腹腔镜下卵巢子宫内膜异位症囊肿剥除术不同止血方法对卵巢储备功能影响的系统评价  

Influence of Various Hemostatic Methods on Ovarian Reserve Function in Women with Ovarian Endometriotic Cyst Treated by Laparoscopic Cystectomy:A Systematic Review

作　　者：李婧[1] 吕娟[1] 王宇娟[1] 王赞宏[2] 

机构地区：[1]山西医科大学,太原030001 [2]山西医学科学院/山西大医院妇产科,太原030032

出　　处：《中国循证医学杂志》2015年第7期833-839,共7页Chinese Journal of Evidence-based Medicine

基　　金：山西省科技攻关项目研究基金(编号:2014071011)

摘　　要：目的系统评价腹腔镜手术治疗卵巢子宫内膜异位囊肿时不同止血方式对卵巢储备功能的影响。方法计算机检索The Cochrane Library、Pub Med、EMbase、CNKI、CBM和Wan Fang Data数据库,搜集腹腔镜下卵巢子宫内膜异位囊肿剥除术不同止血方式对卵巢储备功能影响的相关随机对照试验(RCT),检索时限均为1990年至2014年3月。同时,追溯纳入文献的参考文献,以补充获取相关文献。由2位研究者根据纳入与排除标准筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入16个研究,共1236例患者。Meta分析结果显示:除术后1个月、2个月、6个月和12个月的黄体生成素(LH)水平和术后2个月和6个月的雌二醇(E2)水平差异无统计学意义,以及术后12个月缝合组E2水平明显低于电凝组外,其余各随访时点缝合组的卵泡刺激素(FSH)、LH、E2、基础窦卵泡计数(AFC)、卵巢基质动脉血流的收缩期峰值(PSV)和抗苗勒管激素(AMH)水平均明显优于电凝组。结论当前证据显示,在腹腔镜下卵巢子宫内膜异位囊肿剥除术中,单纯缝合法止血较电凝止血法对卵巢储备功能的影响小。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the influence on ovarian reserve tunction by different hemostatic methods during laparoscopic cystectomy in treatment of ovarian endometrioma （OE）. Methods Databases including The Cochrane Library, PubMed, EMbase, CNKI, CBM and WanFang Data were electronically searched, to collect relevant randomized controlled trials （RCTs） about laparoscopic electro coagulation vs. microscopically suture for OE from 1990 to Mar, 2014. Meanwhile, references of included studies were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then RevMan 5.2 software was used for meta-analysis. Results A total of 16 RCTs involving 1 236 patients were finally included. The results of meta-analysis showed that the luteinizing hormone （LH） levels after 1 month, 2 months, 6 months and 12 months and estradiol （E2） levels after 2 months, 6 months had no significant differences between the two groups and the E2 level after 12 month of the suture group was significantly lower than that of the electro coagulation group. The levels of follicle stimulating hormone （FSH）, LH, E2, antral follicle count （AFC）, mean ovarian stromal peak systolic blood flow velocity （PSV） and anti-Mullerian hormone （AMH） in the suture group were significantly superior to those in the electro coagulation group at other follow-up time. Conclusion Current evidence suggests that in treatment of ovarian endometriotic cyst by laparoscopic cystectomy, compared with electro coagulation hemostasis, suture hemostasis has less influence on ovarian reserve function. Due to limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.

关 键 词：腹腔镜手术 卵巢子宫内膜异位囊肿 止血方式 卵巢功能 系统评价 Meta分析 随机对照试验 

分 类 号：R713[医药卫生—妇产科学]