Efficacy and Safety of Focused Ultrasound for Cervical Ectopy: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 TANGXue-li ¹ , GAOZhan ² ,  LIYou-ping ¹ , YUJia-jie ¹ , LIXiang-lian ¹

1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
2. 404 Hospital of Mianyang, Mianyang 621000, China;

Corresponding author：

LIYou-ping, Email: yzmylab@hotmail.com

Keywords：

Cervical ectopy; Focused ultrasound; Microwave; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150072

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To assess the efficacy and safety of focused ultrasound (FU) and microwave therapy (MW) for cervical ectopy (CE). Methods We searched the following databases:PubMed, EMbase, The Cochrane Library, CBM, VIP, CNKI and WanFang Data from inception to 30th August 2014. Two reviewers (Tang XL and Gao Z) independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.2.0 software. Results A total of 33 randomized controlled trials (RCTs) involving 1 759 patients were included. All the included studies were considered to be at high risk of bias. The results of meta-analysis showed that:compared with MW, FU could significantly reduce the risk of vaginal bleeding (RR=0.09, 95%CI 0.05 to 0.17, P<0.000 01) and vaginal discharge (RR=0.10, 95%CI 0.04 to 0.24, P<0.000 01), increase cure rate (RR=1.10, 95%CI 1.05 to 1.15, P<0.000 1) and total effective rate (RR=1.04, 95%CI 1.02 to 1.06, P=0.000 5). However, there was no difference in decreasing recurrence rate (RR=0.13, 95%CI 0.02 to 1.00, P=0.05). Conclusion Current available evidence suggest that FU is safer and more effective than MW for treating CE. Due to the limitation of quality of included studies, more high quality RCTs are needed to verify the above conclusion.

Citation： TANGXue-li, GAOZhan, LIYou-ping, YUJia-jie, LIXiang-lian. Efficacy and Safety of Focused Ultrasound for Cervical Ectopy: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(4): 425-438. doi: 10.7507/1672-2531.20150072 Copy

1.	World Health Organization (WHO). Global strategy for the prevention and control of sexually transmitted infections:2006-2015:breaking the chain of transmission. 2007. Available at:http://www.who.int/publications/list/9789241563475/zh/.
2.	Ministry of Foreign Affairs of the People's Republic of China United Nations System in China. China's Progress Towards The Millennium Development Goals 2013 Report. 2013. Available at:http://www.cn.undp.org/content/china/zh/home/library/mdg/mdgs-report-2013/.
3.	中华人民共和国国家卫生和计划生育委员会. 2013中国卫生统计年鉴. 2014. Available at:http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2013/index2013.html.
4.	WHO. Comprehensive cervical cancer control:a guide to essential practice. 2006. Available at:http://apps.who.int/iris/handle/10665/43469.
5.	Lee V, Tobin JM, Foley E. Relationship of cervical ectopy to chlamydia infection in young women. J Fam Plann Reprod Health Care, 2006; 32(2):104-106.
6.	Clemetson DB, Moss GB, Willerford DM, et al. Detection of HIV DNA in Cervical and Vaginal Secretions:Prevalence and Correlates Among Women in Nairobi, Kenya. J Am Med Assoc, 1993, 269(22):2860-2864.
7.	Plourde PJ, Pepin J, Agoki E, et al. Human immunodeficiency virus type1 seroconversion in women with genital ulcers. J Infect Dis, 1994, 170(2):313-317.
8.	Tanton C, Weiss HA, Le Goff J, et al. Correlates of HIV-1 genital shedding in Tanzanian women. PLoS ONE, 2011, 6(3):e17480.
9.	Rocha-Zavaleta L, Yescas G, Cruz RM, et al. Human papillomavirus infection and cervical ectopy. Int J Gynaecol Obstet, 2004, 85(3):259-266.
10.	Monroy OL, Aguilar C, Lizano M, et al. Prevalence of human papillomavirus genotypes, and mucosal IgA anti-viral responses in women with cervical ectopy. J Clin Virol, 2010, 47(1):43-48.
11.	Li CD, Wu MH, Wang JD, et al. A population-based study on the risks of cervical lesion and human papillomavirus infection among women in Beijing, People's Republic of China. Cancer Epidemiol Biomarkers Prev, 2010, 19(10):2655-2664.
12.	Dowe G, Smikle M, King SD, et al. High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica:implications for control strategies. Sex Transm Infect, 1999, 75(6):412-416.
13.	李晓艳, 李学军, 胡义芹, 等. 聚焦超声治疗宫颈炎的临床分析. 现代中西医结合杂志, 2009, 18(35):4365-4366.
14.	Yang K, Li J, Liu Y, et al. Microwave therapy for cervical ectropion(Review). Cochrane Database Syst Rev, 2007, 17(4):CD006227.
15.	饶赟, 胡樱, 陈雪花. 聚焦超声在治疗慢性子宫颈炎中的价值. 临床超声医学杂志, 2008, 10(6):391-394.
16.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0.[updated March 2011]. Available at:http://www.handbook.cochrane.org/.
17.	何佳, 李海燕. 聚焦超声治疗慢性宫颈炎500例临床分析. 中华妇幼临床医学杂志, 2005, 1(2):113-114.
18.	毛静月, 刘蕊, 余秀华, 等. 高频聚焦超声与微波治疗宫颈糜烂的临床研究. 中国基层医药, 2006, 13(7):1125-1126.
19.	张爱香. 聚焦超声与微波治疗宫颈糜烂疗效的比较. 解放军护理杂志, 2007, 24(8A):21-22.
20.	穆玉梅, 阿孜古丽. 聚焦超声治疗慢性宫颈炎的临床研究. 中国社区医师, 2007, 9(17):74.
21.	蓝雪琴, 胡肖玲, 黄巧萍. 聚焦超声治疗慢性宫颈炎866例临床分析. 微创医学, 2007, 2(5):467-468.
22.	林庭佳. 聚焦超声治疗慢性宫颈炎的临床分析. 现代医院, 2008, 8(6):39-40.
23.	龚世雄, 李力, 许秀萍, 等. 微波与高强度聚焦超声治疗宫颈糜烂的对照研究. 临床超声医学杂志, 2009, 11(1):62-63.
24.	张军莲, 杜玉琴. 超声聚焦治疗慢性宫颈炎1128例的临床体会. 中国当代医药, 2009, 16(15):87-88.
25.	李虹, 聂敦利, 隆玉华. 聚焦超声治疗慢性宫颈糜烂550例临床分析. 中国妇幼保健, 2009, 24(17):2435-2436.
26.	赵璐. 聚焦超声波治疗慢性宫颈炎260例报告. 山东医药, 2009, 49(51):30.
27.	姬红. 聚焦超声与微波治疗慢性子宫颈炎的对比研究. 中国煤炭工业医学杂志, 2010, 13(7):983-984.
28.	易春辉. 超声治疗宫颈炎100例临床分析. 中国现代药物应用, 2010, 4(13):33-33.
29.	陈粉合. 聚焦超声术与微波在宫颈糜烂治疗中的效果对比. 医药论坛杂志, 2010, 31(12):107-108.
30.	雷晓凤, 吴岚慧. 聚焦超声与微波治疗宫颈糜烂的疗效比较. 中国社区医师, 2010, 12(22):115-115.
31.	李艳红, 王云清. 聚焦超声治疗宫颈炎临床分析. 中国误诊学杂志, 2010, 10(34):8357.
32.	陈汉君. 微波与超声聚焦治疗慢性宫颈炎的效果观察. 中国康复, 2010, 25(4):261.
33.	胡锦霞. 聚焦超声治疗宫颈炎62例临床观察. 亚太传统医药, 2010, 6(12):135-136.
34.	杨辅琼. 超声聚焦治疗与微波治疗宫颈糜烂疗效比较分析. 中国民族民间医药, 2010, (8):81.
35.	陈润玲. 聚焦超声术与微波在宫颈糜烂治疗中的效果比较. 中外医疗, 2011, 30(29):41.
36.	要静. 聚焦超声治疗慢性宫颈炎302例疗效观察. 实用临床医学, 2011, 12(7):64-65.
37.	朱驰玉. 微波治疗31例慢性宫颈炎临床体会. 中国当代医药, 2011, 18(18):34-35.
38.	宁杨. 三种不同方法治疗宫颈糜烂的临床效果. 临床医学, 2011, 31(8):27-29.
39.	李蕾. 聚焦超声治疗慢性宫颈炎的临床观察. 中国实用医刊, 2012, 39(17):46-49.
40.	徐红霞. 微波治疗慢性宫颈炎的疗效观察. 临床合理用药杂志, 2012, 5(2c):115-116.
41.	朱弘宇, 赵旻. 聚焦超声治疗慢性宫颈炎的临床疗效分析. 数理医药学杂志, 2013, 26(2):148-150.
42.	安芳, 齐素云, 张帅. 海扶刀治疗宫颈糜烂疗效观察. 中国社区医师, 2013, 15(9):128.
43.	陈霞. 聚焦超声治疗慢性宫颈炎的临床疗效研究. 中国医药指南, 2013, 11(21):202-203.
44.	冯丽. 聚焦超声治疗慢性宫颈炎的疗效及临床观察. 维吾尔医药, 2013, (3):98.
45.	黄美晨. 聚焦超声治疗慢性宫颈炎的疗效及临床观察. 中国保健营养, 2013, (8):2155-2156.
46.	刘丙莲, 杨华英, 游社香, 等. 聚焦超声治疗慢性宫颈炎的疗效. 实用临床医学 (江西), 2013, 14(7):78-79.
47.	陆仪. 聚焦超声治疗慢性宫颈炎86例临床观察. 大家健康, 2011, (8):141-142.
48.	贺国丽,王世阆. 关于"宫颈糜烂"的认识进展. 现代妇产科进展, 2011, 20(5):407-408.
49.	Myer L, Wright TC Jr, Denny L, et al. Nested Case-Control Study of Cervical Mucosal Lesions, Ectopy, and Incident HIV Infection Among Women in Cape Town, South Africa. Sex Transm Dis, 2006, 33(11):683-687.
50.	陈文直, 王智彪, 伍烽. 单纯高强度聚焦超声治疗恶性实体肿瘤. 中华肿瘤杂志, 2002, 24(3):278-281.
51.	段洁, 李红英, 熊俊, 阳艳, 吴绪峰, 肖冬会. 微波与聚焦超声治疗CINI的临床疗效对比分析. 公共卫生与预防医学, 2010, 21(6):124-125.
52.	袁小芳, 张小芬. 聚焦超声与微波治疗尖锐湿疣的临床体会. 实用临床医学, 2009, 10(3):79-79.
53.	张胜莲, 蒋芝蓉. 聚焦超声治疗外阴上皮内非瘤变效果及临床意义的探讨. 中国计划生育和妇产科, 2014, 6(2):50-52.
54.	李成志, 王智彪, 陈文直. 聚焦超声治疗外阴白色病变的研究. 中华妇产科杂志, 2004, 39(6):373-377.
55.	林川, 杨君, 李成志, 等. 聚焦超声治疗低级别宫颈上皮内瘤样病变. 中国介入影像与治疗学, 2012, 9(12):873-876.

1. World Health Organization (WHO). Global strategy for the prevention and control of sexually transmitted infections:2006-2015:breaking the chain of transmission. 2007. Available at:http://www.who.int/publications/list/9789241563475/zh/.
2. Ministry of Foreign Affairs of the People's Republic of China United Nations System in China. China's Progress Towards The Millennium Development Goals 2013 Report. 2013. Available at:http://www.cn.undp.org/content/china/zh/home/library/mdg/mdgs-report-2013/.
3. 中华人民共和国国家卫生和计划生育委员会. 2013中国卫生统计年鉴. 2014. Available at:http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2013/index2013.html.
4. WHO. Comprehensive cervical cancer control:a guide to essential practice. 2006. Available at:http://apps.who.int/iris/handle/10665/43469.
5. Lee V, Tobin JM, Foley E. Relationship of cervical ectopy to chlamydia infection in young women. J Fam Plann Reprod Health Care, 2006; 32(2):104-106.
6. Clemetson DB, Moss GB, Willerford DM, et al. Detection of HIV DNA in Cervical and Vaginal Secretions:Prevalence and Correlates Among Women in Nairobi, Kenya. J Am Med Assoc, 1993, 269(22):2860-2864.
7. Plourde PJ, Pepin J, Agoki E, et al. Human immunodeficiency virus type1 seroconversion in women with genital ulcers. J Infect Dis, 1994, 170(2):313-317.
8. Tanton C, Weiss HA, Le Goff J, et al. Correlates of HIV-1 genital shedding in Tanzanian women. PLoS ONE, 2011, 6(3):e17480.
9. Rocha-Zavaleta L, Yescas G, Cruz RM, et al. Human papillomavirus infection and cervical ectopy. Int J Gynaecol Obstet, 2004, 85(3):259-266.
10. Monroy OL, Aguilar C, Lizano M, et al. Prevalence of human papillomavirus genotypes, and mucosal IgA anti-viral responses in women with cervical ectopy. J Clin Virol, 2010, 47(1):43-48.
11. Li CD, Wu MH, Wang JD, et al. A population-based study on the risks of cervical lesion and human papillomavirus infection among women in Beijing, People's Republic of China. Cancer Epidemiol Biomarkers Prev, 2010, 19(10):2655-2664.
12. Dowe G, Smikle M, King SD, et al. High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica:implications for control strategies. Sex Transm Infect, 1999, 75(6):412-416.
13. 李晓艳, 李学军, 胡义芹, 等. 聚焦超声治疗宫颈炎的临床分析. 现代中西医结合杂志, 2009, 18(35):4365-4366.
14. Yang K, Li J, Liu Y, et al. Microwave therapy for cervical ectropion(Review). Cochrane Database Syst Rev, 2007, 17(4):CD006227.
15. 饶赟, 胡樱, 陈雪花. 聚焦超声在治疗慢性子宫颈炎中的价值. 临床超声医学杂志, 2008, 10(6):391-394.
16. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0.[updated March 2011]. Available at:http://www.handbook.cochrane.org/.
17. 何佳, 李海燕. 聚焦超声治疗慢性宫颈炎500例临床分析. 中华妇幼临床医学杂志, 2005, 1(2):113-114.
18. 毛静月, 刘蕊, 余秀华, 等. 高频聚焦超声与微波治疗宫颈糜烂的临床研究. 中国基层医药, 2006, 13(7):1125-1126.
19. 张爱香. 聚焦超声与微波治疗宫颈糜烂疗效的比较. 解放军护理杂志, 2007, 24(8A):21-22.
20. 穆玉梅, 阿孜古丽. 聚焦超声治疗慢性宫颈炎的临床研究. 中国社区医师, 2007, 9(17):74.
21. 蓝雪琴, 胡肖玲, 黄巧萍. 聚焦超声治疗慢性宫颈炎866例临床分析. 微创医学, 2007, 2(5):467-468.
22. 林庭佳. 聚焦超声治疗慢性宫颈炎的临床分析. 现代医院, 2008, 8(6):39-40.
23. 龚世雄, 李力, 许秀萍, 等. 微波与高强度聚焦超声治疗宫颈糜烂的对照研究. 临床超声医学杂志, 2009, 11(1):62-63.
24. 张军莲, 杜玉琴. 超声聚焦治疗慢性宫颈炎1128例的临床体会. 中国当代医药, 2009, 16(15):87-88.
25. 李虹, 聂敦利, 隆玉华. 聚焦超声治疗慢性宫颈糜烂550例临床分析. 中国妇幼保健, 2009, 24(17):2435-2436.
26. 赵璐. 聚焦超声波治疗慢性宫颈炎260例报告. 山东医药, 2009, 49(51):30.
27. 姬红. 聚焦超声与微波治疗慢性子宫颈炎的对比研究. 中国煤炭工业医学杂志, 2010, 13(7):983-984.
28. 易春辉. 超声治疗宫颈炎100例临床分析. 中国现代药物应用, 2010, 4(13):33-33.
29. 陈粉合. 聚焦超声术与微波在宫颈糜烂治疗中的效果对比. 医药论坛杂志, 2010, 31(12):107-108.
30. 雷晓凤, 吴岚慧. 聚焦超声与微波治疗宫颈糜烂的疗效比较. 中国社区医师, 2010, 12(22):115-115.
31. 李艳红, 王云清. 聚焦超声治疗宫颈炎临床分析. 中国误诊学杂志, 2010, 10(34):8357.
32. 陈汉君. 微波与超声聚焦治疗慢性宫颈炎的效果观察. 中国康复, 2010, 25(4):261.
33. 胡锦霞. 聚焦超声治疗宫颈炎62例临床观察. 亚太传统医药, 2010, 6(12):135-136.
34. 杨辅琼. 超声聚焦治疗与微波治疗宫颈糜烂疗效比较分析. 中国民族民间医药, 2010, (8):81.
35. 陈润玲. 聚焦超声术与微波在宫颈糜烂治疗中的效果比较. 中外医疗, 2011, 30(29):41.
36. 要静. 聚焦超声治疗慢性宫颈炎302例疗效观察. 实用临床医学, 2011, 12(7):64-65.
37. 朱驰玉. 微波治疗31例慢性宫颈炎临床体会. 中国当代医药, 2011, 18(18):34-35.
38. 宁杨. 三种不同方法治疗宫颈糜烂的临床效果. 临床医学, 2011, 31(8):27-29.
39. 李蕾. 聚焦超声治疗慢性宫颈炎的临床观察. 中国实用医刊, 2012, 39(17):46-49.
40. 徐红霞. 微波治疗慢性宫颈炎的疗效观察. 临床合理用药杂志, 2012, 5(2c):115-116.
41. 朱弘宇, 赵旻. 聚焦超声治疗慢性宫颈炎的临床疗效分析. 数理医药学杂志, 2013, 26(2):148-150.
42. 安芳, 齐素云, 张帅. 海扶刀治疗宫颈糜烂疗效观察. 中国社区医师, 2013, 15(9):128.
43. 陈霞. 聚焦超声治疗慢性宫颈炎的临床疗效研究. 中国医药指南, 2013, 11(21):202-203.
44. 冯丽. 聚焦超声治疗慢性宫颈炎的疗效及临床观察. 维吾尔医药, 2013, (3):98.
45. 黄美晨. 聚焦超声治疗慢性宫颈炎的疗效及临床观察. 中国保健营养, 2013, (8):2155-2156.
46. 刘丙莲, 杨华英, 游社香, 等. 聚焦超声治疗慢性宫颈炎的疗效. 实用临床医学 (江西), 2013, 14(7):78-79.
47. 陆仪. 聚焦超声治疗慢性宫颈炎86例临床观察. 大家健康, 2011, (8):141-142.
48. 贺国丽,王世阆. 关于"宫颈糜烂"的认识进展. 现代妇产科进展, 2011, 20(5):407-408.
49. Myer L, Wright TC Jr, Denny L, et al. Nested Case-Control Study of Cervical Mucosal Lesions, Ectopy, and Incident HIV Infection Among Women in Cape Town, South Africa. Sex Transm Dis, 2006, 33(11):683-687.
50. 陈文直, 王智彪, 伍烽. 单纯高强度聚焦超声治疗恶性实体肿瘤. 中华肿瘤杂志, 2002, 24(3):278-281.
51. 段洁, 李红英, 熊俊, 阳艳, 吴绪峰, 肖冬会. 微波与聚焦超声治疗CINI的临床疗效对比分析. 公共卫生与预防医学, 2010, 21(6):124-125.
52. 袁小芳, 张小芬. 聚焦超声与微波治疗尖锐湿疣的临床体会. 实用临床医学, 2009, 10(3):79-79.
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Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Focused Ultrasound for Cervical Ectopy: A Meta-analysis

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