Systematic Review Of The Effects Of Different Hemostasis Methods On Ovarian Reserve Function During Ovarian Endometriosis Cyst Stripping

Objective:Ovarian endometriosis cyst is the main pathological change after endometriosis invades ovarian tissue.Ectopic endometrial tissue causes the decrease of ovarian reserve function by invading ovarian cortex,and severe cases may lead to infertility.When the pain caused by endometriosis or infertility is ineffective after conservative treatment,it may cause further decline of ovarian reserve function,and severe cases may lead to premature ovarian failure and infertility.Especially,when laparoscopic ovarian endometriotic cyst removal is performed,energy instruments are often used to stop bleeding during the operation,which causes thermal damage to the tissues around the lesion,thus causing functional deterioration of residual ovarian tissues.In order to explore the influence of hemostatic methods on ovarian reserve function,the previous literatures were summarized and analyzed by Meta-analysis,and the effects of bipolar electrocoagulation,ultrasonic scalpel and suture on ovarian reserve function were evaluated by taking AMH and AFC as evaluation indexes.So as to guide the selection of appropriate hemostatic methods for protecting ovarian reserve function in clinical work.Methods:According to our selected topics,we determined keywords and search strategies,searched Pubmed,Cochrane Library,CNKI,Wanfang and other databases from January 2009 to September 2020,selected them by inclusion criteria and exclusion criteria,and evaluated their quality by Cochrane risk bias assessment tool,obtained the included documents,and extracted the relevant data information of the included documents.By using Revman5.3software to analyze the data,the effects of bipolar electrocoagulation,ultrasonic scalpel and suture on ovarian reserve function were compared in pairs,so as to find the hemostatic method with the least effect on ovarian reserve function.Results:1.The results of AMH value in electrocoagulation group and ultrasonic scalpel group showed that there was no difference in AMH value between electrocoagulation group and ultrasonic scalpel group at 3,6 and 12 months after operation.2.During the whole follow-up period,the level of AMH in suture group was higher than that in electrocoagulation group.The total effect of the whole follow-up period was MD = 0.52,95% CI(0.04,0.99),P < 0.1,which indicated that the AMH in suture group was higher than that in electrocoagulation group.3.AMH values of suture hemostasis group were higher than those of ultrasonic scalpel hemostasis at 3 and 6 months after operation,but there was no significant difference between them at 12 months after operation.4.The results of AFC value in electrocoagulation group and ultrasonic scalpel group showed that there was no difference in AFC value level between electrocoagulation group and ultrasonic scalpel group at 3,6 and 12 months after operation.5.The AFC value of the suture group was higher than that of the electrocoagulation group in the whole follow-up period.The total effect of the whole follow-up period was MD = 1.72,95% CI(1.59,1.85),P < 0.00001,which indicated that the AFC value of the suture group was higher than that of the electrocoagulation group after operation.6.The AFC value of suture hemostasis group was higher than that of ultrasonic scalpel hemostasis group in the whole follow-up period.The total effect of the whole follow-up period was MD = 1.60,95% CI(1.28,1.93),P <0.00001,which indicated that the AFC value of suture hemostasis group was higher than that of ultrasonic scalpel hemostasis group after operation..Conclusion:In laparoscopic ovarian endometriosis cyst removal,suture hemostasis,electrocoagulation hemostasis and ultrasonic scalpel hemostasis show that suture hemostasis has the least effect on ovarian reserve function.There is no significant difference between electrocoagulation hemostasis and ultrasonic scalpel hemostasis on ovarian reserve function.