腹腔镜下卵巢子宫内膜异位囊肿剥除术中不同止血方式对卵巢功能影响的Meta分析  

Meta analysis of the impact of different hemostasis methods on postoperative ovarian function during laparoscopic removal of ovarian endometriotic cysts

作　　者：周凌 戴艳玲 郑志群[1] ZHOU Ling;DAI Yanling;ZHENG Zhiqun(Department of Gynecology and Obstetrics,Fujian Medical University Union Hospital,Fuzhou,Fujian,350001,China)

机构地区：[1]福建医科大学附属协和医院妇产科,福建福州350001

出　　处：《当代医学》2024年第5期28-36,共9页Contemporary Medicine

摘　　要：目的探讨腹腔镜下卵巢子宫内膜异位囊肿剥除术中不同止血方式对术后卵巢功能的影响。方法计算机全面检索PubMed、Cochrane Library、Embase、中国期刊全文数据库(CNKI)、中国学术期刊数据库(万方)、中文科技期刊服数据库(维普),检索时间自建库至2021年4月,由2名系统评价员根据纳入/排除标准经独立筛选、资料提取和质量评价后,应用Review Manager 5.3软件进行Meta分析。结果共纳入12项研究,Meta分析结果显示:术后1、3、6、12个月,双极电凝止血组、超声刀止血组抗苗勒氏管激素(AMH)水平均低于缝合止血组,差异有统计学意义(P<0.05);术后1个月,超声刀止血组AMH水平低于电凝止血组,差异有统计学意义(P<0.05),而术后3、6、12个月,两组AMH水平比较差异无统计学意义;术后1、3个月,明胶基质凝血酶封闭剂(Floseal)组与双极电凝止血组AMH水平比较差异无统计学意义。结论腹腔镜下卵巢子宫内膜异位囊肿剥除术中使用不同止血方式对卵巢功能影响程度不同,相对于缝合止血,超声刀止血及双极电凝止血对卵巢功能损伤较大,且对卵巢功能的影响程度相近,明胶基质凝血酶封闭剂对卵巢功能未见明显保护性作用。Objective To Explore the impact of different hemostasis methods on postoperative ovarian function during laparoscopic removal of ovarian endometriotic cysts.Methods PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),China Academic Journal Database(Wanfang),China Science and Technology Journal Database(VIP)were search by computer from database establishment until April 2021,literature screening,data extraction and quality evaluation were based on inclusion and exclusion criteria by two reviewers respectively.Meta-analysis was performed by Reviewer Manager 5.3 software.Result A total of 12 randomized controlled trials were included,Meta analysis showed that:1,3,6,and 12 months after surgery,the levels of anti-Mullerian hormone(AMH)in the bipolar electrocoagulation hemostasis group and the ultrasound knife hemostasis group were lower than those in the suture hemostasis group,and the differences were statistically significant(P<0.05);1 month after surgery,the AMH level in the ultrasound knife hemostasis group was lower than that in the electrocoagulation hemostasis group,and the difference was statistically significant(P<0.05),however,at 3,6,and 12 months after surgery,there were no statistically significant differences in AMH levels between the two groups;1 and 3 months after surgery,there were no significant differences in AMH levels between gelatin matrix thrombin sealant(Floseal)group and bipolar electrocoagulation hemostasis group.Conclusion Different methods of hemostatic influence ovarian reserve during laparoscopic cystectomy of ovarian endometrioma differently,in compare with suture,ultrasound knife hemostasis and bipolar electrocoagulation hemostasis are more harmful on ovarian fuction,and the effects are similar,gelatin matrix thrombin sealant has no significant protective effect on ovarian function.

关 键 词：子宫内膜异位症 卵巢 腹腔镜 卵巢功能 META分析 

分 类 号：R713.6[医药卫生—妇产科学]