腹腔镜卵巢打孔术与药物治疗克罗米酚抵抗的多囊卵巢综合征临床疗效的Meta分析

Clinical effect of laparoscopic ovarian drilling and medications in patients with clomiphene resistant polycystic ovary syndrome: a Meta-analysis

目的:评估腹腔镜卵巢打孔术(laparoscopic ovarian drilling,LOD)与药物治疗克罗米酚抵抗的多囊卵巢综合征(clomiphene citrate resistant-polycystic ovarian syndrome,CCR-PCOS)临床疗效,为临床治疗提供依据。方法:检索2000年1月起至2015年8月Pubmed、中国生物医学文献数据库、中国学术期刊全文数据库、万方数据库中有关CCR-PCOS通过LOD与药物治疗的随机对照试验的文献。运用Rev Man 5.0软件进行Meta分析,对两者的临床疗效包括多胎妊娠率、活胎率、妊娠率、流产率、排卵率、OHSS发生率、子宫内膜厚度和正常月经周期率进行综合评估。结果:本研究纳入了17篇随机对照研究。Meta分析结果表明:LOD组的多胎妊娠率低于药物组(RR=0.22,95%CI=0.09~0.54,P=0.001),子宫内膜厚度小于药物组(WMD=-1.88,95%CI=-2.84^-0.91,P=0.000);活胎率、妊娠率、流产率、排卵率、OHSS发生率、和正常月经周期率LOD组和药物组间差异无统计学意义。结论:LOD能降低多胎妊娠率,且减少子宫内膜厚度,但在活胎率、妊娠率、流产率、排卵率、OHSS发生率、和正常月经周期率方面与药物组相似。本次结果受纳入研究质量限制,尚需更多高质量、大样本、多中心随机对照试验验证。

Objective ：To evaluate the effectiveness of the methods of induced ovulation in patients with clomiphene resistant polycystic ovary syndrome by laparoscopie ovarian drilling （LOD） or medications. Methods ： Data were obtained from Pubmed, CNKI, Wanfang database. All randomized controlled trials（RCTs） involving the effectiveness of laparoscopic ovarian drilling and medications in pa- tients with clomiphene resistant polycystic ovary syndrome were included in the study. The RevMan 5.0 software package was used for the Meta-analysis. The clinical curative effect included multiple pregenanacy ratelive birth ratepregnancy ratemiscarriage rateincidence of ovarian hyperstimulation syndromeovulation ratemidcycle endometrial thickness,and regular menstruation. Results：Seventeen ran- domized controlled trials were included. Meta-analysis showed that the multiple pregnancy rate of LOD groups were lower than that of medication group （RR =0.22,95%CI=0.09 to 0.54, P=0.O01 ）. And the midcycle endometrial thickness of LOD groups was lower than that of medication group（WMD=-1.88,95%CI=-2.84 to-0.91 ,P=0.000）. Howeverthere was no difference in the live birth ratepregnancy ratemiscarriage rateincidence ol ovarian layper- stimulation syndromeovulation rate and regular menstruation between LOD group and medication group. Conclusian：LOD can reduce the multiple pregenanaey rate and midcycle en- dometrial thicknessbut the live birth ratepregnancy ratemiscar- riage rateincidence of ovarian byperstimulation syndromeovula- tion rate and regular menstruation between LOD group and medication group are similar.