腹腔镜卵巢钻孔术治疗枸橼酸氯米酚抵抗的多囊卵巢综合征不孕患者的疗效变异：一项荟萃分析。
Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis.
机构信息
Department of Obstetrics and Gynecology (Drs. Zhang, Zhou, Xu, and Ms. Luo, Shen, and Yang); Reproductive Endocrinology and Regulation Laboratory (Drs. Zhang, Zhou, Xu, and Ms. Luo); West China Second University Hospital and the Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education (Drs. Zhang, Zhou, Xu, and Ms. Luo), Sichuan University, Chengdu, Sichuan, China..
Department of Obstetrics and Gynecology (Drs. Zhang, Zhou, Xu, and Ms. Luo, Shen, and Yang); Reproductive Endocrinology and Regulation Laboratory (Drs. Zhang, Zhou, Xu, and Ms. Luo); West China Second University Hospital and the Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education (Drs. Zhang, Zhou, Xu, and Ms. Luo), Sichuan University, Chengdu, Sichuan, China.
出版信息
J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1048-1058. doi: 10.1016/j.jmig.2019.06.022. Epub 2020 Apr 11.
OBJECTIVE
To evaluate novel surgical variations of laparoscopic ovarian drilling (LOD) and compare with standard bilateral LOD.
DATA SOURCES
Electronic databases were searched, including Cochrane database, CENTRAL, Ovid MEDLINE, Embase, PsycINFO, PubMed, Virtual Health Library, OpenSIGLE, ClinicalTrials.gov, ISRCTN, and The Chinese Clinical Trial Register in February 2019.
METHODS OF STUDY SELECTION
Randomized controlled trials (RCTs) evaluating LOD for patients with clomiphene citrate-resistant polycystic ovary syndrome and infertility and reporting reproductive outcomes, surgical complications, serum indexes, menses resumption, and ultrasound results were included. Quality and risk of bias were evaluated by 2 authors, respectively.
TABULATION, INTEGRATION, AND RESULTS: A total of 20 RCTs with 1615 patients were included. Evaluation of the quality of evidence for each study was based on each study's limitations of 5 outcome domains described by the Grading of Recommendations, Assessment, Development, and Evaluation and found to be moderate to very low. Live births were only reported by 4 studies. Unilateral LOD did not differ with bilateral LOD in reproductive outcomes, such as pregnancy (p = .11, I = 75%), ovulation (p = .08, I = 0%), miscarriage (p = .61), and menstruation resumption (p = .06). There was insufficient evidence regarding efficacy and safety of novel methods of LOD, such as transvaginal hydrolaparoscopy (1 RCT) and micro-LOD (3 RCTs). Evidence regarding the suitable number of ovarian punctures, duration of drilling, and antimüllerian hormone or antral follicle numbers following LOD were inconclusive.
CONCLUSION
Unilateral LOD seems to be suitable replacement for conventional bilateral LOD for clomiphene citrate-resistant polycystic ovary syndrome, although more studies involving long-term reproductive efficacy, adverse events, and varying forms of LOD are warranted.
目的
评估腹腔镜卵巢打孔术（LOD）的新手术变异，并与标准双侧 LOD 进行比较。
资料来源
检索了电子数据库，包括 Cochrane 数据库、CENTRAL、Ovid MEDLINE、Embase、PsycINFO、PubMed、虚拟健康图书馆、OpenSIGLE、ClinicalTrials.gov、ISRCTN 和中国临床试验注册中心，检索时间截至 2019 年 2 月。
研究选择方法
纳入评估枸橼酸氯米酚抵抗多囊卵巢综合征和不孕患者 LOD 并报告生殖结局、手术并发症、血清指标、月经恢复和超声结果的随机对照试验（RCT）。由 2 位作者分别评估质量和偏倚风险。
列表、整合和结果：共纳入 20 项 RCT，共 1615 例患者。对每项研究的证据质量评估基于每个研究在描述推荐、评估、开发和评估的 5 个结果领域的局限性，发现为中度至非常低。只有 4 项研究报告了活产。在生殖结局方面，单侧 LOD 与双侧 LOD 没有差异，如妊娠（p = .11，I = 75%）、排卵（p = .08，I = 0%）、流产（p = .61）和月经恢复（p = .06）。经阴道水腹腔镜（1 项 RCT）和微 LOD（3 项 RCT）等 LOD 新方法的疗效和安全性证据不足。关于 LOD 后合适的卵巢穿刺次数、钻孔时间以及抗苗勒管激素或窦卵泡数的证据尚无定论。
结论
单侧 LOD 似乎适合替代枸橼酸氯米酚抵抗多囊卵巢综合征的常规双侧 LOD，但需要更多涉及长期生殖疗效、不良事件和不同形式 LOD 的研究。
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