本文選題：腹腔鏡 + 不明原因�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)系統(tǒng)評(píng)價(jià)探討腹腔鏡對(duì)不明原因女性不孕癥診斷價(jià)值的綜合效能;了解腹腔鏡對(duì)不明原因女性不孕癥的診斷實(shí)效性以及與現(xiàn)有診斷方法比較的優(yōu)勢(shì),為今后不明原因女性不孕癥的診斷和治療方案的選擇提供重要的依據(jù)。方法:制定檢索式,通過(guò)檢索PubMed、Cochrane Library、Wed of Science、CNKI、WanFang Data及CBM數(shù)據(jù)庫(kù)中的關(guān)于腹腔鏡與不明原因女性不孕癥的文獻(xiàn)。文獻(xiàn)檢索時(shí)間均為建庫(kù)至2017年3月1日。嚴(yán)格按照制定的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),對(duì)國(guó)內(nèi)外已發(fā)表的文獻(xiàn)進(jìn)行篩選、質(zhì)量評(píng)價(jià)、異質(zhì)性分析并提取相關(guān)臨床研究的基本資料。對(duì)符合病例對(duì)照研究的文獻(xiàn)利用Rev Man 5.3軟件對(duì)腹腔鏡與妊娠率進(jìn)行meta分析。通過(guò)RevMan 5.3軟件計(jì)算合并的比值比(Odds Ratio,OR)及其95%可信區(qū)間(Confidence Interval,CI),并對(duì)數(shù)據(jù)合并結(jié)果進(jìn)行分析,討論兩者之間的關(guān)聯(lián)強(qiáng)度。結(jié)果:本研究共納入文獻(xiàn)13篇,實(shí)施腹腔鏡檢的不明原因女性不孕癥患者共2104例,術(shù)中發(fā)現(xiàn)盆腔異常1354,盆腔正常750例,其中盆腔異常以子宮內(nèi)膜異位癥為主,共789例,其次為盆腔粘連、輸卵管因素、盆腔結(jié)核、多囊卵巢、卵巢囊腫、子宮肌瘤等,其中有10篇文獻(xiàn)進(jìn)行術(shù)后妊娠率的研究,妊娠率為45.8%-75.5%,平均約60%,3篇未研究妊娠結(jié)局。有3篇文獻(xiàn)為臨床對(duì)照試驗(yàn),納入meta分析合并數(shù)據(jù)結(jié)果顯示腹腔鏡與妊娠率變化無(wú)統(tǒng)計(jì)學(xué)差異,OR=1.39,95%CI=[0.69,2.83],P=0.36,I2=86%,研究變量之間存在較大的異質(zhì)性,提示數(shù)據(jù)合并結(jié)果可信性差,原則上不能進(jìn)行數(shù)據(jù)的合并分析。結(jié)論:腹腔鏡能夠較為準(zhǔn)確的發(fā)現(xiàn)并處理不明原因女性不孕癥患者的隱秘性盆腔異常,解除可能影響妊娠的盆腔因素,具有明確的診斷價(jià)值和一定的治療價(jià)值,為今后不明原因女性不孕癥的診斷和治療方案的選擇提供重要的依據(jù)。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R711.6

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