| Objective:Using systematic review and meta-analysis to evaluate the clinical efficacy of traditional Chinese medicine(TCM)in the treatment of postoperative patients with ovarian endometriosis cyst(OEC),and analyze the drug characteristics,so as to provide a real and reliable evidence-based medical basis.Method:According to the purpose of the research,the key words were defined and the retrieval type were constructed.Search the relevant literature in CNKI,Wanfang database,VIP database,CBM,PubMed,Cochrane Library,EMBASE and Web of Science from the establishment of the database to December 31,2021.All literatures were screened according to the inclusion and exclusion criteria,and then the included literature data were extracted.The bias risk assessment tool of Cochrane Collaboration Network was used to assess the bias risk of the literature.The outcome indicators including clinical comprehensive efficacy related indicators,recurrence outcome indicators,safety indicators,ovarian function related indicators,pain assessment indicators and pregnancy outcome indicators were meta analyzed.The results of meta-analysis were tested for heterogeneity,sensitivity analysis,subgroup analysis and publication bias assessment,and the forest map and funnel map were drawn.Relevant prescriptions and drug information were extracted from the included literature,entered into excel 2019,and a database was established to make statistics on drug category,drug use frequency and property flavors attributive channel.Results:1.A total of 601 articles were retrieved for this study,and 18 articles were finally inciuded after screening,for a total sample size of 1540 patients,769 patients in the experimental group,and 771 patients in the control group.2.Meta-analysis results:(1)clinical comprehensive efficacy:① TCM oral alone vs Western medicine:RR=1.19,95%CI(0.94,1.51),Z=1.46(P=0.15>0.05);TCM combined with western medicine vs Western medicine:RR=1.17,95%CI(1.11,1.24),Z=5.68(P<0.00001).(2)Recurrence rate:① recurrence rate within half a year after operation:TCM oral alone vs Western medicine:RR=0.67,95%CI(0.12,3.71),Z=0.46(P=0.64>0.05);TCM combined with western medicine vs Western medicine:RR=0.39,95%CI(0.23,0.67),Z=3.38(P=0.0007<0.05).②The recurrence rate within one year after operation:TCM oral alone vs Western medicine:RR=0.26,95%CI(0.10,0.66),Z=2.83(P=0.005<0.05);TCM combined with western medicine vs Western medicine:RR=0.26,95%CI(0.12,0.54),Z=3.59(P=0.0003<0.05).(3)Incidence of adverse effects:TCM oral alone vs Western medicine alone:RR=0.06,95%CI(0.01,0.32),Z=3.33(P=0.0009<0.05);TCM combined with western medicine:RR=0.40,95%CI(0.25,0.64),Z=3.82(P=0.0001<0.05).(4)Related indicators of ovarian function ① AMH:TCM combined with western medicine:MD=1.01,95%CI(0.64,1.37),Z=5.44(P<0.00001).②AFC:TCM combined with western medicine:MD=1.89,95%CI(1.54,2.23),Z=10.70(P<0.00001).③(FSH,LH):TCM combined with western medicine vs Western medicine:[FSH:MD=-1.60,95%CI(2.46,-0.74),Z=3.64(P=0.0003<0.05)];[LH:MD=-0.87,95%CI(-1.27,-0.47),Z=4.26(P<0.0001)].(5)VAS score:TCM oral alone vs Western medicine:MD=-0.17,95%CI(-0.66,0.32),Z=0.69(P=0.49>0.05);TCM combined with western medicine vs Western medicine:MD=-1.03,95%CI(-1.08,-0.99),Z=47.01(P<0.00001).(6)CA125 levels:TCM oral alone vs Western medicine:MD=-8.06,95%CI(-24.31,8.20),Z=0.97(P=0.33>0.05);TCM combined with western medicine vs Western medicine:MD=-4.04,95%CI(-6.12,-1.97),Z=3.81(P=0.0001<0.05).(7)Pregnancy rate:TCM oral alone vs Western medicine:RR=2.44,95%CI(1.33,4.45),Z=2.89(P=0.004<0.05);TCM combined with western medicine vs Western medicine:RR=6.33,95%CI(1.16,34.58),Z=2.13(P=0.03<0.05).3.A total of 18 prescriptions were included,involving 87 drugs,which were divided into 15 categories according to efficacy,with a total frequency of 194 times.The top three drugs used frequently are drugs for promoting blood circulation and removing blood stasis,drugs for tonifying deficiency and drugs for soothing liver and regulating qi.The top three drug frequency were warm,cold and peaceful.The top three of the drug flavor frequency were bitter,acrid and sweet.The first four frequencies of meridian tropisms were liver,heart,spleen and kidney.Conclusion:1.TCM combined with western medicine may be superior to western medicine alone in improving the clinical comprehensive efficacy,reducing the recurrence rate,CA125 levels and incidence of adverse effects,improving ovarian function,alleviating postoperative pain,and increasing pregnancy rate in patients with OEC post operation.2.TCM oral alone may be superior to western medicine in reducing the one-year recurrence rate and the incidence of adverse reactions and improving the pregnancy rate in patients after OEC surgery,but it is not superior in terms of total clinical response rate,CA125 level,half year recurrence rate after surgery,and pain symptoms compared with western medicine treatment.3.The postoperative treatment of TCM follows the guiding ideology of "prevention of disease" and "holistic view",strengthening health and eliminating evil at the same time.The drugs used are mainly for promoting blood circulation and removing blood stasis,tonifying deficiency,and soothing liver and regulating Qi. |
