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目的系统评价孕三烯酮与左炔诺孕酮宫内节育系统治疗子宫腺肌病(adenomyosis,AM)疗效差异。方法检索Library、EMBASE、BMJ、MEDLINE、万方医学数据库、中国生物医学文献数据库和CNKI等数据库和手工检索1998—2016年我校图书馆中的相关书籍及报道,搜集左炔诺孕酮宫内节育系统和孕三烯酮治疗AM的对照试验研究并对这些研究中的相关文献进行追溯。选择两位独立的文献评价者对入选的与研究内容相关的文献进行筛选,提取资料和评价纳入研究的质量,应用Rev Man 5.0软件对两种治疗方式的疗效差异进行系统Meta评价。结果最终纳入7篇文献,共554例患者,其中观察组280例,对照组274例。设计均为随机分组,并且描述的过程也采用了随机方法,并且在统计数据时采用盲法,均为高质量文献。Meta结果显示,观察组患者的痛经程度低于对照组[12个月加权均数差(weighted mean difference,WMD)=4.36,95%CI(-7.471~15.415),Z=3.39,P=0.006],月经量明显下降[6个月WMD=4.35,95%CI(-7.328~14.715),Z=3.29,P=0.010],子宫内膜厚度显著变小[12个月WMD=4.37,95%CI(-7.332~12.516),Z=3.03,P=0.010],子宫体积明显变小[12个月WMD=4.35,95%CI(-6.241~16.076),Z=3.15,P=0.002]。结论左炔诺孕酮宫内节育系统在降低AM患者的痛经程度的同时,还可以减少月经量、子宫内膜厚度和子宫体积,并且对于子宫内膜厚度和子宫体积的长期改善效果更明显,是一种较好的保守治疗方式。
Objective To evaluate the efficacy of gestrinone and levonorgestrel intrauterine system in the treatment of adenomyosis (AM). Methods The databases of Library, EMBASE, BMJ, MEDLINE, Wanfang Medical Database, China Biomedical Literature Database and CNKI were retrieved and searched for relevant books and reports from 1998 to 2016 in our library. The levonorgestrel intrauterine function Controlled trials of birth control and gestrinone treatment of AM and retrospectively reviewed the literature in these studies. Two independent literature reviewers were selected to screen the selected study-related literature, to extract data and to evaluate the quality of the included studies. A systematic meta-analysis of the efficacy differences between the two treatment modalities was performed using RevMan 5.0 software. The results of the final inclusion of 7 articles, a total of 554 patients, including observation group 280 cases, control group 274 cases. The designs are randomly grouped, and the process described is also based on a randomized approach, and blind statistics are used, all of which are high quality literature. The results of Meta showed that the degree of dysmenorrhea in the observation group was lower than that in the control group [12-month weighted mean difference (WMD) = 4.36, 95% CI (-7.471 to 15.415), Z = 3.39, P = 0.006] (WMD = 4.35, 95% CI (-7.328-14.715), Z = 3.29, P = 0.010] at 6 months, with a significantly smaller endometrial thickness (12 months WMD = 4.37, 95% CI (-7.332-12.516), Z = 3.03, P = 0.010]. The uterine volume was significantly smaller (WMD = 4.35,95% CI: -6.241-16.076 at 12 months, Z = 3.15, P = 0.002). Conclusion Levonorgestrel-induced intrauterine system can reduce the degree of dysmenorrhea in patients with AM while reducing menstrual flow, endometrial thickness and uterine volume, and the long-term improvement effect on endometrial thickness and uterine volume is more obvious. Is a better conservative treatment.