机会性输卵管切除术对卵巢储备的短期影响:基于GRADE证据分级系统的随机对照试验荟萃分析  

Short-term Effects of Opportunistic Salpingectomy on Ovarian Reserve:a Meta-analysis of Randomized Controlled Trials Based on GRADE Evidence Grading System

作　　者：赵丽 杨春艳[1] 左漫云 杨红梅[1] ZHAO Li;YANG Chunyan;ZUO Manyun;YANG Hongmei(Department of Oncology,Nanchong Central Hospital,North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属南充市中心医院肿瘤科,四川省南允市637000

出　　处：《中国全科医学》2024年第9期1142-1148,共7页Chinese General Practice

基　　金：南充市社科联科研项目(NC2018B017)。

摘　　要：背景机会性输卵管切除术(OS)可以作为卵巢癌(OC)的一级预防手段,但由于卵巢与输卵管拥有同源血供系统,OS可能会引起卵巢功能的损害,从而增加卵巢老化和更年期提前的风险。目的基于GRADE证据分级系统,评价OS对卵巢储备的短期影响。方法于2022年9月,检索中国知网、万方数据知识服务平台、维普网、PubMed、Web of Science、Scopus,获取评估OS对卵巢储备短期影响的文献,检索时限均为建库至2022-09-10。由2名研究者独立筛选文献并提取数据,使用Jadad量表评价文献质量,Stata 17.0软件用于数据处理与荟萃分析,GRADEpro 3.2软件用于评估荟萃分析结果的证据质量。结果共纳入9项随机对照试验(RCT),包含482例患者,其中OS组238例、non-OS组244例。Jadad风险评估量表结果显示所纳入的RCT均为高质量文献。荟萃分析结果表明:相对于non-OS组,OS组抗苗勒氏激素(AMH)(WMD=-0.07,95%CI=-0.28~0.13,P=0.13)、卵泡刺激素(FSH)(WMD=-0.03,95%CI=-1.65~1.59,P=0.24)、黄体生成素(LH)(WMD=-0.39,95%CI=-1.62~0.83,P=0.08)、雌二醇(E2)(WMD=3.08,95%CI=-4.26~10.43,P=0.35)手术前后的变化差异无统计学意义(P>0.05)。GRADEpro软件对荟萃分析的结果显示,AMH的研究为高质量证据,FSH的研究为中等质量证据,E2和LH的研究为低质量证据。结论在短期内因良性疾病接受OS的未绝经女性的卵巢储备功能指标与未接受OS的女性无明显差异。已完成生育的绝经前女性通过OS来预防OC是合理的,但是这个结论仍有待于更长随访时间、设计更严谨且样本量更大的RCT来验证。Background Opportunistic salpingectomy(OS)can be used as a primary prevention of ovarian cancer(OC),but OS may cause impairment of ovarian function due to the homologous blood supply system shared by ovaries and fallopian tubes,thereby increasing the risk of ovarian aging and early menopause.Objective To evaluate the short-term effects of OS on ovarian reserve based on GRADE evidence grading system.Methods In September 2022,CNKI,Wanfang,VIP,PubMed,Web of Science,and Scopus were searched for literature assessing the short-term effects of OS on ovarian reserve from inception to 10 September 2022.Two investigators independently screened the literature and extracted the data.The Jadad scale was used to evaluate the quality of literature,Stata 17.0 software was used for data processing and meta-analysis,and GRADEpro 3.2 software was used to assess the evidence quality for the results of meta-analysis.Results A total of 9 randomized controlled trials(RCT)were included,involving 482 patients,including 238 cases in the OS group and 244 in the non-OS group.The results of the Jadad risk assessment scale showed that the included RCTs were all of high quality literature.The results of meta-analysis showed that the differences in changes of anti-mullerian hormone(AMH)(WMD=-0.07,95%CI=-0.28-0.13,P=0.13),follicle-stimulating hormone(FSH)(WMD=-0.03,95%CI=-1.65-1.59,P=0.24),luteinizing hormone(LH)(WMD=-0.39,95%CI=-1.62-0.83,P=0.08)and estradiol(E2)(WMD=3.08,95%CI=-4.26-10.43,P=0.35)before and after surgery between the OS and non-OS groups were not significant(P>0.05).The results of the meta-analysis by GRADEpro software showed high quality evidence for AMH,moderate quality evidence for FSH,and low quality evidence for E2 and LH.Conclusion There is no significant difference in ovarian reserve indicators between the non-menopausal women who receive OS for benign disease in the short term and those who did not receive OS.It is reasonable for premenopausal women who have completed childbearing to prevent OC by OS,but this conclusion

关 键 词：输卵管切除术 机会性输卵管切除术 卵巢肿瘤 卵巢储备功能 荟萃分析 

分 类 号：R713.5[医药卫生—妇产科学]