而,子宫内膜良性病变诊断率[MD=0.57,95%CI(0.17,1.87),P=0.35]和子宫内膜癌累及宫颈诊断率[MD=0.06,95%CI(0.01,36.86),P=0.81]无统计学差异。结论对纳入的11篇RCT进行Meta分析结果显示:宫腔镜诊刮组标本送检率、子宫内膜癌诊断率、子宫内膜不典型增生诊断率、子宫内膜癌手术后腹水细胞学阳性率均高于传统诊刮组,两组对子宫内膜良性病变及子宫内膜癌累及宫颈诊断率相似。但是,其结论仍不能取代高质量、大样本、多中心的随机对照研究,因此结论还有待于高质量随机对照研究的证实。
Objective To evaluate the clinical efficacy of traditional segmental curettage and hysteroscopic segmental curettage in the diagnosis of endometrial lesions. Methods The databases such as CBM, CNKI, Wanfang Database, VIP, Cochrane Library, OVID, PubMed and Embase were searched and the web data of Baidu and Google were retrieved manually. A randomized controlled trial (RCT) comparing endoscopic curettage with hysteroscopic diagnosis of endometrial lesions was included. Two researchers independently screened the literature according to the inclusion criteria, extracted data and cross-checked, and then used the Cochrane Reviewer’s Manual 5.1.0 document quality evaluation criteria to evaluate the quality of the included studies and Meta-analysis using Rev Man5.1 software. Results A total of 11 randomized controlled trials were enrolled in a total of 2 588 patients. Meta analysis showed that there were significant differences between the hysteroscopy curettage group and the traditional curettage group, the postoperative specimens submission rate, the diagnosis rate of endometrial cancer, the diagnosis rate of atypical hyperplasia and the postoperative ascites tumor cell positive rate, (MD = 0.30, 95% CI (0.29, 0.53), P <0.000 01], [MD = 0.30, 95% CI However, the diagnostic rate of benign endometrial lesions [MD = 0.57, 95% CI (0.17, 1.87, P = 0.003) ), P = 0.35] and endometrial cancer involving the diagnosis of cervical [MD = 0.06,95% CI (0.01,36.86), P = 0.81] no statistical difference. Conclusions Meta-analysis of 11 RCTs included in this study showed that the rate of hysteroscopy diagnosis, the diagnosis rate of endometrial cancer, the diagnosis rate of endometrial dysplasia, the ascitic cytology after endometrial cancer surgery Rates were higher than the traditional curettage group, two groups of endometrial benign lesions and endometrial cancer involving the diagnosis of cervical similar. However, its conclusion still can not replace the high-quality, large sample, multicenter randomized controlled study, so the conclusions have yet to be confirmed by high-quality randomized controlled studies.