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, Hogström 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, 陈友国, 沈宗姬, 等.腹腔镜手术联合GnRH-a类药物治疗子宫内膜异位症伴不孕的疗效观察.医学信息手术学分册, 2007, 20(10):867-869.
10.	苏丽, 岳瑛, 何凯. GnRH-a用于子宫内膜异位症术后的疗效观察.中国伤残医学, 2008, 16(5):54-55.
11.	唐淼, 陈华莲.曲普瑞林在卵巢子宫内膜异位囊肿腹腔镜术后的疗效观察.安徽医药, 2010, 14(10):1215-1216.
12.	关菁, 沈浣, 刘亚南, 等.腹腔镜术后应用促性腺激素释放激素激动剂对I期子宫内膜异位症不孕患者生育能力的影响.中华妇产科杂志, 2010, 45(4):264-268.
13.	姚翠红, 腹腔镜联合药物治疗子宫内膜异位症的效果观察.临床医学, 2010, 23(1):64.
14.	陈旭萍, 手术联合药物治疗子宫内膜异位症89例观察.中国基层医药, 2011, 18(15):2100-2101.
15.	顾汉平, 孟丽.腹腔镜手术联合达菲林治疗子宫内膜异位症伴不孕症的疗效.实用临床医学, 2012, 13(10):79-80.
16.	何家纯, 杨艳明, 陈卓, 等.腹腔镜术后辅助GnRH治疗子宫内膜异位症的临床观察.医学信息, 2012, 25(1):137-138.
17.	金筱筱.腹腔镜手术联合GnRH激动剂治疗子宫内膜异位症的临床分析.海峡药学, 2012, 24(9):166-167.
18.	刘艳红, 陆晓媛.保守手术联合药物治疗Ⅲ-Ⅳ期子宫内膜异位症的临床疗效分析.吉林医学, 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, Hogström 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, 陈友国, 沈宗姬, 等.腹腔镜手术联合GnRH-a类药物治疗子宫内膜异位症伴不孕的疗效观察.医学信息手术学分册, 2007, 20(10):867-869.
10. 苏丽, 岳瑛, 何凯. GnRH-a用于子宫内膜异位症术后的疗效观察.中国伤残医学, 2008, 16(5):54-55.
11. 唐淼, 陈华莲.曲普瑞林在卵巢子宫内膜异位囊肿腹腔镜术后的疗效观察.安徽医药, 2010, 14(10):1215-1216.
12. 关菁, 沈浣, 刘亚南, 等.腹腔镜术后应用促性腺激素释放激素激动剂对I期子宫内膜异位症不孕患者生育能力的影响.中华妇产科杂志, 2010, 45(4):264-268.
13. 姚翠红, 腹腔镜联合药物治疗子宫内膜异位症的效果观察.临床医学, 2010, 23(1):64.
14. 陈旭萍, 手术联合药物治疗子宫内膜异位症89例观察.中国基层医药, 2011, 18(15):2100-2101.
15. 顾汉平, 孟丽.腹腔镜手术联合达菲林治疗子宫内膜异位症伴不孕症的疗效.实用临床医学, 2012, 13(10):79-80.
16. 何家纯, 杨艳明, 陈卓, 等.腹腔镜术后辅助GnRH治疗子宫内膜异位症的临床观察.医学信息, 2012, 25(1):137-138.
17. 金筱筱.腹腔镜手术联合GnRH激动剂治疗子宫内膜异位症的临床分析.海峡药学, 2012, 24(9):166-167.
18. 刘艳红, 陆晓媛.保守手术联合药物治疗Ⅲ-Ⅳ期子宫内膜异位症的临床疗效分析.吉林医学, 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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