腹腔镜下水分离法治疗卵巢型子宫内膜异位症的系统评价  

Systematic evaluation of laparoscopic water separation for ovarian endometriosis

作　　者：范伟森 张英杰 张雯雯 殷增兰 齐英华[4] FAN Wei-sen;ZHANG Ying-jie;ZHANG Wen-wen(The First Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Department of Reproduction,Huantai Maternal and Child Health Hospital)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250014 [2]桓台妇幼保健院生殖科 [3]沂水县人民医院妇科 [4]山东中医药大学附属医院山东省中西医结合生殖与遗传中心

出　　处：《腹腔镜外科杂志》2022年第6期466-473,共8页Journal of Laparoscopic Surgery

摘　　要：目的:系统评价腹腔镜下采用水分离法剥离卵巢型子宫内膜异位症与普通机械剥离法对卵巢功能的保护作用。方法:计算机检索中国知网、万方、维普、Embase、PubMed、Web of Science六个数据库中关于腹腔镜下水分离法治疗卵巢型子宫内膜异位症的随机对照试验,检索时限均为建库至2021年8月。由两位研究员独立筛选文献、提取基本资料,并评价纳入研究的偏倚风险。采用RevMan 5.3软件进行Meta分析。结果:最终纳入16项研究、1393例患者。Meta分析结果显示,水分离法较直接剥离法手术时间短[MD=-17.32,95%CI(-30.15,-4.49),P=0.008]、术中出血少[MD=-32.55,95%CI(-42.22,-22.87),P<0.00001]、剥离的囊肿组织中卵巢组织[RR=0.38,95%CI(0.26,0.56),P<0.0001]与卵泡数量[MD=-3.31,95%CI(-4.56,-2.06),P<0.00001]少,术后6个月抗苗勒管激素[MD=0.61,95%CI(0.29,0.93),P=0.0002]与卵巢窦卵泡数量[MD=1.92,95%CI(0.33,3.52),P=0.02]高,卵泡刺激素[MD=-1.83,95%CI(-2.49,-1.18),P<0.00001]与促黄体生成素[MD=-1.05,95%CI(-1.89,-0.21),P=0.01]低;但术后3个月卵泡刺激素两组差异无统计学意义[MD=-1.10,95%CI(-2.34,-0.15),P=0.08]。结论:与直接剥离法相比,水分离法剥离卵巢型子宫内膜异位症对卵巢组织损伤更少,更能保护卵巢功能。Objective:To systematically evaluate the protective effect of water separation on ovarian function in laparoscopic explantation of ovarian endometriosis compared with conventional mechanical explantation.Methods:Randomized controlled clinical trials on laparoscopic water separation for treating ovarian endometriosis were searched in six databases including CNKI,Wanfang,VIP,Embase,PubMed and Web of Science,and the search time was from database establishment to Aug.2021.Two researchers independently screened the literatures,extracted the basic data,and evaluated the bias risk of included trials.Meta-analysis was performed using RevMan 5.3 software.Results:Sixteen studies with 1393 patients were included.Meta-analysis showed that,compared with direct exfoliation,water separation was associated with shorter operative time[MD=-17.32,95%CI(-30.15,-4.49),P=0.008],less intraoperative bleeding[MD=-32.55,95%CI(-42.22,-22.87),P<0.00001],and fewer ovarian tissue[RR=0.38,95%CI(0.26,0.56),P<0.0001]and follicles[MD=-3.31,95%CI(-4.56,-2.06),P<0.00001]in the exfoliated cyst tissue;in 6 months after operation,anti-Müllerian hormone[MD=0.61,95%CI(0.29,0.93),P=0.0002]and antral follicle count[MD=1.92,95%CI(0.33,3.52),P=0.02]were higher,follicle-stimulating hormone[MD=-1.83,95%CI(-2.49,-1.18),P<0.00001]and luteinizing hormone[MD=-1.05,95%CI(-1.89,-0.21),P=0.01]were lower.However,there was no significant difference in follicle-stimulating hormone value 3 months after surgery[MD=-1.10,95%CI(-2.34,-0.15),P=0.08].Conclusions:Water separation for exfoliation of ovarian endometriosis is less damaging to ovarian tissue and more protective towards ovarian function than direct dissection.

关 键 词：子宫内膜异位症 腹腔镜检查 水分离 卵巢功能 系统评价 

分 类 号：R711.71[医药卫生—妇产科学]