Effect Of Laparoscopic Cystectomy Of Ovarial Endometrioma On Ovarian Reserve: A Meta-analysis

【Objective】Endometriosis is a disorder in which hormonally responsive endometrial tissue is found outside the uterus.The most common site of this disease is ovary.Stripping the ovarian cyst wall by laparoscopic approach is the first line choice.However,many researches show that the surgery may decrease ovarian reserve during hemostasis.This Meta-analysis is to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy.【Method】Search electronic databases（Pubmed、EMBASE、Cochrane Library、CNKI、Wang Fang、VIP）and scan reference lists of articles about the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy written by English and Chinese from the establishing time of database to September 2019.Literature screening,data extraction and quality evaluation were based on inclusion and exclusion criteria by two reviewers respectively.Then meta-analysis was performed by Reviewer Manager 5.3 software.【Result】A total of 14 randomized controlled trials involving 1377 patients were included in the meta-analysis.Results showed a significant decrease in AMH and AFC and a significant increase in FSH in the comparison between bipolar coagulation and suture.Except the AFC level in the 1^st month show no difference between ultrasonic energy and suture,pooled analysis showed the level of AFC in the 3^rd,6^thand 12^th month after surgery and the level of AMH were lower in the ultrasonic energy group than in the suture group while the FSH level was higher.The AMH, FSH and AFC showed no different between bipolar coagulation and ultrasonic energy.And the use of hemostatic sealants was not superior to the use of bipolar coagulation in protecting the ovarian reserve. Meta-analysis showed a significant increase in AMH in the comparison between the 6^th month and the 1^st month after bipolar coagulation,while no difference between the 3^rd or 6^th month and the 1^st month.In the 3^rd,6^th and 12^th month after ultrasonic energy,the AMH was significantly increased compared by the 1^st month.There is no different in AMH until 12 months after suture.The AMH in the 3^rd month was not superior to that in the 1^st month after using Floseal.【Conclusion】1.Different methods of hemostatic show different influence during laparoscopic cystectomy of ovarian endometrioma.2.Bipolar coagulation and ultrasonic energy are more harmful than suture in ovarian reserve.And there is no difference between bipolar coagulation and ultrasonic energy on the effect of ovarian reserve.3.The use of hemostatic sealants are no better than the use of bipolar coagulation in protecting ovarian reserve.4.Suture can reduce the decrease of ovarian reserve.5.AMH,FSH and AFC are do well in evaluating ovarian reserve.6.There was a trend of recovery of ovarian function in 3 months after ultrasonic energy or 12 months after suture.There is no trend of recovery of ovarian reserve in 3 months after the use of hemostatic sealants or 12 months after bipolar coagulation.