腹腔镜电凝术对卵巢子宫内膜异位囊肿和良性卵巢囊肿患者卵巢储备功能的潜在损害：系统评价和荟萃分析。
Potential damage to ovarian reserve from laparoscopic electrocoagulation in endometriomas and benign ovarian cysts: a systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology, South District, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N Rd, Taichung City, 402, Taiwan (R.O.C.).
Institute of Medicine, Chung Shan Medical University, Taichung City, 402, Taiwan (R.O.C.).
出版信息
J Assist Reprod Genet. 2024 Oct;41(10):2727-2738. doi: 10.1007/s10815-024-03227-1. Epub 2024 Aug 15.
PURPOSE
Laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts is often conducted through hemostatic methods, with bipolar electrocoagulation as a common approach. This study evaluated the impact of electrocoagulation, primarily through bipolar energy, versus nonthermal hemostatic methods on ovarian reserve in patients undergoing laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts.
METHODS
A systematic review with meta-analysis was conducted by searching the Cochrane Library, PubMed, EMBASE, and Web of Science databases. Randomized controlled trials (RCTs) comparing the impact of nonthermal hemostatic methods and electrocoagulation on the ovarian reserve during laparoscopic cystectomy were included. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (ROB 2.0) was utilized to assess the quality of the included studies. The meta-analysis included 13 RCTs involving 1043 patients. Postoperative serum anti-Müllerian hormone (AMH) levels and antral follicle counts (AFCs) were analyzed using Review Manager ver. 5.4.
RESULTS
Compared with the bipolar group, patients with endometriomas in the nonthermal hemostatic group exhibited significantly higher postoperative AMH levels at 1, 3, 6, and 12 months. Conversely, no significant differences in AMH levels were observed in patients with benign ovarian cysts. Similarly, AFCs showed no significant differences, except for lower postoperative AFCs in patients with endometrioma in the electrocoagulation group.
CONCLUSION
Nonthermal hemostatic methods are associated with more effective preservation of the ovarian reserve compared with bipolar electrocoagulation in laparoscopic cystectomy for ovarian endometriomas. However, no significant impact of bipolar electrocoagulation on the ovarian reserve was observed in patients with benign ovarian cysts.
TRIAL REGISTRATION
Registered in PROSPERO on April 10, 2023; ID # CRD42023413158.
目的
腹腔镜卵巢子宫内膜异位囊肿和良性卵巢囊肿切除术常采用止血方法，双极电凝是常用的方法。本研究评估了电凝（主要通过双极能量）与非热止血方法对腹腔镜卵巢子宫内膜异位囊肿和良性卵巢囊肿切除术患者卵巢储备的影响。
方法
通过检索 Cochrane 图书馆、PubMed、EMBASE 和 Web of Science 数据库进行系统评价和荟萃分析。纳入比较非热止血方法和电凝对腹腔镜卵巢囊肿切除术中卵巢储备影响的随机对照试验（RCT）。使用 Cochrane 随机对照试验偏倚风险工具（ROB 2.0）评估纳入研究的质量。荟萃分析纳入了 13 项 RCT，共 1043 例患者。使用 Review Manager ver. 5.4 分析术后血清抗苗勒管激素（AMH）水平和窦卵泡计数（AFC）。
结果
与双极组相比，子宫内膜异位症患者中非热止血组术后 1、3、6 和 12 个月时 AMH 水平明显更高。然而，良性卵巢囊肿患者的 AMH 水平无显著差异。同样，AFC 也无显著差异，除了电凝组子宫内膜异位症患者术后 AFC 较低。
结论
与双极电凝相比，非热止血方法在腹腔镜卵巢子宫内膜异位囊肿切除术时更能有效保护卵巢储备。然而，在腹腔镜良性卵巢囊肿切除术中，双极电凝对卵巢储备没有明显影响。
试验注册
2023 年 4 月 10 日在 PROSPERO 注册；编号：CRD42023413158。
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