腔镜腋窝淋巴结清扫术与传统开放手术治疗乳腺癌的 Meta 分析

目的：对腔镜腋窝淋巴结清扫术和传统开放手术治疗乳腺癌的疗效及临床价值进行评价。方法：按照Cochrane系统评价的方法，计算机检索Medline，PubMed，Embase，Cochrane图书馆及维普、万方、中国期刊全文数据库、中国生物医学数据库，并采用手工检索等方法收集所有相关随机对照试验和会议文献。采用Cochrane协作网提供的软件Revman 5.0进行Meta分析，以获得腔镜腋窝淋巴结清扫术和传统手术治疗乳腺癌的疗效是否有差异的相关证据。结果：共纳入25项研究，包括3 028例患者。Meta分析结果显示：腔镜腋窝淋巴结清扫术在清扫淋巴结数和肿瘤复发率上与传统开放手术无明显差异(P>0.05)；手术时间比传统开放手术时间长，术中出血量、术后并发症比传统开放手术少(P<0.05)。结论：作为治疗乳腺癌的一种微创手术方式，腔镜腋窝淋巴结清扫术替代传统开放腋窝淋巴结清扫术是可行的。

Meta-analysis of endoscopic axillary lymph node dissection versus conventional open excision for breast cancer

Objective: To compare the surgical outcome and the clinical value between endoscopic axillary lymph node dissection and conventional open excision in the treatment of breast cancer.Methods: A computer-based online search of Medline, PubMed, Embase, Ovid, Cochrane Library,Vip, Wanfang, CNKI and Chinese Biological Medicine Database was performed, and conference literatures were manually searched. Using the Cochrane Collaboration guidelines, all randomized controlled trials comparing endoscopic axillary lymph node dissection and conventional open excision were systematically reviewed. The Cochrane Collaboration’s RevMan 5.0 software was used for data analysis.Results: A total of 25 studies involving 3 028 patients were included. The results of Meta-analysesshowed that there were no significant difference in the number of lymph nodes harvested andrecurrence between endoscopic axillary lymph node dissection and conventional open excision(P>0.05). The operative time of endoscopic axillary lymph node dissection was longer than that ofconventional open excision. However, it was superior to open excision in the rate of complication andintra-operative blood loss (P<0.05).Conclusion: As a minimally invasive surgery technique to treat breast cancer, endoscopic axillarylymph node dissection might be a promising replacement for conventional axillary lymph nodedissection.