| Purpose:Benign ovarian cyst is a common tumor occurrs in female reproductive organs,especially in women of reproductive age.Laparoscopic excision of ovarian cyst is often used in clinic,but there is no consensus on the choice of hemostasis after cyst removal.Whether the different hemostatic methods of the wound after cyst exfoliation will have different effects on the ovarian reserve function and the fertility of the patients,and whether the appropriate hemostatic method can be chosen to give better protection to the ovary has been paid more and more attention.In this paper,the effects of bipolar electrocoagulation and suture on ovarian function in laparoscopic ovarian cystectomy were compared by systematic analysis of published literature,in order to provide evidence-based basis for the choice of intraoperative hemostasis and to maximize the protection of ovarian function.Method:Using computer to retrieve English databases such as Pubmed、Web of science 、 Embase Library and Chinese databases such as Wanfang Medical Network,China Zhiwang(CNKI),a randomized controlled trial of hemostasis in laparoscopic ovarian cyst exfoliation was included,and relevant references were retrieved manually.The retrieval time is from the beginning of database construction to January 2021.the retrieved literature was screened,evaluated and comprehensively analyzed according to the Cochrane systematic evaluation method.the data of the screened literature were divided into bipolar electrocoagulation group and suture group according to the different methods of intraoperative hemostasis.finally,the included research was Meta analyzed using statistical software Review Mananger 5.4.Results:After screening,a total of 12 papers were included,including 8English papers and 4 Chinese papers,all of which were randomized controlled studies.Patients were divided into two groups according to different hemostatic methods used in laparoscopic ovarian cyst removal:bipolar electrocoagulation group(625 cases)and suture group(624cases),with a total of 1249.Meta-analysis results are as follows:Meta analysis results are as follows :(1)Comparison between the two groups,the AMH level after 1 month,suture group is higher than the bipolar electrocoagulation group,the difference is statistically significant(SMD=0.66,95%CI[0.51,0.82],P<0.00001);(2)Comparison between the two groups,the AMH level after 3 months,suture group is higher than the bipolar electrocoagulation group,the difference is statistically significant(SMD=0.47,95%CI[0.21,0.74],P=0.0004);(3)Comparison between the two groups,AMH level of 6 months after surgery,the difference is not statistically significant(SMD=0.40,95%CI[-0.04,0.85],P=0.07);(4)Comparison between the two groups,the AFC level after 1month,suture group is higher than the bipolar electrocoagulation group,the difference is statistically significant(SMD=0.33,95%CI[0.17,0.49],P<0.0001);(5)Comparison between the two groups,the AFC level after3 months,suture group is higher than the bipolar electrocoagulation group,the difference is statistically significant(SMD=0.37,95%CI[0.03,0.70],P=0.03);(6)Comparison between the two groups,the AFC level after 6months,suture group is higher than the bipolar electrocoagulation group,the difference is statistically significant(SMD=0.50,95%CI[0.25,0.74],P<0.0001).Conclusion1.Laparoscopic cystectomy will have a certain effect on ovarian reserve function in the short term with suture hemostasis or electrocoagulation hemostasis.And the ovarian function can be adjusted and restored slowly with the progress of time.But whether it can be restored to preoperative level needs to be studied.2.Compared with the two methods of hemostasis,suture hemostasis has little damage to ovarian function.3.For women with fertility requirements,suture instead of bipolar coagulation hemostasis is best used to reduce the effect on ovarian ovulation. |
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