腹腔镜与开腹手术治疗子宫内膜癌临床疗效的系统评价  

Systematic Review of Clinical Efficacy on Treating Endometrial Cancer with Laparoscopy Versus Laparotomy

作　　者：王迪[1] 马彩玲[1] 

机构地区：[1]新疆医科大学第一附属医院妇科,新疆乌鲁木齐830054

出　　处：《新疆医学》2012年第10期8-18,共11页Xinjiang Medical Journal

摘　　要：目的:评价腹腔镜与开腹手术治疗子宫内膜癌的临床应用疗效。方法:检索了中国生物医学文献数据库、CNKI、万方数据库、维普数据库、Cochrane Library、OVID、PubMed、Embase等数据库,并手工检索百度和谷歌等网络数据。纳入对比腹腔镜与开腹手术治疗子宫内膜癌的随机对照试验(RCT)。由2名研究者独立按照纳入标准筛选文献、提取资料并交叉核对,而后采用Cochrane评价员手册5.1.0文献质量评价标准评价纳入研究质量,用RevMan5.1软件进行Meta分析。结果:共纳入11篇随机对照试验,共1421个病人。Meta分析结果表明:开腹手术的操作时间较腹腔镜手术短[MD=15.17,95%CI(-26.56,56.85),P<0.00001],但腹腔镜较开腹手术治疗子宫内膜癌术中出血量少[MD=-89.01,95%CI(-130.13,-47.90),P<0.00001]、术后排气时间短[MD=-8.47,95%CI(-9.77,-7.16),P<0.00001]、术后住院时间短[MD=-2.88,95%CI(-3.46,-2.29),P<0.00001],然而,腹腔镜组与开腹组清扫盆腔淋巴结数目差异无统计学意义,为[MD=7.17,95%CI(-1.95,12.68),P=0.12];手术并发症差异无统计学意义,为[MD=0.78,95%CI(0.58,1.05),P=0.10];术后1～5年子宫内膜癌复发率和死亡率差异无统计学意义,分别为[MD=0.67,95%CI(0.23,1.97),P=0.47]和[MD=1.14,95%CI(0.62,2.08),P=0.68]。结论:对最终纳入的11篇RCT进行Meta分析结果示:腹腔镜手术和开腹手术相比操作时间长、术中出血量少、术后排气时间和住院时间短,但清扫盆腔淋巴结数目、手术并发症以及术后1～5年子宫内膜癌复发率以及死亡率均无统计学差异。由于本系统评价纳入研究的英文文献方法学质量较高,因此提高了结论的可信度,但仍不能取代高质量、大样本、多中心的随机对照研究,因此本结论还有待于今后高质量随机对照研究的证实。同时,对于远期结果的观察和研究更有待进一步完善。Objective To compare the surgical outcome and investigate the clinic value between laparoscopic operation and laparotomy in the treatment of endometrial cancer.Methods We searched the Chinese Biomedical Literature Database,CNKI and Wanfang Database,VIP,the Cochrane Library,OVID,PubMed, Embase,and references of the included studies up to April 2012.And v/e manual searched other international databases,such as Baidu and googJe.Studies involves Randomized controlled trials about the comparison of laparoscopic and open surgery for treating endometrial cancer.Date were extracted and methodological quality were evaluated by two reviewers independently with designed extraction form.The Cochrane Collaboration＇s RevMan 5.1 software was used for Meta -analysis.Results A total of 11 studies involving 1421 patients were included.The results of Meta - analysis showed that;laparotomy＇s operation time is less than laparoscopic surgery [MD = 15.17,95%CI（-26.56,56.85）,P 0.00001],but laparoscopic s blood loss is less than open surgery[MD= -89.01,95%CI（-130.13,-47.90）,P 0.00001];postoperative exhaust[MD = -8.47, 95%CI（-9.77,-7.16）,P 0.00001]and postoperative hospital stay[MD = -2.88,95%CI（- 3.46,- 2.29）,P 0.00001]is shorter;however,Sweeping pelvic lymph node number in the laparoscopy group and laparotomy group surgery were no significant differences,it is[MD -1.17,95%CI（- 1.95,12.68 ）,P = 0.12];operative complications were no differences,it is[MD =0.78,95%CI（0.58,1.05）,P =0.10];recurrence rate and mortality after operation 1 to 5 years were no differences,they are respectively[MD =0.67, 95%CI（0.23,1.97）,P=0.47]and[MD = l.14,95%CI（0.62,2.08）,P =0.68]？ Conclusion The result of Meta - analysis showed Uiat：laparoscopy and laparotomy compared,operation time is longer;Less blood is losing;Postoperative exhaust time and hospital stay are shorter0 However,Sweeping pelvic lymph node number; operative complications.recurrence rate and mortality after operation 1 to 5 years were no differences。This sy

关 键 词：子宫内膜癌 腹腔镜手术 开腹手术 系统评价 META-分析 

分 类 号：R656[医药卫生—外科学]