腹腔鏡不同術式治療卵巢子宮內膜異位囊腫療效及安全性的系統評價_《中國循證醫學雜志》

作者：

新疆醫科大學第一附屬醫院婦科（烏魯木齊 830054）;

關鍵詞：

腹腔鏡手術子宮內膜異位癥系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130012

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目的　系統評價腹腔鏡手術治療卵巢子宮內膜異位囊腫的療效及安全性。
方法　計算機檢索The Cochrane Library、MEDLINE（1966～2011.11）、EMbase（1980～2011.11）、CNKI（1980～2011.11）、CBM（1980～2011.11）和WanFang Data（1978～2011.11），并手工檢索相關文獻，收集關于腹腔鏡卵巢子宮內膜異位囊腫剝除術與凝固術比較治療卵巢子宮內膜異位囊腫療效及安全性的隨機對照試驗（RCT），檢索時限截至2011年11月。由2位研究者根據納入與排除標準篩選文獻、提取資料并評價質量后，采用RevMan 5.1軟件進行Meta分析。
結果　最終納入5個研究。Meta分析結果顯示：腹腔鏡卵巢子宮內膜異位囊腫剝除術能降低子宮內膜異位癥患者的痛經復發率［RR=0.29，95%CI（0.15，0.55），P=0.000 2］、性交痛復發率［RR=0.27，95%CI（0.09，0.77），P=0.01］、非經期盆腔痛復發率［RR=0.19，95%CI（0.05，0.76），P=0.02］、卵巢子宮內膜異位囊腫術后1、2年復發率［1年：RR=0.33，95%CI（0.15，0.74），P=0.007；2年：RR=0.49，95%CI（0.26，0.95），P=0.03］以及短期再次手術風險［RR=0.25，95%CI（0.07，0.85），P=0.03］，并增加不孕患者術后12個月和24個月的自然妊娠率［術后12個月：RR=2.82，95%CI（1.44，5.50），P=0.002；術后24個月：RR=2.62，95%CI（1.47，4.68），P=0.001］。此外，患者腹腔鏡子宮內膜異位囊腫凝固術后6個月的卵巢儲備功能優于剝除術［WMD=–4.26，95%CI（–5.98，–2.55），P lt;0.000 01］，但兩者術后5年的卵巢儲備功能差異無統計學意義［WMD=0.27，95%CI（–0.18，0.73），P=0.24］。
結論　腹腔鏡子宮內膜異位囊腫剝除術能減少患者痛經、性交痛、非經期盆腔痛以及子宮內膜異位癥的復發，還能降低短期再次手術的風險，并增加確診為不孕患者的術后自然妊娠率。鑒于現有臨床研究數量尚少，上述結論尚需開展更多高質量RCT加以驗證。

引用本文： 葉遠征,王彥紅,何艷,馬彩玲. 腹腔鏡不同術式治療卵巢子宮內膜異位囊腫療效及安全性的系統評價. 中國循證醫學雜志, 2013, 13(1): 55-61. doi: 10.7507/1672-2531.20130012 復制

1.	American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril, 1985, 43(3): 351-353.
2.	Daniell JF, Kurtz BR, Gurley LD. Laser laparoscopic management of large endometriomas. Fertil Steril, 1991, 55(4): 692-695.
3.	Donnez J, Nisolle M, Gillet N, et al. Large ovarian endometriomas. Hum Reprod, 1996, 11(3): 641-646.
4.	Sutton CJ, Ewen SP, Jacobs SA, et al. Laser laparoscopic surgery in the treatment of ovarian endometriomas. J Am Assoc Gynecol Laparosc, 1997, 4(3): 319-323.
5.	Yuen PM, Yu KM, Yip SK, et al. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol, 1997, 177(1): 109-114.
6.	Luciano AA, Lowney J, Jacobs SL. Endoscopic treatment of endometriosis-associated infertility. Therapeutic, economic and social benefits. J Reprod Med, 1992, 37(7): 573-576.
7.	Hachisuga T, Kawarabayashi T. Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Hum Reprod, 2002, 17(2): 432-435.
8.	Maouris P, Brett L. Endometrioitic ovarian cysts: the case for excisional laparoscopic surgery. Gynaecol Endoscopy, 2002, 11(3): 231-234.
9.	Beretta P, Franchi M, Ghezzi F, et al. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril, 1998, 70(6): 1176-1180.
10.	Alborzi S, Momtahan M, Parsanezhad ME, et al. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril, 2004, 82(6): 1633-1637.
11.	Alborzi S, Ravanbakhsh R, Parsanezhad ME, et al. A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril, 2007, 88(2): 507-509.
12.	Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril, 2010, 94(1): 71-77.
13.	Carmona F, Martínez-Zamora M, Rabanal A, et al. Ovarian cystectomy versus laser vaporization in thetreatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril, 2011, 96(1): 251-254.
14.	Whiteside JL, Keup HL. Laparoscopic management of the ovarian mass: a practical approach. Clin Obstet Gynecol, 2009, 52(3): 327-334.
15.	Mais V, Ajossa S, Guerriero S, et al. Laparoscopic management of endometriomas: a randomized trial versus laparotomy. J Gynecol Surgery, 1996, 12(1): 41-46.
16.	Busacca M, Riparini J, Somigliana E, et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol, 2006, 195(2): 421-425.

1. American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril, 1985, 43(3): 351-353.
2. Daniell JF, Kurtz BR, Gurley LD. Laser laparoscopic management of large endometriomas. Fertil Steril, 1991, 55(4): 692-695.
3. Donnez J, Nisolle M, Gillet N, et al. Large ovarian endometriomas. Hum Reprod, 1996, 11(3): 641-646.
4. Sutton CJ, Ewen SP, Jacobs SA, et al. Laser laparoscopic surgery in the treatment of ovarian endometriomas. J Am Assoc Gynecol Laparosc, 1997, 4(3): 319-323.
5. Yuen PM, Yu KM, Yip SK, et al. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol, 1997, 177(1): 109-114.
6. Luciano AA, Lowney J, Jacobs SL. Endoscopic treatment of endometriosis-associated infertility. Therapeutic, economic and social benefits. J Reprod Med, 1992, 37(7): 573-576.
7. Hachisuga T, Kawarabayashi T. Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Hum Reprod, 2002, 17(2): 432-435.
8. Maouris P, Brett L. Endometrioitic ovarian cysts: the case for excisional laparoscopic surgery. Gynaecol Endoscopy, 2002, 11(3): 231-234.
9. Beretta P, Franchi M, Ghezzi F, et al. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril, 1998, 70(6): 1176-1180.
10. Alborzi S, Momtahan M, Parsanezhad ME, et al. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril, 2004, 82(6): 1633-1637.
11. Alborzi S, Ravanbakhsh R, Parsanezhad ME, et al. A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril, 2007, 88(2): 507-509.
12. Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril, 2010, 94(1): 71-77.
13. Carmona F, Martínez-Zamora M, Rabanal A, et al. Ovarian cystectomy versus laser vaporization in thetreatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril, 2011, 96(1): 251-254.
14. Whiteside JL, Keup HL. Laparoscopic management of the ovarian mass: a practical approach. Clin Obstet Gynecol, 2009, 52(3): 327-334.
15. Mais V, Ajossa S, Guerriero S, et al. Laparoscopic management of endometriomas: a randomized trial versus laparotomy. J Gynecol Surgery, 1996, 12(1): 41-46.
16. Busacca M, Riparini J, Somigliana E, et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol, 2006, 195(2): 421-425.

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《中國循證醫學雜志》

腹腔鏡不同術式治療卵巢子宮內膜異位囊腫療效及安全性的系統評價

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