腹腔镜下卵巢囊肿切除术中电凝和缝合止血对卵巢储备功能影响的Meta分析

Comparison of the effects of electrocoagulation and suture hemostasis on ovarian reserve during laparoscopic ovarian cystectomy:a systematic review and meta-analysis

目的探讨腹腔镜下卵巢囊肿切除术中电凝止血及缝合止血方式对卵巢储备功能的影响。方法纳入腹腔镜下卵巢囊肿切除术患者的随机对照试验(RCT),其中术中行缝合止血者为缝合组,行电凝止血者为电凝组。由两名评估员独立筛查文献,进行质量评价和资料提取。使用Cochrane协作网提供的RevMan 5.2软件进行Meta分析。结果共19个腹腔镜下卵巢囊肿切除术的RCT符合纳入标准。Meta分析结果显示,电凝组抗苗勒管激素(RR=0.58,95%CI:0.36~0.81,P<0.001)、E2(RR=2.93,95%CI:1.92~3.94,P<0.001)、卵巢间质动脉血流收缩期峰值(RR=0.90,95%CI:0.57~1.23,P<0.001)水平较缝合组低;电凝组窦卵泡数(RR=1.89,95%CI:1.22~2.56,P<0.001)较缝合组少;电凝组FSH高于缝合组(RR=-1.38,95%CI:-2.11^-0.65,P<0.001);电凝组LH(RR=-0.41,95%CI:-1.19~0.38,P>0.05)、卵巢大小(RR=2.77,95%CI:-0.54~6.07,P>0.05)与缝合组比较,差异无统计学意义(P>0.05)。结论腹腔镜下卵巢囊肿切除术后可能造成卵巢储备功能下降,对卵巢创面出血的处理中,电凝止血法导致卵巢储备功能下降较缝合止血法明显,但需要更多的高质量研究证实。

Objective The aim of this meta-analysis was to compare of the effects of electrocoagulation and suture hemostasis on ovarian reserve during laparoscopic ovarian cystectomy.Methods Randomized controlled trials about laparoscopic ovarian cystectomy was included in this study,patients with suture hemostasis was included in esperimental group and electrocoagulation in control group.Two experimenter were screening literatures all alone.Conducting the meta analysis by RevMan 5.2software provided by Cochrane Collaboration.Results Nineteen studies were identified.The revelant examinations of ovarian reserve were analyzed and recorded at 6 months after the surgery.The meta-analysis showed that the AMH（RR=0.58,95%CI：0.36-0.81,P0.001）,E2level（RR=2.93,95%CI：1.92-3.94,P〈0.05）,PSV（RR=0.90,95%CI：0.57-1.23,P〈0.05）of electrocoagulation group were lower than suture group;the AFC（RR=1.89,95%CI：1.22-2.56,P〈0.05）of electrocoagulation group were less than suture group;the FSH（RR=-1.38,95%CI：-2.11--0.65,P〈0.05）of electrocoagulation group were higher than suture group;between the two groups,there was no difference in LH level（RR=-0.41,95%CI：-1.19-0.38,P〈0.05）and ovarian volume（RR=2.77,95%CI：-0.54-6.07,P〈0.05）.Conclusions Electrocoagulation and suture hemostasis during laparoscopic ovarian cystectomy may associated with a significant reduction in ovarian reserve,especially in electrocoagulation.Further more,we need more higher quality researches to compare the ovarian reserve during the two hemostasis.