Intervention Review

Laparoscopic surgery for subfertility associated with endometriosis

  1. Tal Z Jacobson1,*,
  2. James MN Duffy2,
  3. David Barlow3,
  4. Cindy Farquhar4,
  5. Philippe R Koninckx5,
  6. David Olive6

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 31 MAY 2008

DOI: 10.1002/14651858.CD001398.pub2

Database Title

Additional Information

How to Cite

Jacobson TZ, Duffy JMN, Barlow D, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001398. DOI: 10.1002/14651858.CD001398.pub2.

Author Information

  1. 1

    South Auckland Clinical School, Department of Obstetrics and Gynaecology, Auckland, New Zealand

  2. 2

    Guy's and St Thomas' Hospital, London, UK

  3. 3

    University of Glasgow, Wolfson Medical School Building, Glasgow, Scotland, UK

  4. 4

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  5. 5

    Univ. Hospital Leuven, Campus Gasthuisberg, Department of Obstetrics & Gynecology, Leuven, Belgium

  6. 6

    Wisconsin Fertility Institute, Middleton, Wisconsin, USA

*Tal Z Jacobson, Department of Obstetrics and Gynaecology, South Auckland Clinical School, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand. tal@obsgyn.co.nz.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 JAN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity. It is variable in both its surgical appearance and clinical manifestation, often with poor correlation between the two. Surgical treatment of endometriosis aims to remove visible areas of endometriosis and restore anatomy by the division of adhesions.

Objectives

To assess the efficacy of laparoscopic surgery in the treatment of subfertility associated with endometriosis. The review aims to compare outcomes of laparoscopic surgical interventions compared to no treatment or medical treatment with regard to improved fertility.

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials (June 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2), MEDLINE (1966 to June 2009), EMBASE (1980 to June 2009), and reference lists of articles.

Selection criteria

Trials were selected if they were randomised and compared the effectiveness of laparoscopic surgery in the treatment of subfertility associated with endometriosis versus other treatment modalities or placebo.

Data collection and analysis

Two studies were eligible for inclusion within the review. Both studies compared laparoscopic surgical treatment of minimal and mild endometriosis compared with diagnostic laparoscopy only. The recorded outcomes included live birth, pregnancy, fetal losses, and complications of surgery.

Main results

When combining live birth rate and ongoing pregnancy after 20 weeks, meta-analysis demonstrated an advantage of laparoscopic surgery when compared to diagnostic laparoscopy only. The odds ratio (OR) was 1.64 (95% confidence interval (Cl) 1.05 to 2.57) in favour of laparoscopic surgery. Meta-analysis also demonstrated an advantage of laparoscopic surgery when compared to diagnostic laparoscopy only in terms of clinical pregnancy rates, with an OR of 1.66 (95% Cl 1.09 to 2.51) favouring laparoscopic surgery. The results still need to be interpreted with caution as Marcoux 1997 reported a large positive effect of surgery whereas Gruppo Italiano reported a small negative effect. When considering fetal losses, meta-analysis did not demonstrate an effect of laparoscopic surgery when compared to diagnostic laparoscopy only. The OR was 1.33 (95% Cl 0.60 to 2.94) favouring diagnostic laparoscopy only.

Authors' conclusions

The use of laparoscopic surgery in the treatment of subfertility related to minimal and mild endometriosis may improve future fertility.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Laparoscopic surgery may be of benefit in treating subfertility associated with mild to moderate endometriosis

Endometriosis is the presence of tissue that normally lines the uterus in inappropriate sites (usually within the pelvic cavity). It can cause fertility problems and symptoms such as painful menstruation and painful sexual intercourse. Hormonal drugs including the oral contraceptive pill are used but have adverse effects and are not suitable for women wishing to become pregnant. Laparoscopic surgery (where small incisions are made in the abdomen) is performed to remove visible areas of endometriosis. The review of trials found that laparoscopic surgery may be of benefit in treating subfertility associated with mild to moderate endometriosis. However, the two studies on the subject show conflicting results. Additional studies in this field are needed before definitive conclusions can be drawn. 

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

腹腔鏡手術對於有子宮內膜異位症的低生育力女性的效果

子宮內膜異位症是子宮內膜組織或是基質生長在子宮腔以外的地方. 在臨床上的表現和手術中看到的長相是多樣性的,而且兩者常常缺乏關係。手術治療子宮內膜異位症的目的在於移除可見到的內膜異位組織及沾黏剝離以恢復正常的解剖位置。

目標

為了評估腹腔鏡手術對於有子宮內膜異位症的低生育力女性的效果。 比較腹腔鏡手術和沒有接受治療或是單純藥物治療對於改善生育力的效果。

搜尋策略

我們搜尋了the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials (2009年6月)、Cochrane Central Register of Controlled Trials (考科藍圖書館2009年第2期)、 EDLINE (1966年2009年6月)、 EMBASE (1980年2009年6月)，以及這些文章的參考文獻。

選擇標準

選擇隨機分配的試驗，並比較腹腔鏡手術相對於其他治療方法或是安慰劑對於改善有子宮內膜異位症的病人生育力的效果。

資料收集與分析

有兩個研究符合入選的條件，這些研究比較了極微小的和輕微的子宮內膜異位症的病人接受治療性或是診斷性腹腔鏡的效果。紀錄的結果包含了活產數、懷孕、流產和手術的併發症。

主要結論

當合併活產率與20周後持續懷孕，統合分析(metaanalysis)顯示：腹腔鏡手術相較於只用診斷性腹腔鏡來說具有優勢。 dds ratio (OR)是1.64 (95% confidence interval (Cl .05 – 2.57)，偏好使用腹腔鏡手術。 統合分析也顯示，只就臨床懷孕率來說，腹腔鏡手術相較於診斷性腹腔鏡來得有優勢， R 1.66 (95% Cl 1.09 – 2.51)偏好使用腹腔鏡手術。該結果外推上仍需小心，因為 arcoux 1997年報告手術具有強大正面的效果，然而Gruppo Italiano卻報告具有少量負面效果。 在流產方面，統合分析並沒有呈現腹腔鏡手術與診斷性腹腔鏡的效果。O .33 (95% Cl 0.60 to 2.94) 偏好使用只用診斷性腹腔鏡。

作者結論

使用腹腔鏡手術治療極微小和輕微的子宮內膜異位症也許可以改善將來的生育力。

翻譯人

本摘要由高雄醫學大學附設醫院翁淑芬翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

腹腔鏡手術也許對於治療與不孕有關的輕、中度子宮內膜炎有幫助： 子宮內膜炎是指通常位於子宮的組織，位於不正確的位置(通常存在於骨盆腔)。 它會造成發燒的狀況，以及如經痛、性交疼痛症狀。使用的賀爾蒙藥物包括了口服避孕藥，不過會造成副作用並且不適合用於希望懷孕的婦女。腹腔鏡手術(在腹部切出一個小切口)被用來移除可見的子宮內膜炎區域。 試驗回顧發現腹腔鏡手術有許對於治療與不孕有關的輕、中度子宮內膜炎有幫助。 不過兩個關於此一主題的研究呈現相衝突的結果。在明確的結論出現之前，需要更進一步關於此領域的研究。

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