Cesarean scar pregnancy: a systematic review of treatment studies
Cesarean scar pregnancy: a systematic review of treatment studies
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DOI：
10.1016/j.fertnstert.2015.12.130
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发表时间：
2016-04-01
影响因子：
6.7
通讯作者：
Nielsen, Henriette Svarre
中科院分区：
文献类型：
--
作者：
Petersen, Kathrine Birch;Hoffmann, Elise;Nielsen, Henriette Svarre
目的：探讨剖宫产瘢痕妊娠（CSPs）的治疗方法，探讨其疗效和并发症与研究质量的关系。设计：系统回顾。设置：不适用。患者：共2037例CSP患者。干预措施：回顾MEDLINE、EMBASE和Cochrane图书馆，寻找包括5名或更多女性的研究。收集了主要治疗方式/疗效、并发症和未来生育的数据。证据水平根据牛津循证医学中心指南进行分类。使用Cochrane协作组织的随机对照试验偏倚风险工具和改进的德尔菲技术对病例系列进行质量评估。由于治疗方法繁多，无法进行meta分析。主要观察指标：一线治疗成功。并发症有子宫切除、剖腹手术、出血100ml或输血。结果：纳入52项研究：4项随机对照试验和48例病例系列。在被分析的52项研究中，有15项被评为高质量。治疗方式浓缩为14种不同的方法。综合研究质量、证据水平、疗效和安全性，根据可用性、患者症状的严重程度和手术技巧，推荐5种治疗CSP的方法：经阴道[1]切除、[2]腹腔镜、[3]子宫动脉栓塞联合扩张刮除和宫腔镜、[4]子宫动脉栓塞联合扩张刮除和[5]宫腔镜。结论：本综述在疗效和安全性的基础上，为临床实践推荐了CSP的治疗方案。文献支持介入而非医学方法。目前的建议主要基于病例系列。需要多中心、精心设计的研究来得出如何治疗CSP的明确结论。(C) 2016年由美国生殖医学学会发布。
Objective: To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality.Design: Systematic review.Setting: Not applicable.Patient(s): A total of 2,037 women with CSP.Intervention(s): Review of MEDLINE, EMBASE, and Cochrane Library to find studies including five or more women. Data were extracted on primary treatment modality/efficacy, complications, and future fertility. The level of evidence was categorized according to Oxford Centre for Evidence-based Medicine guidelines. Quality was assessed using The Cochrane Collaboration's Risk of Bias Tools for Randomized Controlled Trials and the modified Delphi techniques for case series. Meta-analysis was impossible owing to multifarious treatments.Main Outcome Measure(s): Successful first-line treatment. Complications were hysterectomy, laparotomy, bleeding >1,000 mL, or blood transfusion.Result(s): Fifty-two studies were included: four randomized, controlled trials and 48 case series. Fifteen of the 52 analyzed studies were scored as high quality. Treatment modalities were condensed to 14 different approaches. Combining study quality, level of evidence, efficacy, and safety, five approaches for treating CSP are recommended, depending on availability, severity of patient symptoms, and surgical skills: [1] resection through a transvaginal approach, [2] laparoscopy, [3] uterine artery embolization in combination with dilatation and curettage and hysteroscopy, [4] uterine artery embolization in combination with dilatation and curettage, and [5] hysteroscopy.Conclusion(s): This review recommends treatment options for CSP in clinical practice, based on efficacy and safety. The literature supports an interventional rather than medical approach. Present recommendations are primarily based on case series. Multicenter, well-designed studies are needed to draw definite conclusions on how to treat CSP. (C) 2016 by American Society for Reproductive Medicine.