手术治疗卵巢子宫内膜异位囊肿对妊娠结局利弊影响的Meta分析

Effect of cystectomy of endometriomas on the pregnancy: A meta-analysis

目的:探讨手术治疗卵巢子宫内膜异位囊肿(OEM)对妊娠结局利弊的影响。方法:检索2014年12月以前在Pubmed、EMbase、The Cochrane Library、CBM、CNKI、Wan Fang等数据库发表的关于手术治疗OEM对妊娠结局利弊影响的文献。对纳入文献进行质量评价及数据提取,采用STATA11.0软件进行Meta分析。结果:本研究纳入13篇文献,手术组1135例,非手术组856例,两组基线均衡。Meta分析结果提示,对于患有r AFS I^II期OEM且有生育要求的育龄妇女,手术切除OEM能改善妊娠率(RR 1.35,95%CI 1.09~1.68,P=0.006);对于r AFS III^IV期患者,手术切除OEM未改善妊娠率(RR 1.66,95%CI 0.74~3.75,P=0.221)。对于患有直径≥3cm或单侧OEM的患者,手术切除OEM未改善妊娠率(RR 1.27,95%CI 0.80~2.02,P=0.305;RR 1.04,95%CI0.76~1.42,P=0.795)。对于未接受任何ART治疗的OEM患者,手术切除OEM改善妊娠率(RR 3.56,95%CI 1.98~6.43,P<0.001)。手术切除OEM未改善活产率(RR 0.81,95%CI 0.45~1.47,P=0.489)。结论:对于患有r AFS I^II期OEM且有生育要求的育龄妇女,手术切除OEM改善妊娠率,术后是否采取ART助孕对妊娠结局无明显影响,推荐确诊OEM后行手术切除OEM。对于患有r AFS III^IV期、直径≥3cm或单侧OEM且具有生育要求的育龄妇女,尚无证据支持手术切除OEM能改善妊娠结局。

Objective： To evaluate the effect of cystectomy of endometriomas on the pregnancy. Methods： The studies about the influence of cystectomy of endometriomas on the pregnancy were searched in Pubmed,Embase,The Cochrane Library,CBM,CNKI,Wan Fang Data to Dec. 2014. Quality assessment and data collection were performed. Meta-analysis was performed by STATA 11. 0 software. Results： Thirteen studies were selected including 1135 patients in surgery group and 856 patients in non-surgery group. The baselines of the two groups were in balance. The results of the meta-analysis showed that,for the patients with r AFS I ~ II stage endometrioma,cystectomy of endometrioma improved the pregnancy rate（ RR 1. 35,95%CI 1. 09 ~ 1. 68,P = 0. 006）. But for the patients with r AFS III ~ IV stage endometrioma,cystectomy of endometrioma did not improve the pregnancy rate（ RR 1. 66,95% CI 0. 74 ~ 3. 75,P= 0. 221）. For the patients with size ≥3cm or unilateral endometrioma,cystectomy of endometrioma did not improve the pregnancy rate（ RR 1. 27,95% CI 0. 80 ~ 2. 02,P = 0. 305; RR 1.04,95% CI 0. 76 ~ 1. 42,P = 0. 795）. For the patients with endometrioma but without ART,cystectomy of endometrioma did not improve the pregnancy rate（ RR 3. 56,95% CI 1. 98 ~6. 43,P 0. 001）. Furthermore,for the patients with endometrioma,cystectomy of endometrioma did not improve the live birth rate（ RR 0. 81,95% CI 0. 45 ~ 1. 47,P = 0. 489）. Conclusion：For the patients with r AFS I-II stage endometrioma,cystectomy of endometrioma improved the pregnancy rate. Whether having ART after surgery or not did not affect the pregnancy. For the patients with r AFS III ~ IV stage,size≥3cm or unilateral endometrioma,no evidence suggested cystectomy of endometrioma improved the pregnancy.