Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Obstet Gynaecol Res. 2024 Jun;50(6):1020-1031. doi: 10.1111/jog.15925. Epub 2024 Mar 19.
The purpose of the study was to compare the ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants (HSs).
We performed a meta-analysis of studies in which post-cystectomy serum anti-Müllerian hormone (AMH) values were compared between bipolar coagulation and suture method or between bipolar coagulation and HSs. Through a literature search, we retrieved 14 articles which met inclusion criteria and were eligible for final analysis. The articles included 10 randomized trials, 3 prospective studies, and 1 retrospective study (n = 1435). The primary outcome was post-cystectomy serum AMH values.
Both bipolar coagulation and suture methods showed significantly lower post-cystectomy AMH values at 3, 6, and 12 months. However, post-cystectomy serum AMH values at 12 months were significantly higher in the suture method group compared to the bipolar coagulation (weighted mean difference [WMD]: -1.10, 95% confidence interval [CI]: -1.83, -0.38, p = 0.003, I = 89, n = 3). The suture method also showed a lower decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: -25.13%, 95% CI: -49.56 to -0.70, p = 0.04, I = 95%, n = 2). Overall, pregnancy rates were similar between the two groups. Between the bipolar coagulation and HSs group, serum AMH values at 3 months post-cystectomy were similar (WMD: -0.46, 95% CI: -1.04 to 0.13, p = 0.13, I = 0%, n = 3). However, the HSs group showed a less decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: -17.02%, 95% CI: -22.81, -11.23, p < 0.00001, I = 0%, n = 3).
Both the suture method and HSs may have potential benefits in the preservation of ovarian reserve over the bipolar coagulation method when cystectomy for ovarian endometrioma is performed.
本研究旨在比较卵巢子宫内膜异位囊肿剔除术后采用双极电凝、缝合或止血剂（HSs）对卵巢储备功能的影响。
我们对比较双极电凝与缝合或双极电凝与 HSs 术后血清抗苗勒管激素（AMH）值的研究进行了荟萃分析。通过文献检索，我们共检索到 14 篇符合纳入标准并可进行最终分析的文章。这些文章包括 10 项随机试验、3 项前瞻性研究和 1 项回顾性研究（n=1435）。主要结局为囊肿剔除术后血清 AMH 值。
双极电凝和缝合方法在术后 3、6 和 12 个月时均显示出显著较低的术后血清 AMH 值。然而，与双极电凝组相比，缝合组术后 12 个月时血清 AMH 值显著更高（加权均数差[WMD]：-1.10，95%置信区间[CI]：-1.83，-0.38，p=0.003，I²=89，n=3）。与双极电凝组相比，缝合组在术后 3 个月时的下降率也较低（WMD：-25.13%，95%CI：-49.56 至-0.70，p=0.04，I²=95%，n=2）。总体而言，两组的妊娠率相似。在双极电凝与 HSs 组之间，术后 3 个月时血清 AMH 值相似（WMD：-0.46，95%CI：-1.04 至 0.13，p=0.13，I²=0%，n=3）。然而，HSs 组在术后 3 个月时的下降率较双极电凝组低（WMD：-17.02%，95%CI：-22.81，-11.23，p<0.00001，I²=0%，n=3）。
在进行卵巢子宫内膜异位囊肿剔除术时，与双极电凝法相比，缝合或 HSs 可能具有保留卵巢储备功能的潜在优势。
