腹腔镜不同术式治疗卵巢子宫内膜异位囊肿疗效及安全性的系统评价

目的系统评价腹腔镜手术治疗卵巢子宫内膜异位囊肿的疗效及安全性。方法计算机检索The Cochrane Library、MEDLINE（1966～2011．11）、EMbase（1980～2011．11）、CNKI（1980—2011．11）、CBM（1980—2011．11）和WanFangData（1978～2011．11），并手T检索相关文献，收集关于腹腔镜卵巢子宫内膜异位囊肿剥除术与凝同术比较治疗卵巢子宫内膜异位囊肿疗效及安全性的随机对照试验（RCT），检索时限截至2011年11月。南2位研究者根据纳入与排除标准筛选文献、提取资料并评价质量后，采用RevMan5．1软件进行Meta分析。结果最终纳入5个研究。Meta分析结果显示：腹腔镜卵巢子宫内膜异位囊肿剥除术能降低子宫内膜异位症患者的痛经复发率[RR=0．29，95％CI（0．15，0．55），P=0．0002]、性交痛复发率[RR=0．27，95％CI（0．09，0．77），P=0．01]、非经期盆腔痛复发率[RR=0．19，95％CI（0．05，0．76），P=0．02]、卵巢子宫内膜异位囊肿术后1、2年复发率[1年：RR=0．33，95％CI（0．15，O．74），P=0．007；2年：RR=0．49，95％CI（0．26，0．95），P=0．03]以及短期再次手术风险[RR=0．25，95％CI（0．07，O．85），P=0．03]，并增加不孕患者术后12个月和24个月的自然妊娠率[术后12个月：RR=2．82，95％CI（1．44，5．50），P=0．002；术后24个月：RR=2．62，95％CI（1．47，4．68），P=0．001]。此外，患者腹腔镜子宫内膜异位囊肿凝固术后6个月的卵巢储备功能优于剥除术[WMD=-4．26，95％CI（-5．98，-2．55），P〈0．00001），但两者术后5年的卵巢储备功能差异无统计学意义[WMD=0．27，95％CI（-0．18，0．73），P=0．24]。结论腹腔镜子宫内膜异位囊肿剥除术能减少患者痛经、性交痛、非经期盆腔痛以及子宫内膜异位症的复发，还能降低短期再次手术的风险，并增加确诊为不孕患者的术后自然妊娠率。鉴于现有临床研究数量尚少，上述结论尚需开展更多高质量RCT加以验证。

Effectiveness and Safety of Different Laparoscopic Surgeries for Ovarian Endometrioma: A Systematic Review

Objective To systematically review the effectiveness and safety of different laparoscopic surgeries for ovarian endometrioma （OE）. Methods Such databases as The Cochrane Library （Issue 3, 2011）, MEDLINE （1966 to November 2011）, EMbase （1980 to November 2011）, CNKI （1980 to November 2011）, GBM （1980 to November 2011） and WanFang Data （1978 to November 2011） were searched on computer, and the relevant references of the included literature were also retrieved manually to collect the randomized controlled trials （RCTs） about laparoscopic cystectomy vs. laparoscopic coagulation for OE. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs were included. The results of meta-analysis showed that, laparoscopic cystectomy for OE could reduce the reocurrence rates of dysmenorrhoea （RR=0.29, 95%CI 0.15 to 0.55, P=0.000 2）, dyspareunia （RR=0.27, 95% CI 0.09 to 0.77, P=0.01） and non-menstrual pelvic pain （RR=0.19, 95% CI 0.05 to 0.76, P=0.02）, decrease 1-year （RR=0.33, 95%CI 0.15 to 0.74, P=0.007） and 2-year （RR=0.49, 95%CI 0.26 to 0.95, P=O.03） postoperative reoccurence of OE, and lower the risk of short-term secondary operation （RR=0.25, 95%CI 0.07 to 0.85, P=0.03）. However, it didn＇t increase the 12-month （RR=2.82, 95%CI 1.44 to 5.50, P=0.002） and 24-month （RR=2.62, 95%CI 1.47 to 4.68, P=0.001） postoperative spontaneous pregnancy rates （SPR）. In addition, although laparoscopic coagulation was superior to laparoscopic cystectomy in the 6-month postoperative ovarian reserve function （ORF）, there was no significant difference in the 5-year postoperative ORF between the two groups （WMD=0.27, 95%CI -0.18 to 0.73, P=0.24）. Conclusion Laparoscopic cystectomy for OE can reduce the reoccurence of dysmenorrhoea, dyspareunia, non-menstrual pelvic pain and endometriosis, decrease the risk of short-term secondary operation, and increase the postoperative SPR in women who had been diagnosed as infertility. Because of the quantity limitation of present clinical trials, this conclusion requires to be further proved by performing more high quality RCTs.