根治性宫颈切除治疗早期宫颈癌临床价值的循证评价

目的系统评价根治性宫颈切除术治疗早期宫颈癌的安全性及保留生育功能的可行性。方法 我们系统检索PubMed、Embase、Cochrane Library以及中文全文数据库，对2000年1月至2009年12月国内外公开发表的所有有关根治性宫颈切除术治疗早期宫颈癌的文献进行回顾，对符合纳入标准的临床对照试验，采用Stata 9.2软件进行Meta分析，对无对照的临床研究则采用描述性分析，主要评价指标为生存率。结果 共纳入4篇根治性宫颈切除术和根治性全子宫切除术治疗早期宫颈癌生存率比较的临床对照试验和17篇无对照的临床研究，结果显示，根治性宫颈切除术和根治性全子宫切除术治疗早期宫颈癌的生存率差异无统计学意义，根治性宫颈切除术术后总妊娠率为47%。结论 宫颈根治切除术不会降低早期宫颈癌患者术后生存时间，不增加术后复发率，且能维持正常的妊娠及生育功能，提高患者生存质量，因而是安全可行的，但需要更多高质量的临床随机对照试验进一步验证。

Clinical Value of Radical Trachelectomy in Patients with Early Cervical Cancer: A System Review

Objective To systematically evaluate the safety and feasibility of radical trachelectomy in patients with early-stage cervical cancer who desired to maintain fertility.Methods Electronic databases including Pubmed,EMBASE,Cochrane Library and Chinese full-text database were systematically searched for all relevant published studies on radical trachelectomy(RT)and(or) radical hysterectomy(RH) in patients with early stage of cervical cancer.Meta-analysis was performed on controlled trials of RT and RH,and homogeneous merger analysis was only performed on non-controlled of RT.The primary outcome measures were survival rate and pregnancy rate.Results A total of four controlled trials of RT and RH were included in this meta-analysis and 17 non-controlled trials of RT also met the inclusion criteria.No significant differences were found.The total pregnancy rate was 47% after radical trachelectomy in patients with early-stage cervical cancer.Conclusion Radical trachelectomy appears safe when performed by sufficient surgery.It can satisfy the patients’needs to preserve the fertility.The conclusion is needed to be further assessed by rigorously designed,random and double-blind,controlled clinical trials.