Ding Wenjing, Li Ming, Teng Yincheng
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Reprod Biomed Online. 2015 Jun;30(6):635-42. doi: 10.1016/j.rbmo.2015.02.012. Epub 2015 Mar 9.
Concern is increasing that the use of bipolar coagulation or suturing to obtain haemostasis after surgical stripping of ovarian endometrioma could affect ovarian reserve. To compare the ovarian damage associated with the use of bipolar coagulation with ovarian suture as determined by anti-Müllerian hormone (AMH), FSH and antral follicle count, 21 studies were identified. Pooled analysis of 312 patients showed the average serum level of AMH was lower in the coagulation group than in the suture group (3-month follow-up: weighted mean difference (WMD) -0.75 ng/ml, 95% confidence interval (CI) -1.82 to 0.31; 6 months: WMD -1.45 ng/ml, 95% CI -2.43 to -0.47; 12 months: WMD -1.01 ng/ml; 95% CI -1.85 to -0.17), although heterogeneity was high. The weighted overall average levels of FSH between the two groups were not statistically significantly different 3 months after surgery (WMD 0.37 mIU/ml; 95% CI -1.56 to 1.30). The mean antral follicle count in the coagulation group was significantly less than in the suture group at 3 months' follow-up (WMD -2.53, with 95% CI -4.94 to -0.12). This study showed bipolar coagulation did more harm to the ovarian reserve than the suture haemostasis during excision of ovarian cyst as shown by a significant postoperative reduction in AMH.
人们越来越担心，在手术剥除卵巢子宫内膜异位症后使用双极电凝或缝合来实现止血可能会影响卵巢储备。为了比较使用双极电凝与卵巢缝合所导致的卵巢损伤（通过抗苗勒管激素（AMH）、促卵泡生成素（FSH）和窦卵泡计数来确定），共纳入了21项研究。对312例患者的汇总分析显示，电凝组的平均血清AMH水平低于缝合组（3个月随访：加权平均差（WMD）-0.75 ng/ml，95%置信区间（CI）-1.82至0.31；6个月：WMD -1.45 ng/ml，95% CI -2.43至-0.47；12个月：WMD -1.01 ng/ml；95% CI -1.85至-0.17），尽管异质性较高。两组术后3个月FSH的加权总体平均水平无统计学显著差异（WMD 0.37 mIU/ml；95% CI -1.56至1.30）。在3个月的随访中，电凝组的平均窦卵泡计数显著低于缝合组（WMD -2.53，95% CI -4.94至-0.12）。这项研究表明，在卵巢囊肿切除术中，双极电凝对卵巢储备的损害比缝合止血更大，术后AMH显著降低就表明了这一点。
