| Objective 1.To evaluate the clinical efficacy and safety of different interventions in the treatment of intrauterine adhesions patients after TCRA by network meta-analysis,providing medical evidence for the clinical treatment.2.The TCM prescriptions of 100 IUA patients after TCRA were retrospectively collected,and the characteristics of He Shi gynecological medicine were summarized,so as to provide reference for TCM treatment after TCRA.Methods 1.Seven online databases including ScienceDirect,PubMed,Cochrane Library,CNKI,Wanfang Database,CMB and VIP Journal were searched from January 1,2011 to December 1,2021.The literature quality was evaluated by Cochrane Handbook.The clinical comprehensive efficacy rate,recurrence rate of intrauterine adhesions,improvement rate of menstruation,pregnancy rate and adverse rate of different interventions were evaluated by a Bayesian network meta-analysis.OR with 95%CI was used to represent the combined results.Stata 16 software was performed for statistical analysis to draw the network map,cumulative probability area map and efficacy ranking map of different interventions.2.A retrospective collection of 100 patients with oral TCM decoction after intrauterine adhesions in the department of TCM of Hangzhou Hospital of Traditional Chinese Medicine was conducted.Through the frequency analysis of TCM prescriptions,the characteristics and experience of He Shi gynecological medication were summarized.Results 1.Network meta-analysis of efficacy and safety of different interventions in the treatment of IUA patients after TCRA.A total of 10,738 patients were enrolled in 135 randomized controlled trials,including 5,406 in the treatment group and 5,332 in the control group,containing 9 treatments:estrogen therapy alone（control group）,amniotic membrane transplantation combined with estrogen,GnRH-a combined with estrogen,aspirin combined with estrogen,dexamethasone combined with estrogen,low molecular weight heparin combined with estrogen,growth hormone combined with estrogen,acupuncture combined with Traditional Chinese medicine combined with estrogen,Traditional Chinese medicine combined with estrogen.The results of network meta-analysis showed that dexamethasone combined with estrogen had the best clinical efficacy,followed by acupuncture combined with estrogen and amniotic membrane transplantation combined with estrogen.In preventing the recurrence of intrauterine adhesions,amniotic membrane transplantation combined with estrogen was the best,followed by Chinese medicine combined with estrogen and GnRH-a combined with estrogen.In improving postoperative menstruation,Chinese medicine combined with estrogen had the best effect,followed by amniotic membrane transplantation combined with estrogen and aspirin+estrogen.In terms of improving postoperative pregnancy rate,TCM combined with estrogen had the best effect,followed by low molecular weight heparin combined with estrogen and acupuncture combined with estrogen.In terms of safety,adverse reactions were reported in 12 literatures,mainly manifested as gastrointestinal reactions,breast tenderness,irregular vaginal bleeding,etc.,and no serious adverse events occurred in any intervention.According to the frequency statistics of TCM prescriptions involved in the included literature,a total of 99 TCM prescriptions were collected,including 139 TCM prescriptions,with a total frequency of 1236 times.Among all the drugs,there were 4 high-frequency drugs,which were Angelica,salvia miltiorrhiza,Dodder and shu Di,with a frequency ratio of 25.18%.There were 35 drugs with medium and high frequency,and the frequency ratio was 75.24%.The main functions are tonifying liver and kidney,promoting blood circulation and removing blood stasis,tonifying blood and nourishing Yin,and the main meridian is liver and kidney meridian.2.Medication characteristics of He Shi gynecological treatment of IUA.A total of 100 patients’ TCM prescriptions were collected,including 183 TCM herbs,with a total frequency of 1769 times.Among all the herbs,the high-frequency drugs were Angelica sinensis,Red vine,salvia miltiorrhiza,radix paeoniae,dandelion and Ligusticum chuanxiong,accounting for 20.12%.Angelica sinensis was the most frequently used drug,82 times,accounting for 4.64%.There were 53 medium and high frequency drugs,accounting for 28.96%of all drugs,and the frequency of use was 1317 times,accounting for 74.45%of the total frequency of use.Therefore,these 53 drugs can be considered as common drugs for the treatment of intrauterine adhesions after operation.From the point of view of efficacy,there are tonifying qi and nourishing blood,tonifying liver and kidney,activating blood to regulate menstruation,activating blood to relieve pain,invigorating spleen and nourishing qi,regulating qi and spleen,dampness and invigorating spleen,nourishing Yin and generating jin,cooling blood and activating blood to remove stasis,clearing heat and detoxifying pus.From the point of view,mainly to the liver,spleen,lung meridian.Conclusion 1.Dexamethasone combined with estrogen has the best efficacy in improving the clinical comprehensive efficacy,followed by acupuncture combined with estrogen and amniotic membrane transplantation combined with estrogen.Since the clinical comprehensive efficacy includes the improvement of menstruation and adhesion recurrence,it is recommended that all IUA patients adopt dexamethasone combined with estrogen after TCRA.2.Amniotic membrane transplantation combined with estrogen has the best efficacy in reducing the recurrence of intrauterine adhesions.It is recommended that patients with a recurrence rate of IUAs should adopt amniotic membrane transplantation combined with estrogen after TCRA.3.TCM combined with estrogen has the best efficacy in improving menstruation and pregnancy rate.It is suggested that IUA patients with menstrual disorders or infertility should adopt TCM combined with estrogen after TCRA.4.The most commonly used drugs for patients with IUA after TCRA are Angelica sinensis,salvia miltiorrhiza,radix paeoniae root,Ligusticum chuanxiong,Shu Di,Dodder,red vine and dandelion.Their functions are mainly to promote blood circulation and remove stasis,nourish liver and kidney,nourish blood and nourish Yin,and mainly belong to liver and kidney. |
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