保留性手术与子宫切除术治疗胎盘植入谱系疾病的比较：一项系统评价与荟萃分析。
完整摘要 · 中文译文
目的：在胎盘植入谱系疾病中，子宫切除与重建可能是子宫切除术的一种替代方案。我们旨在综述这些技术之间的手术结局和母体结局是否具有可比性。 方法：检索Medline、Embase和Cochrane Library数据库，截至2025年1月1日。我们纳入比较保守手术（涉及不取出胎盘的子宫肌层切除与重建）与子宫切除术治疗胎盘粘连、植入或穿透患者的随机对照试验（RCT）和非随机研究（NRSI）。两名作者负责独立筛选标题和摘要，以及所有已识别记录的全文。我们使用ROB-2或ROBINS-I评估偏倚风险，并使用GRADE评估证据质量。主要分析仅纳入不存在高偏倚风险的研究。另与结果一同报告了一项次要的非劣效性贝叶斯分析。 结果：我们纳入1项RCT和11项非随机研究（1586名女性）。大多数女性为FIGO PAS 2级和3a级，并累及子宫上段。与子宫切除术相比，保守手术可能导致相似的输注红细胞袋数（MD -0.70 packs，95% CI -1.28 to -0.12；1项RCT和4项NRSI，649名女性；I2= 0%；低确定性证据），且膀胱损伤风险相似（RR 0.36，95% CI 0.12 to 1.07；1项RCT和4项NRSI，649名女性；I2= 0%；低确定性证据）。排除罕见结局后，保守手术不劣于子宫切除术的概率大于90.0%。 结论：基于低质量证据，与子宫切除术相比，保守性手术可能不会增加临床重要损害的风险，且具有保留子宫的获益。需要进一步开展随机对照试验（RCTs）才能得出明确结论。
完整摘要 · 英文原文
OBJECTIVE: Resection and reconstruction of the uterus may be an alternative to hysterectomy in placenta accreta spectrum disorders. We aimed to review whether surgical and maternal outcomes were comparable between these techniques. METHODS: Medline, Embase, and the Cochrane Library databases were searched until 1 January 2025. We included randomized controlled trials (RCT) and nonrandomized studies (NRSI) comparing conservative surgery, involving resection and reconstruction of the myometrium without placental removal, to hysterectomy in patients with placenta accreta, increta, or percreta. Two authors were responsible for independently screening the title and abstract, and the full texts of all identified records. We assessed the risk of bias with ROB-2 or ROBINS-I, and the quality of evidence with GRADE. The main analysis only included studies without a high risk of bias. A secondary non-inferiority Bayesian analysis was reported alongside the results. RESULTS: We included one RCT and eleven nonrandomized studies (1586 women). Most women had FIGO PAS Grade 2 and 3a and with upper uterine segment involvement. Compared to hysterectomy, conservative surgery may result in a similar number of transfused packs of red blood cells (MD -0.70 packs, 95% CI -1.28 to -0.12; 1 RCT and 4 NRSI, 649 women; I2= 0%; low-certainty evidence), and a similar risk of bladder injury (RR 0.36, 95% CI 0.12 to 1.07; 1 RCT and 4 NRSI, 649 women; I2= 0%; low-certainty evidence). Excluding rare outcomes, the probability that conservative surgery is non-inferior to hysterectomy was greater than 90.0%. CONCLUSION: On the basis of low evidence, conservative surgery may not increase the risk of clinically important harm compared to hysterectomy, with the benefit of uterus preservation. Further RCTs are needed to reach definitive conclusions.