临时卵巢悬吊术减少子宫内膜异位症手术后粘连的Meta分析

摘要

目的:通过Meta分析综合评价临时卵巢悬吊术是否能减少子宫内膜异位症(EMs)患者腹腔镜术后的卵巢粘连.方法:检索PUBMED、MEDLINE、EMBASE、the ISIWeb of Science、Ovid、Cochrane Library、中国知网(CNKI)、万方全文数据库、维普中文科技期刊数据库、中国生物医学文献数据库、中国期刊全文数据库和Google学术搜索等,并辅以手工检索.检索时间截至2017年12月,收集关于临时卵巢悬吊术预防腹腔镜手术治疗EMs术后卵巢粘连的随机对照试验(RCT).由2名研究者按Cochrane系统评价方法提取数据进行Meta分析.结果:共纳入4篇RCT,共计302例患者.结果显示:临时卵巢悬吊术能降低EMs患者腹腔镜治疗后卵巢粘连的发生(RR=0.75,95％CI:0.64～0.87),可能有效缓解EMs患者腹腔镜术后大便困难(RR=-0.30,95％CI:-0.58～-0.02),但并不一定能缓解患者痛经(RR=-0.75,95％CI:-1.92～0.41)、慢性盆腔疼痛(RR=-0.77,95％CI:-1.88～0.35)、性交困难(RR=l.25,95％CI:-0.86～3.37)及尿痛(RR=-1.51,95％CI:-4.22～1.20).结论:运用临时卵巢悬吊术能减少腹腔镜治疗EMs患者术后卵巢粘连的发生,改善患者大便困难的症状,一定程度提高患者生活质量.%Objective:To evaluate the effectiveness of temporary ovarian suspension in reducing the postoperative adhesions of laparoscopy in those patients with endometriosis.Methods:We searched PUBMED,MEDLINE,EMBASE,the ISI Web of Science,Ovid,Cochrane Library,CNKI,Wanfang Data,VIP database and CBM and so on,using the keywords "ovarian suspension","laparoscopy","endometriosis" and "pelvic adhesions",to identify studies involving human subjects published in English between January 1950 and December 2017.No restrictions on language or time were applied.The selection criteria included the randomized controlled trials (RCTs) that compared the effectiveness of temporary ovarian suspension in reducing the postoperative adhesions of laparoscopy in patients with endometriosis.Meta-analysis was performed by two investigators using data from the cochrane systematic review.Results:We included four RCTs involving 302 patients in the meta-analysis.Temporary ovarian suspension significantly lowered the incidence rate of laparoscopy postoperative adhesions in severe endometriosis (RR=0.75,95％CI:0.64～0.87).The dyschezia was more effectively alleviated (RR=-0.30,95％CI:-0.58～-0.02).However,dysmenorrhea (RR=-0.75,95％CI:-1.92～0.41),chronic pelvic pain (RR=-0.77,95％CI:-1.88～0.35),dyspareunia (RR=l.25,95％CI:-0.86～3.37) and dysuria (RR=-1.51,95％CI:-4.22～1.20) were not significantly relieved.Conclusions:Temporary ovarian suspension is an effective technique in preventing the postoperative adhesion in endometriosis women,with the reduced dyschezia,in which the life quality of patients was improved.