子宫内膜异位症和良性卵巢囊肿腹腔镜电凝术对卵巢储备功能的潜在损害:系统回顾和荟萃分析。

IF 3.2 3区 医学 Q2 GENETICS & HEREDITY Journal of Assisted Reproduction and Genetics Pub Date : 2024-10-01 Epub Date: 2024-08-15 DOI:10.1007/s10815-024-03227-1
Yu-Hsuan Lin, Li-Hsin Hsia, Yun-Yao Huang, Hao-Jung Chang, Tsung-Hsien Lee
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引用次数: 0

摘要

目的:针对卵巢子宫内膜异位症和良性卵巢囊肿的腹腔镜囊肿切除术通常通过止血方法进行,双极电凝是一种常用方法。本研究评估了电凝(主要通过双极能量)与非热止血方法对接受腹腔镜卵巢子宫内膜异位症和良性卵巢囊肿囊肿切除术患者卵巢储备功能的影响:通过检索 Cochrane 图书馆、PubMed、EMBASE 和 Web of Science 数据库,进行了一项系统综述和荟萃分析。纳入的随机对照试验(RCT)比较了腹腔镜囊肿切除术中非热止血方法和电凝对卵巢储备的影响。科克伦随机对照试验偏倚风险工具(ROB 2.0)用于评估纳入研究的质量。荟萃分析包括13项随机对照试验,涉及1043名患者。术后血清抗缪勒氏管激素(AMH)水平和前卵泡计数(AFCs)使用Review Manager ver.5.4.结果:与双极组相比,非热止血组的子宫内膜异位症患者在术后 1、3、6 和 12 个月的 AMH 水平明显更高。相反,良性卵巢囊肿患者的 AMH 水平则无明显差异。同样,除电凝组子宫内膜异位症患者术后 AFCs 较低外,其他患者的 AFCs 也无明显差异:结论:在卵巢子宫内膜异位症的腹腔镜囊肿切除术中,非热止血法比双极电凝法能更有效地保留卵巢储备功能。然而,在良性卵巢囊肿患者中,双极电凝对卵巢储备功能没有明显影响:试验注册:2023 年 4 月 10 日在 PROSPERO 注册;ID # CRD42023413158。
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Potential damage to ovarian reserve from laparoscopic electrocoagulation in endometriomas and benign ovarian cysts: a systematic review and meta-analysis.

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.

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来源期刊
CiteScore
5.70
自引率
9.70%
发文量
286
审稿时长
1 months
期刊介绍: The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species. The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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