腹腔镜诊断不明原因女性不孕症的系统评价

发布时间：2018-07-03 18:08

本文选题：腹腔镜 + 不明原因　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:通过系统评价探讨腹腔镜对不明原因女性不孕症诊断价值的综合效能;了解腹腔镜对不明原因女性不孕症的诊断实效性以及与现有诊断方法比较的优势,为今后不明原因女性不孕症的诊断和治疗方案的选择提供重要的依据。方法:制定检索式,通过检索PubMed、Cochrane Library、Wed of Science、CNKI、WanFang Data及CBM数据库中的关于腹腔镜与不明原因女性不孕症的文献。文献检索时间均为建库至2017年3月1日。严格按照制定的纳入标准和排除标准,对国内外已发表的文献进行筛选、质量评价、异质性分析并提取相关临床研究的基本资料。对符合病例对照研究的文献利用Rev Man 5.3软件对腹腔镜与妊娠率进行meta分析。通过RevMan 5.3软件计算合并的比值比(Odds Ratio,OR)及其95%可信区间(Confidence Interval,CI),并对数据合并结果进行分析,讨论两者之间的关联强度。结果:本研究共纳入文献13篇,实施腹腔镜检的不明原因女性不孕症患者共2104例,术中发现盆腔异常1354,盆腔正常750例,其中盆腔异常以子宫内膜异位症为主,共789例,其次为盆腔粘连、输卵管因素、盆腔结核、多囊卵巢、卵巢囊肿、子宫肌瘤等,其中有10篇文献进行术后妊娠率的研究,妊娠率为45.8%-75.5%,平均约60%,3篇未研究妊娠结局。有3篇文献为临床对照试验,纳入meta分析合并数据结果显示腹腔镜与妊娠率变化无统计学差异,OR=1.39,95%CI=[0.69,2.83],P=0.36,I2=86%,研究变量之间存在较大的异质性,提示数据合并结果可信性差,原则上不能进行数据的合并分析。结论:腹腔镜能够较为准确的发现并处理不明原因女性不孕症患者的隐秘性盆腔异常,解除可能影响妊娠的盆腔因素,具有明确的诊断价值和一定的治疗价值,为今后不明原因女性不孕症的诊断和治疗方案的选择提供重要的依据。
[Abstract]:Objective: to explore the comprehensive efficacy of laparoscopy in the diagnosis of female infertility of unknown cause through systematic evaluation, and to understand the effectiveness of laparoscopy in the diagnosis of female infertility of unknown cause and its advantages compared with the existing diagnostic methods. To provide important basis for the diagnosis and treatment of unexplained female infertility in the future. Methods: a search method was established to search the literature on laparoscopy and unexplained female infertility in PubMedine Cochrane Library Wed of Science of CNKI Wan Fang and CBM database. The retrieval time of literature was built to March 1, 2017. According to the standards of inclusion and exclusion, the literature published at home and abroad were screened, evaluated, and heterogeneity were analyzed and the basic data of related clinical studies were extracted. The meta analysis of laparoscopy and pregnancy rate was carried out by using the software Rev Man 5.3. The odds ratio (OR) and its 95% confidence interval (CI) were calculated by RevMan 5.3 software. The results of data merging were analyzed and the correlation strength between them was discussed. Results: totally 13 articles were included in this study. 2104 cases of female infertility with unknown cause were examined by laparoscopy. During the operation, there were 1354 cases of abnormal pelvic cavity and 750 cases of normal pelvic cavity, of which, 789 cases of pelvic abnormalities were mainly endometriosis. The second was pelvic adhesion, fallopian tube factor, pelvic tuberculosis, polycystic ovary, ovarian cyst, hysteromyoma, and so on. Among them, 10 articles were used to study the pregnancy rate after operation. The pregnancy rate was 45.8% -75.5%, with an average of 603 cases. There were three literatures as clinical controlled trials. The results of meta analysis combined with data showed that there was no statistical difference between the changes of laparoscopy and pregnancy rate. The results showed that there was no statistical difference between the changes of laparoscopy and pregnancy rate. There was no statistical difference between the two groups. There was a large heterogeneity among the variables in the study, which suggested that the results of data combination had poor credibility. Data consolidation analysis is not possible in principle. Conclusion: laparoscopy can accurately detect and deal with the hidden pelvic abnormalities in female infertility patients with unknown causes, and relieve the pelvic factors that may affect pregnancy. It has definite diagnostic value and certain therapeutic value. To provide important basis for the diagnosis and treatment of unexplained female infertility in the future.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.6

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