腹腔镜术后应用GnRH-a与单纯腹腔镜治疗子宫内膜异位症临床疗效与安全性的Meta分析  

Effectiveness and Safety of Postoperative GnRH-a versus Laparoscopy Alone for Endometriosis: A Meta-Analysis

作　　者：陈建欢[1] 马彩玲[1] 叶远征[1] 王迪[1] 郭春凤[1] 

机构地区：[1]新疆医科大学第一附属医院妇科,乌鲁木齐830054

出　　处：《中国循证医学杂志》2014年第1期52-58,共7页Chinese Journal of Evidence-based Medicine

基　　金：新疆维吾尔自治区自然科学基金面上项目(编号:2011211A070)

摘　　要：目的系统评价腹腔镜术后应用促性腺激素释放激素激动剂(GnRH-a)与单纯腹腔镜比较治疗子宫内膜异位症的疗效和安全性。方法计算机检索h e Cochrane Library(2013年第3期)、PubMed、EMbase、WanFang Data、CNKI和CBM数据库,查找腹腔镜术后应用GnRH-a与单纯腹腔镜治疗子宫内膜异位症的随机对照试验(RCT),检索时限从建库截至2013年2月。由2位研究者按纳入与排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.1.7软件进行Meta分析。结果共纳入15个RCT,1761例患者。Meta分析结果显示:与单纯腹腔镜治疗相比,腹腔镜术后应用GnRH-a在提高症状缓解率[RR=1.24,95%CI(1.16,1.33),P<0.00001]、降低病灶复发率[RR=0.35,95%CI(0.24,0.51),P<0.00001]、降低疼痛复发率[RR=0.70,95%CI(0.53,0.92),P=0.01]和提高自然妊娠率[RR=1.43,95%CI(1.25,1.65),P<0.00001]方面更有优势。结论腹腔镜术后应用GnRH-a能提高患者症状缓解率,降低疼痛与病灶复发率,同时能提高术后自然妊娠率。但受纳入研究的质量限制及发表偏倚的影响,本研究结论尚需更多高质量RCT加以验证。ObjectiveTo systematically review the effectiveness and safety of laparoscopy with postoperative gonadotropin releasing hormone agonist （GnRH-a） versus laparoscopy alone for endometriosis. MethodsRandomized controlled trials （RCTs） on laparoscopy with postopertative GnRH-a versus laparoscopy alone in treatment of endometriosis were retrieved in the following databases： the Cochrane Library （Issue 3, 2013）, PubMed, EMbase, WanFang Data, CNKI, and CBM from inception to February, 2013. According to the inclusion and exclusion criteria, the literature were screened, the data was extracted and the methodological quality of the included studies was also assessed by two reviewers independently. Then, meta-analysis was performed using RevMan 5.1.7 software. ResultsA total of 15 RCTs involving 1 761 patients were included. There were statistically significant differences between the laparoscopy with postoperative GnRH-a group and the laparoscopy alone group in the following 4 aspects： the symptom relief rate （RR=1.24, 95%CI 1.16 to 1.33, P〈0.000 01）, the recurrence of lesion （RR=0.35, 95%CI 0.24 to 0.51, P〈0.000 01）, the recurrence of pain （RR=0.70, 95%CI 0.53 to 0.92, P=0.01）, and the pregnancy rate （RR=1.43, 95%CI 1.25 to 1.65, P〈0.000 01）. ConclusionLaparoscopy postoperative GnRH-a for endometriosis can enhance the symptom relief rate, reduce the recurrence of lesion and the recurrence of pain, and increase the pregnancy rate. But because of the limitation of the quality of the included studies and publication bias, the above conclusion should be verified by conducting more high quality RCTs.

关 键 词：子宫内膜异位症 促性腺激素释放激素激动剂 腹腔镜术 随机对照试验 META分析 系统评价 

分 类 号：R711.71[医药卫生—妇产科学]