CAJ | 학술논문

目的：通过国内外公开发表的轻刮术对反复种植失败临床研究进行的Meta分析，对在体外受精胚胎移植中胚胎种植率、临床妊娠率、流产率、活产率、内膜厚度做出更客观、可信的评价，为临床提供依据。方法全面检索PubMed、EMCC、Cochrane library、生物医学外文全文服务系统、CNKI、维普科技期刊及万方数字知识平台数据库至2013年的所有有关资料，纳入轻刮术组（治疗组）和非轻刮术组（对照组）对胚胎质量好而反复种植失败的随机对照试验（ RCT）的文献5篇及非随机（前瞻性研究）文献3篇，提取数据资料，使用Revman 5．1软件对入选研究结果进行同质性检验和数据合并迸行Meta分析。结果共有8篇文献被纳入本研究，其中英文文献6篇，中文文献2篇，合计共有患者861例。轻刮术组有406人，非轻刮术组有455人。 Meta分析结果显示：与非轻刮术治疗相比，轻刮术能显著提高胚胎种植率（RR＝1．81，95％CI：1．48～2．23，P＜0．00001），亦显著提高了临床妊娠率（RR＝1．81，95％CI：1．49～2．19，P＜0．00001）及活产率（RR＝1．80，95％CI：1．37～2．37，P＜0．00001），但对流产率（RR＝0．84，95％CI：0．49～1．44，P＝0．53＞0．05）无显著影响。关于人绒毛膜促性腺激素（hCG）日子宫内膜厚度纳入了4个研究，其中有3个研究均显示轻刮术组子宫内膜厚度略高于非轻刮术组，差异均无统计学意义（均P＞0．05）。结论反复种植失败的不孕妇女行轻刮术能改善子宫内膜容受性，从而提高胚胎种植率、临床妊娠率以及活产率。该操作在临床上具有可行性。受纳入研究质量限制及可能存在发表偏倚的影响，研究结论尚需更多高质量的随机对照研究加以验证。
목적：통과국내외공개발표적경괄술대반복충식실패림상연구진행적Meta분석，대재체외수정배태이식중배태충식솔、림상임신솔、유산솔、활산솔、내막후도주출경객관、가신적평개，위림상제공의거。방법전면검색PubMed、EMCC、Cochrane library、생물의학외문전문복무계통、CNKI、유보과기기간급만방수자지식평태수거고지2013년적소유유관자료，납입경괄술조（치료조）화비경괄술조（대조조）대배태질량호이반복충식실패적수궤대조시험（ RCT）적문헌5편급비수궤（전첨성연구）문헌3편，제취수거자료，사용Revman 5．1연건대입선연구결과진행동질성검험화수거합병병행Meta분석。결과공유8편문헌피납입본연구，기중영문문헌6편，중문문헌2편，합계공유환자861례。경괄술조유406인，비경괄술조유455인。 Meta분석결과현시：여비경괄술치료상비，경괄술능현저제고배태충식솔（RR＝1．81，95％CI：1．48～2．23，P＜0．00001），역현저제고료림상임신솔（RR＝1．81，95％CI：1．49～2．19，P＜0．00001）급활산솔（RR＝1．80，95％CI：1．37～2．37，P＜0．00001），단대유산솔（RR＝0．84，95％CI：0．49～1．44，P＝0．53＞0．05）무현저영향。관우인융모막촉성선격소（hCG）일자궁내막후도납입료4개연구，기중유3개연구균현시경괄술조자궁내막후도략고우비경괄술조，차이균무통계학의의（균P＞0．05）。결론반복충식실패적불잉부녀행경괄술능개선자궁내막용수성，종이제고배태충식솔、림상임신솔이급활산솔。해조작재림상상구유가행성。수납입연구질량한제급가능존재발표편의적영향，연구결론상수경다고질량적수궤대조연구가이험증。
Objective To conduct Meta-analysis of home and abroad clinical researches on repeated implantation failure after local mild curettage to make objective and reliable evaluation on implantation rate, clinical pregnancy rate, miscarriage rate, live birth rate and endometrial thickness.Methods All of related literatures published before 2013 were searched from PubMed, EMCC, Cochrane library, biomedical foreign full-text service system, CNKI, VIP journals and Wanfang data including local mild curettage ( treatment group) and non-local mild curettage (control group).Data were extracted from five randomized controlled trials ( RCT) and three non-randomized controlled trials with good embryo quality but repeated implantation failure.Revman 5.1 software was used to conduct homogeneity test and data merge for Meta-analysis.Results Totally eight articles were recruited, including six English articles and two Chinese articles with 861 patients.There were 406 patients in treatment group and 455 patients in control group.Meta-analysis showed that local mild curettage could improve embryo implantation rate significantly (RR=1.81, 95%CI:1.48-2.23, P<0.00001).It also improved pregnancy rate (RR=1.81, 95%CI:1.49-2.19,P<0.00001) and live birth rate significantly (RR=1.80,95%CI:1.37-2.37,P<0.0001), but miscarriage rate was not affected obviously (RR =0.84,95%CI:0.49 -1.44,P >0.05).There were 4 studies on the endometrial thickness on the day of human chorionic gonadotropin ( hCG) , including 3 studies showing higher endometrial thickness in the treatment group than in the control group without significant difference (both P>0.05).Conclusion For repeated implantation failure of infertile women, local mild curettage can improve endometrial receptivity and thus improve embryo implantation rate, clinical pregnancy rate and live birth rate.The operation is feasible in clinics.Due to limited quality of studies and possible publication bias, more high-qualified randomized controlled studies are needed to verify the conclusion.