论文部分内容阅读
目的:评估腹腔镜卵巢打孔术(laparoscopic ovarian drilling,LOD)与药物治疗克罗米酚抵抗的多囊卵巢综合征(clomiphene citrate resistant-polycystic ovarian syndrome,CCR-PCOS)临床疗效,为临床治疗提供依据。方法:检索2000年1月起至2015年8月Pubmed、中国生物医学文献数据库、中国学术期刊全文数据库、万方数据库中有关CCR-PCOS通过LOD与药物治疗的随机对照试验的文献。运用Rev Man 5.0软件进行Meta分析,对两者的临床疗效包括多胎妊娠率、活胎率、妊娠率、流产率、排卵率、OHSS发生率、子宫内膜厚度和正常月经周期率进行综合评估。结果:本研究纳入了17篇随机对照研究。Meta分析结果表明:LOD组的多胎妊娠率低于药物组(RR=0.22,95%CI=0.09~0.54,P=0.001),子宫内膜厚度小于药物组(WMD=-1.88,95%CI=-2.84~-0.91,P=0.000);活胎率、妊娠率、流产率、排卵率、OHSS发生率、和正常月经周期率LOD组和药物组间差异无统计学意义。结论:LOD能降低多胎妊娠率,且减少子宫内膜厚度,但在活胎率、妊娠率、流产率、排卵率、OHSS发生率、和正常月经周期率方面与药物组相似。本次结果受纳入研究质量限制,尚需更多高质量、大样本、多中心随机对照试验验证。
Objective: To evaluate the clinical efficacy of laparoscopic ovarian drilling (LOD) and clomiphene citrate resistant polycystic ovarian syndrome (CCR-PCOS) for clinical treatment in accordance with. Methods: The literature of randomized controlled trials of CCR-PCOS by LOD and drug therapy was searched from Pubmed, China Biomedical Literature Database, Chinese Academic Journal Full-text Database, Wanfang database from January 2000 to August 2015. Meta-analysis was performed using RevMan 5.0 software, and the clinical efficacy of the two methods was evaluated comprehensively including multiple pregnancy rate, live birth rate, pregnancy rate, abortion rate, ovulation rate, OHSS incidence, endometrial thickness and normal menstrual cycle rate. Results: Seventeen RCTs were included in this study. The results of Meta analysis showed that the multiple pregnancy rate in LOD group was lower than that in drug group (RR = 0.22, 95% CI = 0.09-0.54, P = 0.001) and the thickness of endometrium was lower than that in drug group (WMD = -1.88,95% CI = -2.84 ~ -0.91, P = 0.000). There was no significant difference between LOD group and drug group in terms of live birth rate, pregnancy rate, abortion rate, ovulation rate, OHSS incidence rate and normal menstrual cycle rate. CONCLUSIONS: LOD can reduce multiple pregnancy rates and reduce endometrial thickness, but similar to drug groups in terms of live, pregnancy, abortion, ovulation, OHSS, and normal menstrual cycle rates. The results are limited by the quality of the study and require more high-quality, large sample, multicenter randomized controlled trials.