LARVH与RAH治疗妇科恶性肿瘤临床疗效的Meta分析  

Clinical Efficacy Comparison of Lapararoscopic Assisted Radical Vaginal Hysterectomy and Radical Abdominal Hysterectomy for the Treatment of Gynecologic Malignancies:a Meta-Analysis

作　　者：徐玮[1] 滕银成[1] 

机构地区：[1]上海交通大学附属第六人民医院,上海200233

出　　处：《实用妇产科杂志》2013年第2期110-114,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:通过Meta分析综合评价腹腔镜辅助阴式根治性子宫切除术(LARVH)与经腹根治性子宫切除术(RAH)治疗妇科恶性肿瘤的临床疗效。方法:电子检索Cochrane Library、PubMed、Ovid、EMBASE、中国知网数据库(CNKI)、万方全文数据库、维普中文科技期刊数据库、中国生物医学文献数据库,并辅以手工检索。检索时间截至2012年6月,收集LARVH与RAH临床疗效比较的随机对照试验(RCT)或设计良好的回顾性临床对照试验(CCT)。由两名研究者按Cochrane系统评价方法提取有效数据进行Meta分析。结果:共纳入7篇RCT,11篇CCT,共计4046例患者,其中LARVH组2280例,RAH组1766例。结果显示:LARVH与RAH相比,其术中失血量少(MD=-186.00,95%CI-292.48～-79.52,P=0.0006)、住院天数短(MD=-3.37,95%CI-4.23～-2.50,P=0.0000)、术后并发症发生率低(RR=0.60,95%CI0.46～0.79,P=0.0003),但术中并发症发生率高(RR=1.45,95%CI1.15～1.82,P=0.0010);而在手术时间、淋巴结活检数、术后总体复发率方面比较,差异均无统计学意义(P>0.01)。结论:运用LARVH治疗妇科恶性肿瘤在减少住院时间、降低手术失血量和术后并发症方面比RAH具有一定优势,但应注意降低术中并发症的发生。Objective ：To compare the clinical efficacy of lapararoscopic assisted radical vaginal hysterectomy（LARVH） and radical abdominal hysterectomy（RAH） for the treatment of gynecologic malignancies by meta-analysis. Methods： Electronic searches of the Cochrane Libaray, PubMed, Ovid, EMBASE, CNKI, Wanfang Databases,VIP Full-text Databases and CBMdisc Databases, supplemented by manual searches. Retrieval time as of June 2012, the studies included in the references of eligible studies were additionally searched randomized controlled trials（RCTs） or well-designed retrospective controlled clinical trails（CCTs） with the clinical efficacy of LARVH and RAH. All the data were extracted in the same way as Cochrane system analysis. Metaanalysis were performed by two reviewers independently. Results：Seven RCTs and eleven CCTs met all inclusion criteria,with a toal of 4046 patients, in which 2280 patients were in LARVH group, 1766 patients were in RAH group. The meta-analysis showed that：Compared with RAH group,the blood loss of LARVH group was less（ MD = - 186.00,95% CI - 292.48 - -79.52, P =0. 0006） ,the hospital days was shorter（ MD = -3.37,95%CI -4.23 ~ -2.50, P = 0. 0000）, and the incidence of postoperative complications was lower（ RR = 0. 60,95% CI 0. 46 - 0. 79, P = 0. 0003） ;however, the incidence of intraoperative complications was higher（ RR = 1.45,95% CI 1.15 - 1.82, P =0. 0010）. There were no significant differences between the two groups in operative time, number of lymph node biopsy and the overall recurrence rate （ P 〉 0.01 ）. Conclusions：Using LARVH in treating gynecologic malignancies has certain advantages in reducinghospitalization time,surgical blood loss and postoperative complications than RAH treatment, but it should be noted about reducing the incidence of intraoperative complications.

关 键 词：腹腔镜辅助阴式根治性子宫切除术 经腹根治性子宫切除术 妇科肿瘤 META分析 

分 类 号：R737.3[医药卫生—肿瘤]