| Objectives:Adnexal mass is a gynecological disease with a high incidence in women.Persistent adnexal masses during pregnancy may lead to torsion,rupture and delivery obstruction,which may pose a potential threat to the life and health of pregnant women and fetuses.The treatment methods of adnexal masses during pregnancy include laparotomy and laparoscopy.Laparoscopic surgery in pregnancy is still controversial to some extent.So our study analyzed and evaluated the efficacy and safety of laparoscopic surgery and laparotomy for the treatment of pregnant adnexal masses,aiming to provide an ideal surgical method for the treatment of pregnant adnexal mass.Methods:Database of Medline,CENTRAL,Embase,CNKI,Wan Fang and VIP were retrieved by computer and manual on the corresponding retrieval platform.The EndNoteX9 software was used to screen the retrieved literature in strict accordance with the screening flow chart,inclusion criteria and exclusion criteria.And then the included literature was obtained.Two researchers independently evaluated the quality of the included literature according to different study types and extracted the basic information and data of the included literature for data summary.Meta-analysis of statistics was performed using Review Manager 5.3 software.The differences of surgical outcome indexes and pregnancy outcome indexes between the two groups were analyzed and compared,and the OR,Cl and MD were used to describe them.Results:1.Finally,sixteen studies were included,of which eight references were published by English and eight references by Chinese.According to the study type,the included literatures were divided into 4 randomized controlled studies and 12 retrospective case-control studies.Two of the randomized controlled studies had a Jadad quality score of 3,while the other 14 were of medium or high quality.A total of 1241 patients were included,549 patients with laparoscopy and 692 patients with laparotomy.2.The analysis of surgery outcomes suggested that there was no significant difference in the surgery time of laparoscopy and laparotomy(MD=-1.08,CI=(-10.12,7.96),P=0.81).Laparoscopic intraoperative blood loss less than laparotomy group(MD=31.50,CI=(53.71,9.30),P=0.005).Compared with the laparotomic group,the laparoscopic group had shorter hospital stays(MD=-2.51,CI=(-2.86,-2.17),P<0.00001)and the anus exhaust time(MD=12.05,Cl=(19.66,4.44),P=0.002).Besides,laparoscopy was superior to laparotomy in reducing the postoperative complications(OR=0.16,CI=(0.09,0.28),P<0.00001).3.There was no significant difference in the incidence of abortion between the two groups(OR=0.70,CI=(0.37,1.32),P=0.27),but the incidence of preterm birth in laparoscopic treatment group was lower than open surgery group(OR=0.47,CI=(0.29,0.77),P=0.003).There was no significant difference between the two groups in terms of gestational week at delivery(MD=-0.17,CI=(-0.57,0.22),P=0.40),neonatal birth weight(MD=-15.41,CI=(-92.27,61.45),P=0.69)and cesarean section rate(OR=1.01,CI=(0.74,1.40),P=0.93).Conclusion:Laparoscopic surgery is safe and effective for adnexal masses during pregnancy.It has unique and obvious advantages in reducing intraoperative blood loss,shortening hospital stay and reducing postoperative complication rate.Laparoscopic surgery showed no significant increase in miscarriage rates and a decrease in preterm birth rates compared to open surgery.Therefore,laparoscopic surgery is an ideal treatment of adnexal masses during pregnancy. |
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