Wang Jia, Wang Ying Xiang, Wu Hao Tian, Li Xiao Mao
Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, No.600, Tianhe Road, Tianhe District, Guangzhou, 510000, Guangdong Province, China.
Arch Gynecol Obstet. 2025 Jul;312(1):149-158. doi: 10.1007/s00404-024-07926-z. Epub 2025 Jan 31.
The long-term impact of electrocoagulation and suture hemostasis on ovarian reserve (OR) after endometriotic cystectomy remains uncertain. This meta-analysis aimed to compare the short-term and long-term effects of coagulation and suture hemostasis on ovarian reserve based on the postoperative levels of the anti-Müllerian hormone (AMH).
PubMed, MEDLINE, EMBASE, Cochrane, and other databases were searched for eligible studies published up to May 2023.The quality assessment of the RCTs was performed as indicated by the Cochrane Collaboration tool in the Cochrane Handbook. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the non-RCTs. The random-effects or fixed-effects model was used to quantify the weighted mean difference (WMD) at the 95% confidence interval (CI) in the treatment effect across the different studies.
Six randomized controlled trials and two prospective studies were included in this meta-analysis. The meta-analysis showed that there was a statistically significant difference in the AMH levels between the electrocoagulation and the suture group at 1 month (WMD: -0.52, 95%CI (-1.02, -0.01), P = 0.04), 3 months (WMD: -0.72, 95%CI (-1.13, -0.31), P = 0.0005), 6 months (WMD: -0.80, 95%CI (-1.22, -0.38), P = 0.0002) and 12 months (WMD: -0.81, 95%CI (-1.24, -0.37), P = 0.0003), postoperatively. The mean difference of AMH in electrocoagulation group at 1, 3, 6 and 12 months after surgery was -1.75; -1.37; -1.10; -0.92 respectively; meanwhile, in the suture group were -2.50; -2.46; -2.33; -2.24, respectively.
Compared with electrocoagulation, suture hemostasis has less impact on OR. Although the OR of two groups gradually recovered, electrocoagulation still caused more damage to AMH than suture at 12 months after surgery. Suturing could be a better choice after stripping ovarian endometriomas.
电凝止血与缝合止血对子宫内膜异位囊肿剔除术后卵巢储备（OR）的长期影响尚不确定。本荟萃分析旨在基于术后抗苗勒管激素（AMH）水平，比较电凝止血与缝合止血对卵巢储备的短期和长期影响。
检索了PubMed、MEDLINE、EMBASE、Cochrane等数据库，查找截至2023年5月发表的符合条件的研究。按照Cochrane手册中的Cochrane协作工具对随机对照试验（RCT）进行质量评估。使用纽卡斯尔-渥太华量表（NOS）评估非随机对照试验的质量。采用随机效应或固定效应模型，对不同研究中治疗效果的加权平均差（WMD）进行量化，置信区间为95%（CI）。
本荟萃分析纳入了6项随机对照试验和2项前瞻性研究。荟萃分析结果显示，电凝组与缝合组术后1个月（WMD：-0.52，95%CI（-1.02，-0.01），P = 0.04）、3个月（WMD：-0.72，95%CI（-1.13，-0.31），P = 0.0005）、6个月（WMD：-0.80，95%CI（-1.22，-0.38），P = 0.0002）和12个月（WMD：-0.81，95%CI（-1.24，-0.37），P = 0.汗）时的AMH水平存在统计学显著差异。电凝组术后1、3、6和12个月的AMH平均差值分别为-1.75、-1.37、-1.10、-0.92；同期，缝合组分别为-2.50、-2.46、-2.33、-2.24。
与电凝止血相比，缝合止血对卵巢储备的影响较小。虽然两组的卵巢储备功能逐渐恢复，但术后12个月时，电凝止血对AMH的损伤仍大于缝合止血。在剥除卵巢子宫内膜瘤后，缝合可能是更好的选择。
