腹腔镜根治性子宫切除术与开腹根治性子宫切除术治疗早期宫颈癌疗效的Meta分析

目的 系统评价腹腔镜根治性子宫切除术(LRH)与开腹根治性子宫切除术(ARH)治疗早期宫颈癌的疗效与安全性,为临床工作中对宫颈癌的诊治和为患者选择合理手术方式提供决策依据。方法 检索Pub Med、EMbase、Cochrane Library、CBM、CNKI、万方和维普数据库,采用Revman 5.3软件对入选的随机对照试验研究文献进行综合定量分析。结果 本研究共有11篇文献符合入选标准,包括944例早期宫颈癌患者,其中,LRH组患者472例,ARH组患者472例。Meta分析结果显示:与ARH组比较,LRH组治疗早期宫颈癌可以减少术中失血量MD=-60.53,95%CI(-73.09,-47.97),P<0.00001];LRH组淋巴结清除数目明显多于ARH组,且差异有统计学意义MD=4.25,95%CI(1.75,6.76),P=0.0009];LRH组可以缩短术后肛门排气时间MD=-14.12,95%CI(-16.26,-11.97),P<0.00001]。在手术时间、术中并发症发生率、术后并发症发生率、术后随访2~5年宫颈癌复发率以及生存率方面,两组间差异均无统计学意义。结论 LRH与ARH相比,LRH治疗早期宫颈癌在近期疗效、手术创伤和术后疾病的恢复方面具有一定的积极作用。但是,对于远期疗效的作用还不明确,尚需开展更多研究予以验证。

Curative effects of laparoscopic radical hysterectomy and abdominal radical hysterectomy in treatment of early cervical cancer: a Meta-analysis

Objective To systematically evaluate the curative effects and safeties of laparoscopic radical hysterectomy(LRH)and abdominal radical hysterectomy(ARH)in treatment of early cervical cancer,provide a basis for decision making of diagnosis and treatment of cervical cancer and choice of reasonable operation.Methods PubMed,EMbase,Cochrane Library,CBM,CNKI,Wanfang,and VIP databases were searched,Rev Man 5.3 software was used to comprehensively and quantitatively analyze the included randomized controlled trial studies.Results A total of 11 literatures(944 early cervical cancer patients)were included into this study,including 472 patients in LRH group and 472 patients in ARH group.Meta analysis showed that compared with ARH group,the amount of blood loss during operation in LRH group decreasedMD=-60.53,95%CI(-73.09,-47.97),P<0.00001];the number of lymph node clearance in LRH group was statistically significantly higher than that in ARH groupMD=4.25,95%CI(1.75,6.76),P=0.0009];postoperative anal exhausting time in LRH group was shortenedMD=-14.12,95%CI(-16.26,-11.97),P<0.00001].There was no statistically significant difference in operation time,the incidence rate of intraoperative and postoperative complications,the recurrence rate of cervical cancer and survival rate within 2-5 years after operation between the two groups.Conclusion Compared with ARH,LRH plays a certain active role in short-term efficacy,surgical trauma,and recovery of postoperative disease in treatment of early cervical cancer,but the long-term efficacy is not clear,more studies are needed to verify it.