Zhang Ying, Zhang Shiqian, Zhao Zeyi, Wang Changhe, Xu Shuai, Wang Fei
Department of Obstetrics and Gynecology, Jining No.1 People's Hospital, Jining, People's Republic of China.
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
Fertil Steril. 2022 Dec;118(6):1172-1182. doi: 10.1016/j.fertnstert.2022.08.860. Epub 2022 Nov 3.
To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone (AMH) levels.
Systematic review and meta-analysis.
Not applicable.
PATIENT(S): Patients with endometriomas undergoing cystectomy or ablation.
INTERVENTION(S): All prospective studies comparing cystectomy with ablation for endometrioma in the PubMed, EMBASE, MEDLINE and Web of Science until April 3, 2022 were retrieved and reviewed. Medical treatment used as adjuvant therapy for the surgery was excluded. Two authors assessed eligibility and risk of bias independently. The statistical data were pooled using the Review Manager software.
MAIN OUTCOME MEASURE(S): The changes of AMH levels and AFC values in cystectomy group and ablation group, including intergroup comparisons and intragroup comparisons.
RESULT(S): Four randomized clinical trials and 2 prospective cohort studies were eligible for the meta-analysis, with a total of 294 patients. In the intergroup comparisons, preoperative AFC values were similar with low heterogeneity, but postoperative AFC values were significantly lower in cystectomy than ablation (mean differences [MD], -1.33; 95% credible interval, -2.15 to -0.51; I = 57%). In the intragroup comparisons of AFC values, sensitivity analyses showed a significant decrease in cystectomy (MD, -1.93; 95% credible interval, -2.40 to -1.45; I = 0%) at 6-month follow-up, compared with no reduction in ablation. The intragroup comparisons of AMH levels supported negative effects on ovarian reserve of both cystectomy (MD, -1.26; 95% credible interval, -1.64 to -0.88; I = 45%) and ablation (MD, -0.70; 95% credible interval, -1.07 to -0.32; I = 0%).
CONCLUSION(S): Both ablation and cystectomy have significantly detrimental effects on ovarian reserve as evaluated by AMH, but the ablation causes relatively less damage to ovarian reserve as appraised by AFC.
CRD42020152823;PROSPERO (york.ac.uk).
通过窦卵泡计数（AFC）和抗苗勒管激素（AMH）水平评估，探讨子宫内膜异位囊肿切除术或消融术对卵巢储备功能的影响是否较小。
系统评价和荟萃分析。
不适用。
接受囊肿切除术或消融术的子宫内膜异位症患者。
检索并回顾了截至2022年4月3日在PubMed、EMBASE、MEDLINE和Web of Science上所有比较子宫内膜异位囊肿切除术与消融术的前瞻性研究。排除用作手术辅助治疗的药物治疗。两位作者独立评估了纳入标准和偏倚风险。使用Review Manager软件汇总统计数据。
囊肿切除术组和消融术组中AMH水平和AFC值的变化，包括组间比较和组内比较。
四项随机临床试验和两项前瞻性队列研究符合荟萃分析标准，共294例患者。在组间比较中，术前AFC值相似，异质性低，但囊肿切除术后的AFC值显著低于消融术（平均差值[MD]，-1.33；95%可信区间，-2.15至-0.51；I² = 57%）。在AFC值的组内比较中，敏感性分析显示，在6个月随访时，囊肿切除术组AFC值显著降低（MD，-1.93；95%可信区间，-2.40至-1.45；I² = 0%），而消融术组无降低。AMH水平的组内比较支持囊肿切除术（MD，-1.26；95%可信区间，-1.64至-0.88；I² = 45%）和消融术（MD，-0.70；95%可信区间，-1.07至-0.32；I² = 0%）均对卵巢储备功能有负面影响。
通过AMH评估，消融术和囊肿切除术均对卵巢储备功能有显著不利影响，但通过AFC评估，消融术对卵巢储备功能的损害相对较小。
CRD42020152823；PROSPERO（york.ac.uk）。
