对患有纵隔子宫的育龄期女性进行纵隔切除术。
Septum resection for women of reproductive age with a septate uterus.
作者信息
Rikken Judith Fw, Kowalik Claudia R, Emanuel Mark H, Mol Ben Willem J, Van der Veen Fulco, van Wely Madelon, Goddijn Mariëtte
机构信息
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, PO Box 22700, Amsterdam, Netherlands, 1105 AZ.
Department of Obstetrics & Gynecology, Academic Medical Center, University of Amsterdam, PO Box 22700 1100 DE, Amsterdam, Netherlands, 1105 AZ.
出版信息
Cochrane Database Syst Rev. 2017 Jan 17;1(1):CD008576. doi: 10.1002/14651858.CD008576.pub4.
BACKGROUND
Women with a septate uterus are at increased risk for subfertility, recurrent miscarriage, and preterm birth. Restoration of the anatomy of the uterus by hysteroscopic septum resection is an established intervention. This treatment has been assessed mainly in retrospective cohort studies, which suggested a positive effect on pregnancy outcomes. The major flaw in these studies is the before/after design, which will always favour the tested intervention.
OBJECTIVES
To determine whether hysteroscopic septum resection in women of reproductive age with a septate uterus improves live birth rates and to assess the safety of this procedure.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility Group Specialised Register (inception to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL CRSO) (inception to May 2016), MEDLINE (1946 to May 2016), Embase (1974 to May 2016), PsycINFO (1806 to May 2016), and CINAHL database (1982 to May 2016). We also searched trial registers for ongoing and registered trials, reference lists, the Cochrane Library, unpublished dissertations and theses, conference abstracts, OpenGrey, LILACS, PubMed, and Google.
SELECTION CRITERIA
We planned to include randomised controlled trials that assessed the effect on reproductive outcomes and the safety of hysteroscopic septum resection in women of reproductive age with a septate uterus.
DATA COLLECTION AND ANALYSIS
If there had been studies to include, two review authors would have independently selected studies, assessed trial risk of bias, and extracted data. They would also have contacted study authors for additional information.
MAIN RESULTS
As in the 2011 version of this review, we identified no randomised controlled trials for inclusion in this update.
AUTHORS' CONCLUSIONS: Hysteroscopic septum resection in women of reproductive age with a septate uterus is performed worldwide to improve reproductive outcomes. At present, there is no evidence to support the surgical procedure in these women. Randomised controlled trials are urgently needed. Two trials are currently underway.
背景
纵隔子宫女性的生育力低下、复发性流产及早产风险增加。宫腔镜纵隔切除术恢复子宫解剖结构是一种既定的干预措施。该治疗主要在回顾性队列研究中进行了评估，这些研究提示对妊娠结局有积极影响。这些研究的主要缺陷是前后设计，这总是有利于所测试的干预措施。
目的
确定宫腔镜纵隔切除术对纵隔子宫的育龄女性活产率是否有改善，并评估该手术的安全性。
检索方法
我们检索了Cochrane妇科与生育组专业注册库（建库至2016年5月）、Cochrane对照试验中心注册库（CENTRAL CRSO）（建库至2016年5月）、MEDLINE（1946年至2016年5月）、Embase（1974年至2016年5月）、PsycINFO（1806年至2016年5月）和CINAHL数据库（1982年至2016年5月）。我们还检索了试验注册库以查找正在进行和已注册的试验、参考文献列表、Cochrane图书馆、未发表的学位论文和毕业论文、会议摘要、OpenGrey、LILACS、PubMed及谷歌。
选择标准
我们计划纳入评估宫腔镜纵隔切除术对纵隔子宫的育龄女性生殖结局及安全性影响的随机对照试验。
数据收集与分析
如果有可纳入的研究，两名综述作者将独立选择研究、评估试验偏倚风险并提取数据。他们还会联系研究作者以获取更多信息。
主要结果
与本综述2011年版本一样，我们未识别出可纳入本次更新的随机对照试验。
作者结论
全世界都在对纵隔子宫的育龄女性实施宫腔镜纵隔切除术以改善生殖结局。目前，尚无证据支持对这些女性实施该手术。迫切需要随机对照试验。目前有两项试验正在进行中。
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