The perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Weiqing ¹ ,  HU Lina ¹ , XIONG Han ²

1. Department of Obstetrics and Gynecology, The Second Affliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China;
2. Chongqing University, Chongqing, 400044, P.R.China;

Corresponding?author：

HU Lina, Email: cqhulina@126.com

Keywords：

Myomectomy; Pregnancy; Laparoscopy; Laparotomy; Uterine rupture; Randomized controlled trial; Cohort study

DOI：

10.7507/1672-2531.201710049

Video：

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ObjectivesTo systematically review the perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy.MethodsPubMed, Web of Science, Elsevier, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched from inception to July 2017, to collect randomized controlled trials or cohort studies comparing the perinatal outcomes after laparoscopic myomectomy and transabdominal myomectomy. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsEight randomized controlled trials, twenty-one cohort studies involving 4357 patients were included. The results of meta-analysis showed that: the premature birth rate (OR=0.60, 95%CI 0.38 to 0.95, P=0.03) in the laparoscopic myomectomy was lower than that in the laparotomy group. However, the rate of uterine rupture during pregnancy (OR=3.19, 95%CI 1.29 to 7.89, P=0.01) in the laparoscopic myomectomy was higher than that in the laparotomy group. There were no significant differences between two groups in the myoma residual (OR=1.00, 95%CI 0.37 to 2.65, P=0.99), recurrence (OR=0.92, 95%CI 0.68 to 1.25, P=0.60), abortion (OR=0.90, 95%CI 0.63 to 1.28, P=0.56), ectopic pregnancy (OR=1.11, 95%CI 0.54 to 2.26, P=0.78), pregnancy rate (OR=1.06, 95%CI 0.89 to 1.27, P=0.52), cesarean (OR=0.82, 95%CI 0.57 to 1.19, P=0.31), and pregnancy complications (OR=0.84, 95%CI 0.45 to 1.59, P=0.60).ConclusionsCurrent evidence shows that there are no significant differences between two groups in the myoma residual, myoma recurrence, abortion, ectopic pregnancy, pregnancy rate, cesarean and pregnancy complications. While the rate of uterine rupture during pregnancy in the laparoscopic myomectomy is higher than that in the laparotomy group, the premature birth rate after operation in the laparoscopic myomectomy is lower and shorter than that in the laparotomy group. Due to the limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.

Citation： LIU Weiqing, HU Lina, XIONG Han. The perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(8): 831-839. doi: 10.7507/1672-2531.201710049 Copy

1.	Pitter, MC, Srouji SS, Gargiulo AR, et al. Fertility and symptom relief following robot-assisted laparoscopic myomectomy. Obstet Gynecol Int, 2015, 2015: 967568.
2.	Buckley VA, Nesbitt-Hawes EM, Atkinson P, et al. Laparoscopic myomectomy: clinical outcomes and comparative evidence. J Minim Invasive Gynecol, 2015, 22(1): 11-25.
3.	關阿娜. 腹腔鏡與開腹多發性子宮肌瘤剔除術后肌瘤殘留及子宮破裂的對比分析. 中國農村衛生, 2016, (22): 90, 92.
4.	馮艷玲. 用兩種手術對無孕產史的子宮肌瘤患者進行治療的效果對比. 當代醫藥論叢, 2016, 14(20): 22-23.
5.	劉合芳. 腹腔鏡下與開腹子宮肌瘤剔除術術后遠期療效的觀察. 現代診斷與治療, 2016, 27(23): 4520-4521.
6.	劉娜娜. 開腹與腹腔鏡子宮肌瘤剝除術對妊娠結局的影響比較. 醫藥論壇雜志, 2016, 37(6): 103-104.
7.	唐曉霞. 腹腔鏡與開腹手術治療子宮肌瘤對術后妊娠結局的影響. 中外女性健康研究, 2017, (4): 49, 65.
8.	夏愛華. 腹腔鏡及經腹子宮肌瘤剔除術術中及術后情況比較分析. 河北醫藥, 2015, 37(14): 2161-2163.
9.	姚旭陽. 腹腔鏡與開腹子宮肌瘤剔除術后肌瘤殘留、復發及妊娠結局的比較. 當代醫學, 2015, 21(11): 74-75.
10.	宋保志, 劉佳華, 高玉玲, 等. 開腹和腹腔鏡下子宮肌瘤剔除術后妊娠結局分析.中國現代手術學雜志, 2015, 19(6): 458-460.
11.	張映平. 腹腔鏡與開腹子宮肌瘤剔除術對術后妊娠結局的影響. 深圳中西醫結合雜志, 2017, 27(8): 150-151.
12.	徐芳. 腹腔鏡與開腹手術治療子宮肌瘤近期療效比較. 中華全科醫學, 2013, 11(7): 1063-1064.
13.	景明來, 王芬娟, 龔巧. 腹腔鏡與開腹子宮肌瘤剔除術的比較.中國微創外科雜志, 2013, 13(4): 333-335.
14.	李斌, 華克勤, 顧超. 腹腔鏡下子宮肌瘤切除術的評價.上海醫學, 2005, 28(12): 1044-1046.
15.	李曉麗. 不同手術方式子宮肌瘤切除術對妊娠結局的影響研究. 湖南師范大學學報 (醫學版), 2016, 13(5): 51-54.
16.	杜君, 熊傳旭, 張蒙. 子宮肌瘤兩種切除術式對妊娠結局的比較. 武警醫學, 2016, 27(8): 764-766, 770.
17.	梁炳宏. 腹腔鏡與開腹子宮肌瘤剔除術后的對比分析.中國計劃生育和婦產科, 2014, 6(9): 69-71.
18.	王雙雙, 黃偉娟. 腹腔鏡下子宮肌瘤剔除術與經腹子宮肌瘤剔除術比較及對妊娠結局的影響.臨床醫學, 2016, 36(4): 99-100.
19.	王小榕, 范玲, 謝丹. 腹腔鏡與開腹手術治療子宮肌瘤的效果及妊娠結局比較觀察.人民軍醫, 2016, 59(10): 1024-1025.
20.	王鳴, 林萍, 孟慶勇. 腹腔鏡輔助子宮肌瘤剔除術的產科結局.江蘇醫藥, 2009, 35(3): 348-350.
21.	程松. 腹腔鏡與開腹手術治療子宮肌瘤對術后妊娠的影響.臨床合理用藥雜志, 2017, 10(7B): 136-137.
22.	羅芳, 張丹丹, 高琴, 等. 不同途徑下子宮肌瘤剔除術對妊娠的影響研究.中國性科學, 2017, 26(4): 117-119.
23.	翟高科. 腹腔鏡子宮肌瘤剔除術與開腹手術治療子宮肌瘤的對比研究.吉林醫學, 2014, 35(31): 6942-6943.
24.	趙艷, 馬瑞華. 腹腔鏡子宮肌瘤剔除術與開腹手術治療后肌瘤殘留復發及妊娠結局的對比分析.中國實用醫藥, 2013, 8(1): 43-44.
25.	郭海春, 李建軍. 不孕癥合并子宮肌瘤患者行肌瘤剔除術后的妊娠率和流產率及影響因素分析.醫學臨床研究, 2008, 25(6): 1120-1122.
26.	陳詠梅. 腹腔鏡子宮肌瘤剔除術與開腹手術治療后肌瘤殘留、復發及妊娠結局的對比研究.中國現代藥物應用, 2015, 9(2): 50-51.
27.	陳敏紅, 金芙蓉. 腹腔鏡子宮肌瘤剔除術治療子宮肌瘤效果觀察.浙江創傷外科, 2015, 20(2): 235-237.
28.	高青, 陳哲, 梁梅英. 開腹和腹腔鏡下子宮肌瘤切除術后患者妊娠結局臨床分析.中國婦產科臨床雜志, 2015, 16(4): 325-328.
29.	Seracchioli R, Rossi S, Govoni F, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal mypmectomy. Hum Reprod, 2000, 15(12): 2663-2668.
30.	Kim MS, Uhm YK, Kim JY, et al. Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach. Obstet Gynecol Sci, 2013, 56(6): 375-381.
31.	Tian YC, Long TF, Dai YM. Pregnancy outcomes following different surgical approaches of myomectomy. J Obstet Gynaecol Res, 2015, 41(3): 350-357.
32.	Havryliuk Y, Setton R, Carlow JJ, et al. Symptomatic fibroid management: systematic review of the literature. JSLS, 2017, 21(3). SLS, 2017, 21(3): e2017.00041.
33.	Cruikshank DP. The impact of a single- or double-layer closure on uterine rupture. Am J Obstet Gynecol, 2003, 188(1): 295-296; author reply 296.
34.	Kim HS, Oh SY, Choi SJ, et al. Uterine rupture in pregnancies following myomectomy: a multicenter case series. Obstet Gynecol Sci, 2016, 59(6): 454-462.

1. Pitter, MC, Srouji SS, Gargiulo AR, et al. Fertility and symptom relief following robot-assisted laparoscopic myomectomy. Obstet Gynecol Int, 2015, 2015: 967568.
2. Buckley VA, Nesbitt-Hawes EM, Atkinson P, et al. Laparoscopic myomectomy: clinical outcomes and comparative evidence. J Minim Invasive Gynecol, 2015, 22(1): 11-25.
3. 關阿娜. 腹腔鏡與開腹多發性子宮肌瘤剔除術后肌瘤殘留及子宮破裂的對比分析. 中國農村衛生, 2016, (22): 90, 92.
4. 馮艷玲. 用兩種手術對無孕產史的子宮肌瘤患者進行治療的效果對比. 當代醫藥論叢, 2016, 14(20): 22-23.
5. 劉合芳. 腹腔鏡下與開腹子宮肌瘤剔除術術后遠期療效的觀察. 現代診斷與治療, 2016, 27(23): 4520-4521.
6. 劉娜娜. 開腹與腹腔鏡子宮肌瘤剝除術對妊娠結局的影響比較. 醫藥論壇雜志, 2016, 37(6): 103-104.
7. 唐曉霞. 腹腔鏡與開腹手術治療子宮肌瘤對術后妊娠結局的影響. 中外女性健康研究, 2017, (4): 49, 65.
8. 夏愛華. 腹腔鏡及經腹子宮肌瘤剔除術術中及術后情況比較分析. 河北醫藥, 2015, 37(14): 2161-2163.
9. 姚旭陽. 腹腔鏡與開腹子宮肌瘤剔除術后肌瘤殘留、復發及妊娠結局的比較. 當代醫學, 2015, 21(11): 74-75.
10. 宋保志, 劉佳華, 高玉玲, 等. 開腹和腹腔鏡下子宮肌瘤剔除術后妊娠結局分析.中國現代手術學雜志, 2015, 19(6): 458-460.
11. 張映平. 腹腔鏡與開腹子宮肌瘤剔除術對術后妊娠結局的影響. 深圳中西醫結合雜志, 2017, 27(8): 150-151.
12. 徐芳. 腹腔鏡與開腹手術治療子宮肌瘤近期療效比較. 中華全科醫學, 2013, 11(7): 1063-1064.
13. 景明來, 王芬娟, 龔巧. 腹腔鏡與開腹子宮肌瘤剔除術的比較.中國微創外科雜志, 2013, 13(4): 333-335.
14. 李斌, 華克勤, 顧超. 腹腔鏡下子宮肌瘤切除術的評價.上海醫學, 2005, 28(12): 1044-1046.
15. 李曉麗. 不同手術方式子宮肌瘤切除術對妊娠結局的影響研究. 湖南師范大學學報 (醫學版), 2016, 13(5): 51-54.
16. 杜君, 熊傳旭, 張蒙. 子宮肌瘤兩種切除術式對妊娠結局的比較. 武警醫學, 2016, 27(8): 764-766, 770.
17. 梁炳宏. 腹腔鏡與開腹子宮肌瘤剔除術后的對比分析.中國計劃生育和婦產科, 2014, 6(9): 69-71.
18. 王雙雙, 黃偉娟. 腹腔鏡下子宮肌瘤剔除術與經腹子宮肌瘤剔除術比較及對妊娠結局的影響.臨床醫學, 2016, 36(4): 99-100.
19. 王小榕, 范玲, 謝丹. 腹腔鏡與開腹手術治療子宮肌瘤的效果及妊娠結局比較觀察.人民軍醫, 2016, 59(10): 1024-1025.
20. 王鳴, 林萍, 孟慶勇. 腹腔鏡輔助子宮肌瘤剔除術的產科結局.江蘇醫藥, 2009, 35(3): 348-350.
21. 程松. 腹腔鏡與開腹手術治療子宮肌瘤對術后妊娠的影響.臨床合理用藥雜志, 2017, 10(7B): 136-137.
22. 羅芳, 張丹丹, 高琴, 等. 不同途徑下子宮肌瘤剔除術對妊娠的影響研究.中國性科學, 2017, 26(4): 117-119.
23. 翟高科. 腹腔鏡子宮肌瘤剔除術與開腹手術治療子宮肌瘤的對比研究.吉林醫學, 2014, 35(31): 6942-6943.
24. 趙艷, 馬瑞華. 腹腔鏡子宮肌瘤剔除術與開腹手術治療后肌瘤殘留復發及妊娠結局的對比分析.中國實用醫藥, 2013, 8(1): 43-44.
25. 郭海春, 李建軍. 不孕癥合并子宮肌瘤患者行肌瘤剔除術后的妊娠率和流產率及影響因素分析.醫學臨床研究, 2008, 25(6): 1120-1122.
26. 陳詠梅. 腹腔鏡子宮肌瘤剔除術與開腹手術治療后肌瘤殘留、復發及妊娠結局的對比研究.中國現代藥物應用, 2015, 9(2): 50-51.
27. 陳敏紅, 金芙蓉. 腹腔鏡子宮肌瘤剔除術治療子宮肌瘤效果觀察.浙江創傷外科, 2015, 20(2): 235-237.
28. 高青, 陳哲, 梁梅英. 開腹和腹腔鏡下子宮肌瘤切除術后患者妊娠結局臨床分析.中國婦產科臨床雜志, 2015, 16(4): 325-328.
29. Seracchioli R, Rossi S, Govoni F, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal mypmectomy. Hum Reprod, 2000, 15(12): 2663-2668.
30. Kim MS, Uhm YK, Kim JY, et al. Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach. Obstet Gynecol Sci, 2013, 56(6): 375-381.
31. Tian YC, Long TF, Dai YM. Pregnancy outcomes following different surgical approaches of myomectomy. J Obstet Gynaecol Res, 2015, 41(3): 350-357.
32. Havryliuk Y, Setton R, Carlow JJ, et al. Symptomatic fibroid management: systematic review of the literature. JSLS, 2017, 21(3). SLS, 2017, 21(3): e2017.00041.
33. Cruikshank DP. The impact of a single- or double-layer closure on uterine rupture. Am J Obstet Gynecol, 2003, 188(1): 295-296; author reply 296.
34. Kim HS, Oh SY, Choi SJ, et al. Uterine rupture in pregnancies following myomectomy: a multicenter case series. Obstet Gynecol Sci, 2016, 59(6): 454-462.

Chinese Journal of Evidence-Based Medicine

The perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy: a meta-analysis

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