腹腔鏡手術和開腹手術治療多囊卵巢綜合征的系統評價_《中國循證醫學雜志》

作者：

曾慶媛 ¹ ,  許良智 ² , 張楠楠 ³

1. 成都軍區總醫院婦產科（成都 610083）；2. 四川大學華西第二醫院生殖內分泌及計劃生育科（成都 610041）；3.成都軍區總醫院醫務部（成都 610083）;

關鍵詞：

多囊卵巢綜合征腹腔鏡手術剖腹術非隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20100607

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目的　評價腹腔鏡手術和開腹手術治療多囊卵巢綜合征（polycystic ovarian syndrome，PCOS）的近期和遠期療效以及并發癥發生率，為臨床實踐提供依據。
方法　計算機檢索OVID、MEDLINE、EMbase、Cochrane圖書館（2008第2期）、CBM、CNKI、VIP以及萬方數字化期刊全文庫等數據庫。手工檢索相關期刊和會議文獻，并檢索相關綜述及所獲文獻的參考文獻。納入相關隨機和非隨機對照試驗，文獻發表時間和語言不限。采用RevMan 5.0進行統計分析。
結果　最終納入5個非隨機試驗，包括417例患者。Meta分析結果顯示：① 非長期隨訪亞組：腹腔鏡組術后累計妊娠率高于開腹組，差異有統計學意義［RR=1.42，95%CI（1.13，1.80），P=0.003］；長期隨訪亞組：腹腔鏡組術后累計妊娠率與開腹組相似，差異無統計學意義［RR=0.85，95%CI（0.68，1.07），P=0.17］；② 腹腔鏡組術后規律月經恢復率與開腹組差異無統計學意義［RR=0.91，95%CI（0.79，1.05），P=0.18］；③ 腹腔鏡組術后子宮周圍粘連發生率明顯低于開腹組，差異有統計學意義［RR=0.02，95%CI（0.00，0.18），P=0.000 2］；④ 腹腔鏡組術后腹腔內粘連發生率明顯低于開腹組，差異有統計學意義［RR=0.02，95%CI（0.00，0.13），P lt;0.000 1］。
結論　目前證據顯示，腹腔鏡手術治療PCOS不孕患者，術后粘連的發生率和程度均小于開腹手術；術后累計妊娠率是否優于開腹手術尚不能肯定；單個研究顯示，術后規律月經恢復率遠期療效不如開腹手術，有待更多高質量多中心的隨機雙盲對照試驗進一步證實。

引用本文： 曾慶媛,許良智,張楠楠. 腹腔鏡手術和開腹手術治療多囊卵巢綜合征的系統評價. 中國循證醫學雜志, 2010, 10(12): 1425-1431. doi: 10.7507/1672-2531.20100607 復制

1.	Franks S. Polycystic ovary syndrome. N Engl J Med, 1995, 333: 853-861.
2.	許良智, 張靜. 多囊卵巢綜合征. 現代臨床醫學, 2006, 32(4): 311-314.
3.	Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome. Obstet Gynecol Surv, 1998, 53(5): 297-308.
4.	Guzick DS. Ovulation induction management of PCOS. Clin obstet gynecol, 2007, 50(1): 255-267.
5.	Imani B, Eijkemans MJC, te Velde ER, et al. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol and Metab, 1998, 83(7): 2361-2365.
6.	Lobo RA, Gysler M, March CM, et al. Clinical and laboratory predictors of clomiphene response. Fertil Steril, 1982, 37: 168-174.
7.	Hughes E, Collins J, Vandekerckhove P, et al. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev, 2000 (2) (CD000056).
8.	Pritts EA. Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv, 2002, 57(9): 587–597.
9.	Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome. Lancet, 2007, 370(9588): 685-697.
10.	Stein IF, Cohen MR. Surgical treatment of bilateral polycystic ovaries. Am J Obstet Gynecol, 1939, 38: 465-473.
11.	Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril, 1984, 49: 956-960.
12.	Api M, Gorgen H, Certin A. Laparoscopic ovarin drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol, 2005, 119(1): 76-81.
13.	The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004, 19(1): 41-47.
14.	Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7( 27): iii-x, 1-173.
15.	Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
16.	Alieva EA, Pshenichnikova Tla, Gasparov AS. Results of laparoscopy in patients with polycystic ovary syndrome after surgical treatment, akush ginekol, 1990, 7: 63-66.
17.	Kentaro T, Nobuyuki K, Fuminori K, et al. A comparative study using early second-look laparoscopic evaluation of postoperative adhesion formation between two surgical procedures for polycystic ovarian syndrome. Obstet Gynecol Surv, 2007, 62(7): 443-445.
18.	馮淑英, 鄺健全, 翁梅英, 等. 兩種手術方式治療多囊卵巢綜合征的遠期療效追蹤比較. 中山大學學報(醫學科學版), 2004, 25(3): 260-263.
19.	童莉, 盧海明, 朱進梅, 等. 多囊卵巢綜合征所致不孕癥腹腔鏡手術與開腹手術的對比研究. 實用醫學雜志, 2005, 21(20): 2321-2322.
20.	于紅, 任慕蘭. 兩種手術方式治療多囊卵巢綜合征. 東南大學學報, 2004, 23(6): 417-418.
21.	Buttram VC Jr, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril, 1975, 26(9): 874-876.
22.	Amer S A, Gopalan V, Li T C, et al. Long term follow-up of patiens with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod, 2002, 17(8): 2035-2042.
23.	The American Fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril, 1988, 49(6): 944-955.
24.	Creenblatt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril, 1993, 60(2): 766-770.
25.	張梅瑩, 狄文. 手術治療多囊卵巢綜合征的評估. 中國婦幼健康研究, 2007, 18(1): 51-54.
26.	Dabirashrafi H. Complication of laparoscopic ovarian cauterization. Fertil Steril, 1989, 52: 878-880.
27.	Mike Clark. 非隨機對照試驗和診斷性試驗準確度系統評價的新挑戰. 中國循證醫學雜志, 2006, 6(4): 240-242.

1. Franks S. Polycystic ovary syndrome. N Engl J Med, 1995, 333: 853-861.
2. 許良智, 張靜. 多囊卵巢綜合征. 現代臨床醫學, 2006, 32(4): 311-314.
3. Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome. Obstet Gynecol Surv, 1998, 53(5): 297-308.
4. Guzick DS. Ovulation induction management of PCOS. Clin obstet gynecol, 2007, 50(1): 255-267.
5. Imani B, Eijkemans MJC, te Velde ER, et al. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol and Metab, 1998, 83(7): 2361-2365.
6. Lobo RA, Gysler M, March CM, et al. Clinical and laboratory predictors of clomiphene response. Fertil Steril, 1982, 37: 168-174.
7. Hughes E, Collins J, Vandekerckhove P, et al. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev, 2000 (2) (CD000056).
8. Pritts EA. Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv, 2002, 57(9): 587–597.
9. Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome. Lancet, 2007, 370(9588): 685-697.
10. Stein IF, Cohen MR. Surgical treatment of bilateral polycystic ovaries. Am J Obstet Gynecol, 1939, 38: 465-473.
11. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril, 1984, 49: 956-960.
12. Api M, Gorgen H, Certin A. Laparoscopic ovarin drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol, 2005, 119(1): 76-81.
13. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004, 19(1): 41-47.
14. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7( 27): iii-x, 1-173.
15. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
16. Alieva EA, Pshenichnikova Tla, Gasparov AS. Results of laparoscopy in patients with polycystic ovary syndrome after surgical treatment, akush ginekol, 1990, 7: 63-66.
17. Kentaro T, Nobuyuki K, Fuminori K, et al. A comparative study using early second-look laparoscopic evaluation of postoperative adhesion formation between two surgical procedures for polycystic ovarian syndrome. Obstet Gynecol Surv, 2007, 62(7): 443-445.
18. 馮淑英, 鄺健全, 翁梅英, 等. 兩種手術方式治療多囊卵巢綜合征的遠期療效追蹤比較. 中山大學學報(醫學科學版), 2004, 25(3): 260-263.
19. 童莉, 盧海明, 朱進梅, 等. 多囊卵巢綜合征所致不孕癥腹腔鏡手術與開腹手術的對比研究. 實用醫學雜志, 2005, 21(20): 2321-2322.
20. 于紅, 任慕蘭. 兩種手術方式治療多囊卵巢綜合征. 東南大學學報, 2004, 23(6): 417-418.
21. Buttram VC Jr, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril, 1975, 26(9): 874-876.
22. Amer S A, Gopalan V, Li T C, et al. Long term follow-up of patiens with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod, 2002, 17(8): 2035-2042.
23. The American Fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril, 1988, 49(6): 944-955.
24. Creenblatt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril, 1993, 60(2): 766-770.
25. 張梅瑩, 狄文. 手術治療多囊卵巢綜合征的評估. 中國婦幼健康研究, 2007, 18(1): 51-54.
26. Dabirashrafi H. Complication of laparoscopic ovarian cauterization. Fertil Steril, 1989, 52: 878-880.
27. Mike Clark. 非隨機對照試驗和診斷性試驗準確度系統評價的新挑戰. 中國循證醫學雜志, 2006, 6(4): 240-242.

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腹腔鏡手術和開腹手術治療多囊卵巢綜合征的系統評價

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《中國循證醫學雜志》

腹腔鏡手術和開腹手術治療多囊卵巢綜合征的系統評價

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