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

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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.	关阿娜. 腹腔镜与开腹多发性子宫肌瘤剔除术后肌瘤残留及子宫破裂的对比分析. 中国农村卫生, 2016, (22): 90, 92.
4.	冯艳玲. 用两种手术对无孕产史的子宫肌瘤患者进行治疗的效果对比. 当代医药论丛, 2016, 14(20): 22-23.
5.	刘合芳. 腹腔镜下与开腹子宫肌瘤剔除术术后远期疗效的观察. 现代诊断与治疗, 2016, 27(23): 4520-4521.
6.	刘娜娜. 开腹与腹腔镜子宫肌瘤剥除术对妊娠结局的影响比较. 医药论坛杂志, 2016, 37(6): 103-104.
7.	唐晓霞. 腹腔镜与开腹手术治疗子宫肌瘤对术后妊娠结局的影响. 中外女性健康研究, 2017, (4): 49, 65.
8.	夏爱华. 腹腔镜及经腹子宫肌瘤剔除术术中及术后情况比较分析. 河北医药, 2015, 37(14): 2161-2163.
9.	姚旭阳. 腹腔镜与开腹子宫肌瘤剔除术后肌瘤残留、复发及妊娠结局的比较. 当代医学, 2015, 21(11): 74-75.
10.	宋保志, 刘佳华, 高玉玲, 等. 开腹和腹腔镜下子宫肌瘤剔除术后妊娠结局分析.中国现代手术学杂志, 2015, 19(6): 458-460.
11.	张映平. 腹腔镜与开腹子宫肌瘤剔除术对术后妊娠结局的影响. 深圳中西医结合杂志, 2017, 27(8): 150-151.
12.	徐芳. 腹腔镜与开腹手术治疗子宫肌瘤近期疗效比较. 中华全科医学, 2013, 11(7): 1063-1064.
13.	景明来, 王芬娟, 龚巧. 腹腔镜与开腹子宫肌瘤剔除术的比较.中国微创外科杂志, 2013, 13(4): 333-335.
14.	李斌, 华克勤, 顾超. 腹腔镜下子宫肌瘤切除术的评价.上海医学, 2005, 28(12): 1044-1046.
15.	李晓丽. 不同手术方式子宫肌瘤切除术对妊娠结局的影响研究. 湖南师范大学学报 (医学版), 2016, 13(5): 51-54.
16.	杜君, 熊传旭, 张蒙. 子宫肌瘤两种切除术式对妊娠结局的比较. 武警医学, 2016, 27(8): 764-766, 770.
17.	梁炳宏. 腹腔镜与开腹子宫肌瘤剔除术后的对比分析.中国计划生育和妇产科, 2014, 6(9): 69-71.
18.	王双双, 黄伟娟. 腹腔镜下子宫肌瘤剔除术与经腹子宫肌瘤剔除术比较及对妊娠结局的影响.临床医学, 2016, 36(4): 99-100.
19.	王小榕, 范玲, 谢丹. 腹腔镜与开腹手术治疗子宫肌瘤的效果及妊娠结局比较观察.人民军医, 2016, 59(10): 1024-1025.
20.	王鸣, 林萍, 孟庆勇. 腹腔镜辅助子宫肌瘤剔除术的产科结局.江苏医药, 2009, 35(3): 348-350.
21.	程松. 腹腔镜与开腹手术治疗子宫肌瘤对术后妊娠的影响.临床合理用药杂志, 2017, 10(7B): 136-137.
22.	罗芳, 张丹丹, 高琴, 等. 不同途径下子宫肌瘤剔除术对妊娠的影响研究.中国性科学, 2017, 26(4): 117-119.
23.	翟高科. 腹腔镜子宫肌瘤剔除术与开腹手术治疗子宫肌瘤的对比研究.吉林医学, 2014, 35(31): 6942-6943.
24.	赵艳, 马瑞华. 腹腔镜子宫肌瘤剔除术与开腹手术治疗后肌瘤残留复发及妊娠结局的对比分析.中国实用医药, 2013, 8(1): 43-44.
25.	郭海春, 李建军. 不孕症合并子宫肌瘤患者行肌瘤剔除术后的妊娠率和流产率及影响因素分析.医学临床研究, 2008, 25(6): 1120-1122.
26.	陈咏梅. 腹腔镜子宫肌瘤剔除术与开腹手术治疗后肌瘤残留、复发及妊娠结局的对比研究.中国现代药物应用, 2015, 9(2): 50-51.
27.	陈敏红, 金芙蓉. 腹腔镜子宫肌瘤剔除术治疗子宫肌瘤效果观察.浙江创伤外科, 2015, 20(2): 235-237.
28.	高青, 陈哲, 梁梅英. 开腹和腹腔镜下子宫肌瘤切除术后患者妊娠结局临床分析.中国妇产科临床杂志, 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. 关阿娜. 腹腔镜与开腹多发性子宫肌瘤剔除术后肌瘤残留及子宫破裂的对比分析. 中国农村卫生, 2016, (22): 90, 92.
4. 冯艳玲. 用两种手术对无孕产史的子宫肌瘤患者进行治疗的效果对比. 当代医药论丛, 2016, 14(20): 22-23.
5. 刘合芳. 腹腔镜下与开腹子宫肌瘤剔除术术后远期疗效的观察. 现代诊断与治疗, 2016, 27(23): 4520-4521.
6. 刘娜娜. 开腹与腹腔镜子宫肌瘤剥除术对妊娠结局的影响比较. 医药论坛杂志, 2016, 37(6): 103-104.
7. 唐晓霞. 腹腔镜与开腹手术治疗子宫肌瘤对术后妊娠结局的影响. 中外女性健康研究, 2017, (4): 49, 65.
8. 夏爱华. 腹腔镜及经腹子宫肌瘤剔除术术中及术后情况比较分析. 河北医药, 2015, 37(14): 2161-2163.
9. 姚旭阳. 腹腔镜与开腹子宫肌瘤剔除术后肌瘤残留、复发及妊娠结局的比较. 当代医学, 2015, 21(11): 74-75.
10. 宋保志, 刘佳华, 高玉玲, 等. 开腹和腹腔镜下子宫肌瘤剔除术后妊娠结局分析.中国现代手术学杂志, 2015, 19(6): 458-460.
11. 张映平. 腹腔镜与开腹子宫肌瘤剔除术对术后妊娠结局的影响. 深圳中西医结合杂志, 2017, 27(8): 150-151.
12. 徐芳. 腹腔镜与开腹手术治疗子宫肌瘤近期疗效比较. 中华全科医学, 2013, 11(7): 1063-1064.
13. 景明来, 王芬娟, 龚巧. 腹腔镜与开腹子宫肌瘤剔除术的比较.中国微创外科杂志, 2013, 13(4): 333-335.
14. 李斌, 华克勤, 顾超. 腹腔镜下子宫肌瘤切除术的评价.上海医学, 2005, 28(12): 1044-1046.
15. 李晓丽. 不同手术方式子宫肌瘤切除术对妊娠结局的影响研究. 湖南师范大学学报 (医学版), 2016, 13(5): 51-54.
16. 杜君, 熊传旭, 张蒙. 子宫肌瘤两种切除术式对妊娠结局的比较. 武警医学, 2016, 27(8): 764-766, 770.
17. 梁炳宏. 腹腔镜与开腹子宫肌瘤剔除术后的对比分析.中国计划生育和妇产科, 2014, 6(9): 69-71.
18. 王双双, 黄伟娟. 腹腔镜下子宫肌瘤剔除术与经腹子宫肌瘤剔除术比较及对妊娠结局的影响.临床医学, 2016, 36(4): 99-100.
19. 王小榕, 范玲, 谢丹. 腹腔镜与开腹手术治疗子宫肌瘤的效果及妊娠结局比较观察.人民军医, 2016, 59(10): 1024-1025.
20. 王鸣, 林萍, 孟庆勇. 腹腔镜辅助子宫肌瘤剔除术的产科结局.江苏医药, 2009, 35(3): 348-350.
21. 程松. 腹腔镜与开腹手术治疗子宫肌瘤对术后妊娠的影响.临床合理用药杂志, 2017, 10(7B): 136-137.
22. 罗芳, 张丹丹, 高琴, 等. 不同途径下子宫肌瘤剔除术对妊娠的影响研究.中国性科学, 2017, 26(4): 117-119.
23. 翟高科. 腹腔镜子宫肌瘤剔除术与开腹手术治疗子宫肌瘤的对比研究.吉林医学, 2014, 35(31): 6942-6943.
24. 赵艳, 马瑞华. 腹腔镜子宫肌瘤剔除术与开腹手术治疗后肌瘤残留复发及妊娠结局的对比分析.中国实用医药, 2013, 8(1): 43-44.
25. 郭海春, 李建军. 不孕症合并子宫肌瘤患者行肌瘤剔除术后的妊娠率和流产率及影响因素分析.医学临床研究, 2008, 25(6): 1120-1122.
26. 陈咏梅. 腹腔镜子宫肌瘤剔除术与开腹手术治疗后肌瘤残留、复发及妊娠结局的对比研究.中国现代药物应用, 2015, 9(2): 50-51.
27. 陈敏红, 金芙蓉. 腹腔镜子宫肌瘤剔除术治疗子宫肌瘤效果观察.浙江创伤外科, 2015, 20(2): 235-237.
28. 高青, 陈哲, 梁梅英. 开腹和腹腔镜下子宫肌瘤切除术后患者妊娠结局临床分析.中国妇产科临床杂志, 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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