腹腔镜手术和开腹手术治疗多囊卵巢综合征的系统评价_中国循证医学杂志

作者：

曾庆媛 ¹ ,  许良智 ² , 张楠楠 ³

1. 成都军区总医院妇产科（成都 610083）；2. 四川大学华西第二医院生殖内分泌及计划生育科（成都 610041）；3.成都军区总医院医务部（成都 610083）;

关键词：

多囊卵巢综合征腹腔镜手术剖腹术非随机对照试验系统评价

DOI：

10.7507/1672-2531.20100607

视频：

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目的　评价腹腔镜手术和开腹手术治疗多囊卵巢综合征（polycystic ovarian syndrome，PCOS）的近期和远期疗效以及并发症发生率，为临床实践提供依据。
方法　计算机检索OVID、MEDLINE、EMbase、Cochrane图书馆（2008第2期）、CBM、CNKI、VIP以及万方数字化期刊全文库等数据库。手工检索相关期刊和会议文献，并检索相关综述及所获文献的参考文献。纳入相关随机和非随机对照试验，文献发表时间和语言不限。采用RevMan 5.0进行统计分析。
结果　最终纳入5个非随机试验，包括417例患者。Meta分析结果显示：① 非长期随访亚组：腹腔镜组术后累计妊娠率高于开腹组，差异有统计学意义［RR=1.42，95%CI（1.13，1.80），P=0.003］；长期随访亚组：腹腔镜组术后累计妊娠率与开腹组相似，差异无统计学意义［RR=0.85，95%CI（0.68，1.07），P=0.17］；② 腹腔镜组术后规律月经恢复率与开腹组差异无统计学意义［RR=0.91，95%CI（0.79，1.05），P=0.18］；③ 腹腔镜组术后子宫周围粘连发生率明显低于开腹组，差异有统计学意义［RR=0.02，95%CI（0.00，0.18），P=0.000 2］；④ 腹腔镜组术后腹腔内粘连发生率明显低于开腹组，差异有统计学意义［RR=0.02，95%CI（0.00，0.13），P lt;0.000 1］。
结论　目前证据显示，腹腔镜手术治疗PCOS不孕患者，术后粘连的发生率和程度均小于开腹手术；术后累计妊娠率是否优于开腹手术尚不能肯定；单个研究显示，术后规律月经恢复率远期疗效不如开腹手术，有待更多高质量多中心的随机双盲对照试验进一步证实。

引用本文： 曾庆媛,许良智,张楠楠. 腹腔镜手术和开腹手术治疗多囊卵巢综合征的系统评价. 中国循证医学杂志, 2010, 10(12): 1425-1431. doi: 10.7507/1672-2531.20100607 复制

1.	Franks S. Polycystic ovary syndrome. N Engl J Med, 1995, 333: 853-861.
2.	许良智, 张静. 多囊卵巢综合征. 现代临床医学, 2006, 32(4): 311-314.
3.	Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome. Obstet Gynecol Surv, 1998, 53(5): 297-308.
4.	Guzick DS. Ovulation induction management of PCOS. Clin obstet gynecol, 2007, 50(1): 255-267.
5.	Imani B, Eijkemans MJC, te Velde ER, et al. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol and Metab, 1998, 83(7): 2361-2365.
6.	Lobo RA, Gysler M, March CM, et al. Clinical and laboratory predictors of clomiphene response. Fertil Steril, 1982, 37: 168-174.
7.	Hughes E, Collins J, Vandekerckhove P, et al. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev, 2000 (2) (CD000056).
8.	Pritts EA. Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv, 2002, 57(9): 587–597.
9.	Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome. Lancet, 2007, 370(9588): 685-697.
10.	Stein IF, Cohen MR. Surgical treatment of bilateral polycystic ovaries. Am J Obstet Gynecol, 1939, 38: 465-473.
11.	Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril, 1984, 49: 956-960.
12.	Api M, Gorgen H, Certin A. Laparoscopic ovarin drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol, 2005, 119(1): 76-81.
13.	The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004, 19(1): 41-47.
14.	Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7( 27): iii-x, 1-173.
15.	Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
16.	Alieva EA, Pshenichnikova Tla, Gasparov AS. Results of laparoscopy in patients with polycystic ovary syndrome after surgical treatment, akush ginekol, 1990, 7: 63-66.
17.	Kentaro T, Nobuyuki K, Fuminori K, et al. A comparative study using early second-look laparoscopic evaluation of postoperative adhesion formation between two surgical procedures for polycystic ovarian syndrome. Obstet Gynecol Surv, 2007, 62(7): 443-445.
18.	冯淑英, 邝健全, 翁梅英, 等. 两种手术方式治疗多囊卵巢综合征的远期疗效追踪比较. 中山大学学报(医学科学版), 2004, 25(3): 260-263.
19.	童莉, 卢海明, 朱进梅, 等. 多囊卵巢综合征所致不孕症腹腔镜手术与开腹手术的对比研究. 实用医学杂志, 2005, 21(20): 2321-2322.
20.	于红, 任慕兰. 两种手术方式治疗多囊卵巢综合征. 东南大学学报, 2004, 23(6): 417-418.
21.	Buttram VC Jr, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril, 1975, 26(9): 874-876.
22.	Amer S A, Gopalan V, Li T C, et al. Long term follow-up of patiens with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod, 2002, 17(8): 2035-2042.
23.	The American Fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril, 1988, 49(6): 944-955.
24.	Creenblatt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril, 1993, 60(2): 766-770.
25.	张梅莹, 狄文. 手术治疗多囊卵巢综合征的评估. 中国妇幼健康研究, 2007, 18(1): 51-54.
26.	Dabirashrafi H. Complication of laparoscopic ovarian cauterization. Fertil Steril, 1989, 52: 878-880.
27.	Mike Clark. 非随机对照试验和诊断性试验准确度系统评价的新挑战. 中国循证医学杂志, 2006, 6(4): 240-242.

1. Franks S. Polycystic ovary syndrome. N Engl J Med, 1995, 333: 853-861.
2. 许良智, 张静. 多囊卵巢综合征. 现代临床医学, 2006, 32(4): 311-314.
3. Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome. Obstet Gynecol Surv, 1998, 53(5): 297-308.
4. Guzick DS. Ovulation induction management of PCOS. Clin obstet gynecol, 2007, 50(1): 255-267.
5. Imani B, Eijkemans MJC, te Velde ER, et al. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol and Metab, 1998, 83(7): 2361-2365.
6. Lobo RA, Gysler M, March CM, et al. Clinical and laboratory predictors of clomiphene response. Fertil Steril, 1982, 37: 168-174.
7. Hughes E, Collins J, Vandekerckhove P, et al. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev, 2000 (2) (CD000056).
8. Pritts EA. Treatment of the infertile patient with polycystic ovarian syndrome. Obstet Gynecol Surv, 2002, 57(9): 587–597.
9. Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome. Lancet, 2007, 370(9588): 685-697.
10. Stein IF, Cohen MR. Surgical treatment of bilateral polycystic ovaries. Am J Obstet Gynecol, 1939, 38: 465-473.
11. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril, 1984, 49: 956-960.
12. Api M, Gorgen H, Certin A. Laparoscopic ovarin drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol, 2005, 119(1): 76-81.
13. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004, 19(1): 41-47.
14. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7( 27): iii-x, 1-173.
15. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
16. Alieva EA, Pshenichnikova Tla, Gasparov AS. Results of laparoscopy in patients with polycystic ovary syndrome after surgical treatment, akush ginekol, 1990, 7: 63-66.
17. Kentaro T, Nobuyuki K, Fuminori K, et al. A comparative study using early second-look laparoscopic evaluation of postoperative adhesion formation between two surgical procedures for polycystic ovarian syndrome. Obstet Gynecol Surv, 2007, 62(7): 443-445.
18. 冯淑英, 邝健全, 翁梅英, 等. 两种手术方式治疗多囊卵巢综合征的远期疗效追踪比较. 中山大学学报(医学科学版), 2004, 25(3): 260-263.
19. 童莉, 卢海明, 朱进梅, 等. 多囊卵巢综合征所致不孕症腹腔镜手术与开腹手术的对比研究. 实用医学杂志, 2005, 21(20): 2321-2322.
20. 于红, 任慕兰. 两种手术方式治疗多囊卵巢综合征. 东南大学学报, 2004, 23(6): 417-418.
21. Buttram VC Jr, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril, 1975, 26(9): 874-876.
22. Amer S A, Gopalan V, Li T C, et al. Long term follow-up of patiens with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod, 2002, 17(8): 2035-2042.
23. The American Fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril, 1988, 49(6): 944-955.
24. Creenblatt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril, 1993, 60(2): 766-770.
25. 张梅莹, 狄文. 手术治疗多囊卵巢综合征的评估. 中国妇幼健康研究, 2007, 18(1): 51-54.
26. Dabirashrafi H. Complication of laparoscopic ovarian cauterization. Fertil Steril, 1989, 52: 878-880.
27. Mike Clark. 非随机对照试验和诊断性试验准确度系统评价的新挑战. 中国循证医学杂志, 2006, 6(4): 240-242.

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腹腔镜手术和开腹手术治疗多囊卵巢综合征的系统评价

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