腹腔镜下卵巢囊肿剥除术中电凝止血与缝合止血对卵巢储备功能影响的Meta分析

Impact on Ovarian Reserve Function by Different Homostasis Methods During Laparoscopic Cystectomy: A Meta-analysis

目的:评价腹腔镜下卵巢囊肿剥除术中电凝与缝合止血法对卵巢储备功能的影响。方法:计算机检索Medline、EMbase、Cochrance图书馆、中国知识基础设施工程数据库(CNKI)、中国生物医学文献数据库(CMB)和万方数据库(建库至2014年)。对纳入研究进行质量评价及Meta分析。结果:检出可能相关文献共126篇,最终有24篇文献符合纳入标准。共计电凝组(BC)1024例,缝合组(LS)1030例。所纳入的术后观察指标经Meta分析显示,总效应分别为LS组AMH(抗苗勒管激素)值比BC组高0.62倍;LS组的FSH(卵泡刺激素)值比BC组低0.79倍;LS组的LH(黄体生成素)值比BC组低0.22倍;LS组AFC(窦状卵泡数)值比BC组高0.61倍;LS组PSV(卵巢动脉收缩期峰值血流速度)值比BC组高1.28倍。结论:电凝止血对卵巢储备功能的影响明显高于缝合止血,且持续时间久。但目前所有相关研究都没有说明手术后卵巢储备功能的下降是暂时的还是永久性的,所以还需要更长时间的随访追踪。

Objective： To access and compare the effect of hemostasis methods during laparoscopic cystectomy（ including suture or bipolar coagulation） on conserving the function of the ovarian after surgical stripping of ovarian cyst. Method： Studies were identified by searching the Medline,EMBASE,CNKI,CBM,Wan Fang Data and Cochrane library till 2014,Data which met the inclusion criteria of clinical studies were evaluated about the quality,and were analyzed by meta analysis. Results： 126 relevant publications were retrieved,a total of 24 studies were included after reviewing the title and abstract of each publication. 1024 and 1030 samples were included in BC（ bipolar coagulation BC） group and LS（ laparoscopic suturing LS） group respectively. Pooled analysis demonstrated that AMH increased by 0. 62-fold in LS group,compared with BC group; FSH increased by 0. 79-fold in BC group,compared with LS group; LH increased by 0. 22-fold in BC group,compared with LS group; AFC increased by0. 61-fold in LS group,compared with BC group; PSV increased by 1. 28-fold in LS group,compared with BC group. Conclusions： Bipolar coagulation has more severe and persistent impact on ovarian reserving function than suture. Since none of recent research has shown that post-tperative decrease on ovarian reserve is permanent,further follow-wp study is demanded.