目的 系統(tǒng)評價保守性手術(shù)圍術(shù)期應(yīng)用亮丙瑞林治療子宮腺肌?。ˋM）的臨床有效性和安全性。方法 檢索Cochrane Library、PubMed、Web of Science、Embase、ClinicalTrials.gov、中國臨床試驗注冊中心（ChiCTR）、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、萬方數(shù)據(jù)庫（Wanfang Data）、維普中文期刊全文數(shù)據(jù)庫（VIP）和中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM），搜集圍術(shù)期應(yīng)用亮丙瑞林治療AM的臨床隨機(jī)對照試驗（RCT），檢索時限為各數(shù)據(jù)庫建庫至2022年1月8日，兩位研究者獨立進(jìn)行文獻(xiàn)篩選、偏倚風(fēng)險評價和資料提取，采用ReviewManager5.4.1軟件進(jìn)行Meta分析。結(jié)果 共納入11項RCTs、包括1088例患者。Meta分析結(jié)果顯示：術(shù)前應(yīng)用亮丙瑞林能夠減輕術(shù)后3個月痛經(jīng)［SMD=-1.61，95%CI（-2.60，-0.63），P=0.001］，減小術(shù)后3個月月經(jīng)量［SMD=-1.02，95%CI（-1.43，-0.60），P＜0.00001］和術(shù)后12個月月經(jīng)量［SMD=-1.07，95%CI（-1.36，-0.79），P＜0.00001］，兩組術(shù)后12個月痛經(jīng)［SMD=-2.88，95%CI（-5.89，0.13），P=0.06］差異無統(tǒng)計學(xué)意義；術(shù)后應(yīng)用亮丙瑞林能夠減輕術(shù)后3個月痛經(jīng)［SMD=-2.94，95%CI（-3.59，-2.29），P＜0.00001］和12個月痛經(jīng)［SMD=-1.53，95%CI（-2.51，-0.55），P＜0.00001］，減小術(shù)后3個月月經(jīng)量［SMD=-0.62，95%CI（-1.06，-0.18），P=0.006］和12個月月經(jīng)量［SMD=-7.93，95%CI（-9.12，-6.74），P＜0.00001］，差異有統(tǒng)計學(xué)意義。結(jié)論 術(shù)前應(yīng)用亮丙瑞林可以提高手術(shù)安全性和有效率、促進(jìn)術(shù)后康復(fù)，術(shù)后短期應(yīng)用亮丙瑞林療效顯著并能夠減少復(fù)發(fā)，術(shù)前或術(shù)后應(yīng)用亮丙瑞林均可能出現(xiàn)藥品不良反應(yīng)，尚需開展更多高質(zhì)量研究予以驗證。

Objective To systematically evaluate the clinical efficacy and safety of perioperative leuprolide application in conservative surgery for adenomyosis (AM).Methods Cochrane Library, PubMed, Web of Science, Embase, ClinicalTrials. gov, ChiCTR, CNKI, WanFang Data, VIP and CBM for related randomized controlled trials (RCTs) published before 8 January 2022 were searched. Two reviewers independently screened literature, assessed the risk of bias, and extracted data of included studies. Then meta-analysis was performed using ReviewManager 5.4.1 software.Results A total of 11 RCTs involving 1 088 patients were included. Compared with simple conservative surgical therapy, preoperative leuprolide application can moderate postoperative dysmenorrhea at 3rd month [SMD = -1.61, 95%CI (-2.60, -0.63), P = 0.001], reduce menstrual flow at 3rd month [SMD = -1.02, 95%CI (-1.43, -0.60), P <0.00001] and at 12th month [SMD = -1.07, 95%CI (-1.36, -0.79), P <0.00001], the difference was statistically significant. There was no significant difference in dysmenorrhea at 12th months [SMD = -2.88, 95%CI (-5.89, 0.13), P = 0.06] between the two groups after surgery; postoperative leuprolide application can moderate postoperative dysmenorrhea at 3rd month [SMD = -2.94, 95%CI (-3.59, -2.29), P <0.00001] and at 12th month [SMD = -1.53, 95%CI (-2.51, -0.55), P<0.00001], reduce menstrual flow at 3rd month [SMD = -0.62, 95%CI (-1.06, -0.18), P = 0.006] and 12th month [SMD = -7.93, 95%CI (- 9.12, - 6.74), P<0.000 01].Conclusions Preoperative leuprolide application safely improve the surgical efficacy and promote rehabilitation, short-term postoperative application of leuprolide has significant efficacy and can reduce recurrence, adverse drug reactions may occur in both protocols. More high-quality studies are required to verify the above conclusions.

R984;R969.3

國家自然科學(xué)基金青年基金資助項目(81403321);江蘇省中醫(yī)藥科技發(fā)展專項(2020ZX14);江蘇省中醫(yī)藥科技發(fā)展計劃項目(YB2020018);南京市玄武區(qū)蘭園社區(qū)服務(wù)中心工作站建設(shè)項目(18-G2S-G22-003)