Effectiveness and Safety of Postoperative GnRH-a versus Laparoscopy Alone for Endometriosis: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 CHENJian-huan ,  MACai-ling , YEYuan-zheng , WANGDi , GUOChun-feng

Department of Gynecology, The First Affiliated Hospital of Xinjang Medical University, Urumqi 830054, China;

Corresponding?author：

MACai-ling, Email: hymcl@sina.com

Keywords：

Endometriosis; Gonadotropin releasing hormone agonist; Laparoscopy; Randomized controlled trial; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20140010

Video：

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Objective To systematically review the effectiveness and safety of laparoscopy with postoperative gonadotropin releasing hormone agonist (GnRH-a) versus laparoscopy alone for endometriosis. Methods Randomized controlled trials (RCTs) on laparoscopy with postopertative GnRH-a versus laparoscopy alone in treatment of endometriosis were retrieved in the following databases:the Cochrane Library (Issue 3, 2013), PubMed, EMbase, WanFang Data, CNKI, and CBM from inception to February, 2013. According to the inclusion and exclusion criteria, the literature were screened, the data was extracted and the methodological quality of the included studies was also assessed by two reviewers independently. Then, meta-analysis was performed using RevMan 5.1.7 software. Results A total of 15 RCTs involving 1 761 patients were included. There were statistically significant differences between the laparoscopy with postoperative GnRH-a group and the laparoscopy alone group in the following 4 aspects:the symptom relief rate (RR=1.24, 95%CI 1.16 to 1.33, P < 0.000 01), the recurrence of lesion (RR=0.35, 95%CI 0.24 to 0.51, P < 0.000 01), the recurrence of pain (RR=0.70, 95%CI 0.53 to 0.92, P=0.01), and the pregnancy rate (RR=1.43, 95%CI 1.25 to 1.65, P < 0.000 01). Conclusion Laparoscopy postoperative GnRH-a for endometriosis can enhance the symptom relief rate, reduce the recurrence of lesion and the recurrence of pain, and increase the pregnancy rate. But because of the limitation of the quality of the included studies and publication bias, the above conclusion should be verified by conducting more high quality RCTs.

Citation： CHENJian-huan, MACai-ling, YEYuan-zheng, WANGDi, GUOChun-feng. Effectiveness and Safety of Postoperative GnRH-a versus Laparoscopy Alone for Endometriosis: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(1): 52-58. doi: 10.7507/1672-2531.20140010 Copy

1.	?Pouly JL, Canis M, Velemir L. Endometriosis related infertility. J Gynecol Obstet Biol Reprod, 2007, 36(2):151-161.
2.	Vercellini P, Somigliana E, Viganò P, et al. Surgery for endometriosis-associated infertility:a pragmatic approach. Hum Reprod, 2009, 24(2):254-269.
3.	Abu Hashim H. Gonadotrophin-releasing hormone analogues and endometriosis:current strategies and new insights. Gynecological Endocrinol, 2012, 8(4):314-321.
4.	The American Fertility Society. Revised American Fertility Society classification of endometriosis:1985. Fertil Steril, 1985, 43(3):351-352.
5.	Biberoglu KO, Behrman SJ. Dosage aspects of danazol therapy in endometriosis:short-term and long-term effectiveness. Am J Obstet Gynecol, 1981, 139(6):645-654.
6.	Bergqvist A, Bergh T, Hogstr?m L, et al. Effects of triptorelin versus placebo on the symptoms of endometriosis. Fertil Steril, 1998, 69(4):702-708.
7.	Rickes D, Nickel I, Kropf S, et al. Increased pregnancy rates after ultralong postoperative therapy with gonadotropinreleasing hormone analogs in patients with endometriosis. Fertil Steril, 2002, 78(4):757-762.
8.	Cochrane Handbook for Systematic Reviews of Interventions. Accessed at http://handbook.cochrane.org/on1February2013.
9.	秦海霞, 陳友國, 沈宗姬, 等.腹腔鏡手術聯合GnRH-a類藥物治療子宮內膜異位癥伴不孕的療效觀察.醫學信息手術學分冊, 2007, 20(10):867-869.
10.	蘇麗, 岳瑛, 何凱. GnRH-a用于子宮內膜異位癥術后的療效觀察.中國傷殘醫學, 2008, 16(5):54-55.
11.	唐淼, 陳華蓮.曲普瑞林在卵巢子宮內膜異位囊腫腹腔鏡術后的療效觀察.安徽醫藥, 2010, 14(10):1215-1216.
12.	關菁, 沈浣, 劉亞南, 等.腹腔鏡術后應用促性腺激素釋放激素激動劑對I期子宮內膜異位癥不孕患者生育能力的影響.中華婦產科雜志, 2010, 45(4):264-268.
13.	姚翠紅, 腹腔鏡聯合藥物治療子宮內膜異位癥的效果觀察.臨床醫學, 2010, 23(1):64.
14.	陳旭萍, 手術聯合藥物治療子宮內膜異位癥89例觀察.中國基層醫藥, 2011, 18(15):2100-2101.
15.	顧漢平, 孟麗.腹腔鏡手術聯合達菲林治療子宮內膜異位癥伴不孕癥的療效.實用臨床醫學, 2012, 13(10):79-80.
16.	何家純, 楊艷明, 陳卓, 等.腹腔鏡術后輔助GnRH治療子宮內膜異位癥的臨床觀察.醫學信息, 2012, 25(1):137-138.
17.	金筱筱.腹腔鏡手術聯合GnRH激動劑治療子宮內膜異位癥的臨床分析.海峽藥學, 2012, 24(9):166-167.
18.	劉艷紅, 陸曉媛.保守手術聯合藥物治療Ⅲ-Ⅳ期子宮內膜異位癥的臨床療效分析.吉林醫學, 2013, 34(3):442-443.
19.	Parazzini F, Fedele L, Busacca M, et al. Gynecology:Postsurgical Medical Treatment of Advanced Endometriosis:Results of a Randomized Clinical Trial. Am J Obstet Gynecol, 1994, 171(5):1205-1207.
20.	Hornatein MD, Hemmings R, Yuzpe AA. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril, 1997, 68(5):860-864.
21.	Vercellini P, Crosignani PG, Fadini R, et al. A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. Br J Obstet Gynaecol, 1999, 106(7):672-677.
22.	Busacca M, Somigliana E, Bianchi S, et al. Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage Ⅲ-Ⅳ:a randomized controlled trial. Hum Reprod, 2001, 16(11):2399-2402.
23.	Loverro G, Carriero C, Rossi AC, et al. A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage Ⅲ-Ⅳ endometriosis. Eur J Obstet Gynecol Reprod Biol, 2008, 136(2):194-198.
24.	de Ziegler D, Borghese B, Chapron C. Endometriosis and infertility:pathophysiology and management. Lancet, 2010, 3769(9742):730-738.
25.	Hart RJ, Hickey M, Maouris P, et al. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev, 2011:CD004992.
26.	Furness S, Ya C, Farquha C, et al. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev, 2010:CD003678.
27.	Sesti F, Pietropolli A, Capozzolo T, et al. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage Ⅲ-Ⅳ. A randomized comparative trial. Fertil Steril, 2007, 88(6):1541-1547.

1. ?Pouly JL, Canis M, Velemir L. Endometriosis related infertility. J Gynecol Obstet Biol Reprod, 2007, 36(2):151-161.
2. Vercellini P, Somigliana E, Viganò P, et al. Surgery for endometriosis-associated infertility:a pragmatic approach. Hum Reprod, 2009, 24(2):254-269.
3. Abu Hashim H. Gonadotrophin-releasing hormone analogues and endometriosis:current strategies and new insights. Gynecological Endocrinol, 2012, 8(4):314-321.
4. The American Fertility Society. Revised American Fertility Society classification of endometriosis:1985. Fertil Steril, 1985, 43(3):351-352.
5. Biberoglu KO, Behrman SJ. Dosage aspects of danazol therapy in endometriosis:short-term and long-term effectiveness. Am J Obstet Gynecol, 1981, 139(6):645-654.
6. Bergqvist A, Bergh T, Hogstr?m L, et al. Effects of triptorelin versus placebo on the symptoms of endometriosis. Fertil Steril, 1998, 69(4):702-708.
7. Rickes D, Nickel I, Kropf S, et al. Increased pregnancy rates after ultralong postoperative therapy with gonadotropinreleasing hormone analogs in patients with endometriosis. Fertil Steril, 2002, 78(4):757-762.
8. Cochrane Handbook for Systematic Reviews of Interventions. Accessed at http://handbook.cochrane.org/on1February2013.
9. 秦海霞, 陳友國, 沈宗姬, 等.腹腔鏡手術聯合GnRH-a類藥物治療子宮內膜異位癥伴不孕的療效觀察.醫學信息手術學分冊, 2007, 20(10):867-869.
10. 蘇麗, 岳瑛, 何凱. GnRH-a用于子宮內膜異位癥術后的療效觀察.中國傷殘醫學, 2008, 16(5):54-55.
11. 唐淼, 陳華蓮.曲普瑞林在卵巢子宮內膜異位囊腫腹腔鏡術后的療效觀察.安徽醫藥, 2010, 14(10):1215-1216.
12. 關菁, 沈浣, 劉亞南, 等.腹腔鏡術后應用促性腺激素釋放激素激動劑對I期子宮內膜異位癥不孕患者生育能力的影響.中華婦產科雜志, 2010, 45(4):264-268.
13. 姚翠紅, 腹腔鏡聯合藥物治療子宮內膜異位癥的效果觀察.臨床醫學, 2010, 23(1):64.
14. 陳旭萍, 手術聯合藥物治療子宮內膜異位癥89例觀察.中國基層醫藥, 2011, 18(15):2100-2101.
15. 顧漢平, 孟麗.腹腔鏡手術聯合達菲林治療子宮內膜異位癥伴不孕癥的療效.實用臨床醫學, 2012, 13(10):79-80.
16. 何家純, 楊艷明, 陳卓, 等.腹腔鏡術后輔助GnRH治療子宮內膜異位癥的臨床觀察.醫學信息, 2012, 25(1):137-138.
17. 金筱筱.腹腔鏡手術聯合GnRH激動劑治療子宮內膜異位癥的臨床分析.海峽藥學, 2012, 24(9):166-167.
18. 劉艷紅, 陸曉媛.保守手術聯合藥物治療Ⅲ-Ⅳ期子宮內膜異位癥的臨床療效分析.吉林醫學, 2013, 34(3):442-443.
19. Parazzini F, Fedele L, Busacca M, et al. Gynecology:Postsurgical Medical Treatment of Advanced Endometriosis:Results of a Randomized Clinical Trial. Am J Obstet Gynecol, 1994, 171(5):1205-1207.
20. Hornatein MD, Hemmings R, Yuzpe AA. Use of nafarelin versus placebo after reductive laparoscopic surgery for endometriosis. Fertil Steril, 1997, 68(5):860-864.
21. Vercellini P, Crosignani PG, Fadini R, et al. A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. Br J Obstet Gynaecol, 1999, 106(7):672-677.
22. Busacca M, Somigliana E, Bianchi S, et al. Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage Ⅲ-Ⅳ:a randomized controlled trial. Hum Reprod, 2001, 16(11):2399-2402.
23. Loverro G, Carriero C, Rossi AC, et al. A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage Ⅲ-Ⅳ endometriosis. Eur J Obstet Gynecol Reprod Biol, 2008, 136(2):194-198.
24. de Ziegler D, Borghese B, Chapron C. Endometriosis and infertility:pathophysiology and management. Lancet, 2010, 3769(9742):730-738.
25. Hart RJ, Hickey M, Maouris P, et al. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev, 2011:CD004992.
26. Furness S, Ya C, Farquha C, et al. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev, 2010:CD003678.
27. Sesti F, Pietropolli A, Capozzolo T, et al. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage Ⅲ-Ⅳ. A randomized comparative trial. Fertil Steril, 2007, 88(6):1541-1547.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Postoperative GnRH-a versus Laparoscopy Alone for Endometriosis: A Meta-Analysis

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