Jacobson Tal Z, Duffy James M N, Barlow David, Koninckx Philippe R, Garry Ray
Department of Obstetrics and Gynaecology, South Auckland Clinical School, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD001300. doi: 10.1002/14651858.CD001300.pub2.
Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity. It is variable in both its surgical appearance and clinical manifestation often with poor correlation between the two. Surgical treatment of endometriosis aims to remove visible areas of endometriosis and restore anatomy by division of adhesions and relieve painful symptoms.
To assess the efficacy of laparoscopic surgery in the treatment of pelvic pain associated with endometriosis.
For the update in July 2009 we searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched July 2009), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2009), MEDLINE (1966 July 2009), EMBASE (1980 July 2009), and reference lists of articles.
Randomised controlled trials were selected comparing the effectiveness of laparoscopic surgery used to treat pelvic pain associated with endometriosis, with other treatment modalities or diagnostic laparoscopy only.
Assessment of trial quality and extraction of relevant data was performed independently by two reviewers.
Five studies were included in the meta-analysis, including three full papers and two conference reports. All the randomised controlled trials with the exception of Lalchandani 2003 compared different laparoscopic surgical techniques with diagnotic laparoscopy only. Lalchandani 2003 compared laparoscopic coagulation therapy with diagnostic laparoscopy and medical treatment. Three studies (Abbott 2004; Sutton 1994; Tutunaru 2006) reported the pain scores six months post operatively. Meta-analysis demonstrated an advantage of laparoscopic surgery when compared to diagnostic laparoscopy only (OR of 5.72 95%Cl 3.09 to 10.60 ; 171 participants, three trials, Analysis 1.1). A single study (Tutunaru 2006) reported pain scores twelve months after the procedure. Analysis demonstrated an advantage of laparoscopic surgery when compared to diagnostic laparoscopy only (OR of 7.72 95%Cl 2.97 to 20.06 ; 33 participants, one trial, Analysis 1.1).
AUTHORS' CONCLUSIONS: Laparoscopic surgery results in improved pain outcomes when compared to diagnostic laparoscopy alone. There were few women diagnosed with severe endometriosis included in the meta-analysis and therefore any conclusions from this meta-analysis regarding treatment of severe endometriosis should be made with caution. It is not possible to draw conclusions from the meta-analysis which specific laparoscopic surgical intervention is most effective.
子宫内膜异位症是指子宫内膜腺体或间质出现在子宫腔以外的部位。其手术表现和临床表现各不相同,二者之间往往缺乏良好的相关性。子宫内膜异位症的手术治疗旨在切除可见的异位内膜区域,通过分离粘连恢复解剖结构,并缓解疼痛症状。
评估腹腔镜手术治疗与子宫内膜异位症相关的盆腔疼痛的疗效。
为进行2009年7月的更新,我们检索了Cochrane月经紊乱与生育力低下研究组的专业试验注册库(2009年7月检索)、Cochrane对照试验注册库(《Cochrane图书馆》,2009年第2期)、MEDLINE(1966年至2009年7月)、EMBASE(1980年至2009年7月)以及文章的参考文献列表。
选择随机对照试验,比较用于治疗与子宫内膜异位症相关的盆腔疼痛的腹腔镜手术与其他治疗方式或仅与诊断性腹腔镜检查的有效性。
由两名评价员独立进行试验质量评估和相关数据提取。
五项研究纳入荟萃分析,包括三篇全文和两篇会议报告。除Lalchandani 2003年的研究外,所有随机对照试验均将不同的腹腔镜手术技术仅与诊断性腹腔镜检查进行比较。Lalchandani 2003年的研究将腹腔镜凝固疗法与诊断性腹腔镜检查及药物治疗进行了比较。三项研究(Abbott 2004;Sutton 1994;Tutunaru 2006)报告了术后六个月的疼痛评分。荟萃分析表明,与仅进行诊断性腹腔镜检查相比,腹腔镜手术具有优势(比值比为5.72,95%置信区间为3.09至10.60;171名参与者,三项试验,分析1.1)。一项研究(Tutunaru 2006)报告了术后十二个月的疼痛评分。分析表明,与仅进行诊断性腹腔镜检查相比,腹腔镜手术具有优势(比值比为7.72,95%置信区间为2.97至20.06;33名参与者,一项试验,分析1.1)。
与单独的诊断性腹腔镜检查相比,腹腔镜手术可改善疼痛结局。荟萃分析中纳入的被诊断为重度子宫内膜异位症的女性较少,因此对于该荟萃分析中有关重度子宫内膜异位症治疗的任何结论都应谨慎得出。无法从荟萃分析中得出哪种特定的腹腔镜手术干预最有效的结论。