腹腔镜与开腹手术比较治疗子宫内膜癌疗效与安全性的Meta分析  

Clinical Effectiveness and Safety of Laparoscopy versus Laparotomy for Endometrial Cancer: A Meta-Analysis

作　　者：王迪[1] 马彩玲[1] 叶远征[1] Srijana Sharma 

机构地区：[1]新疆医科大学第一附属医院妇科,乌鲁木齐830054

出　　处：《中国循证医学杂志》2013年第5期596-604,共9页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价腹腔镜与开腹手术比较治疗子宫内膜癌的疗效及安全性。方法计算机检索eCochrane Library、PubMed、EMbase、Ovid、WanFang Data、VIP和CNKI数据库,收集腹腔镜和开腹手术比较治疗子宫内膜癌疗效及安全性的随机对照试验,检索时限从1998.1～2012.9,由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。结果最终纳入10个随机对照试验,共6 993例患者。Meta分析结果显示与开腹手术相比,腹腔镜手术治疗子宫内膜癌术中出血量更少、术前与术后第1天血红蛋白下降值更低、术后排气时间和住院时间更短、术后并发症发生率更低。但腹腔镜的手术时间更长、术中并发症发生率更高。此外,两组在术中清扫盆腔淋巴结数目、术中清扫腹主动脉旁淋巴结数目及术后随访3～5年子宫内膜癌复发率和死亡率方面,其差异均无统计学意义。结论腹腔镜手术较开腹手术术中出血量更少、术前与术后第1天血红蛋白下降值更低、术后排气时间和住院时间更短、术后并发症发生率更低;但开腹手术的术中并发症发生率比腹腔镜手术组低且手术时间短;两种手术方式在清扫盆腔淋巴结和腹主动脉旁淋巴结数目及术后随访3～5年子宫内膜癌复发率和死亡率方面相似。由于纳入研究数量有限且方法学质量不高,本研究结果尚需更多高质量的随机对照试验进一步证实。Objective To assess the clinical effectiveness and safety of laparoscopy versus laparotomy for endome- trial cancer. Methods The databases such as The Cochrane Library, PubMed, EMbase, Ovid, CNKI, WanFang Data, and VIP were searched to collect the randomized control trials （RCTs） about the clinical effectiveness and safety of laparos- copy and laparotomy for endometrial cancer. The retrieval time was from January 1998 to September 2012. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Then the meta-analysis was performed by using RevMan 5.0 software. Re- suits A total of 10 RCTs involving 6 993 patients were included. Meta-analysis showed that, compared with laparotomy, laparoscopy had lesser amount of intraoperative bleeding, lower decrease of hemoglobin before and 1-day after operation, shorter time of both waiting for postoperative gas and hospital stay, lower incidence of postoperative complications, long- er operation time, and higher incidence of intraoperative complications. Additionally, there were no differences between the 2 groups in the number of pelvic and para-aortic lymph nodes removed during operation, as well as the postoperative recurrence and mortality rates in 3-5 year follow-up. Conclusion Compared with laparotomy, laparoscopy shows lesser amount of intraoperative bleeding, lower decrease of hemoglobin before and 1-day after operation, shorter time of both waiting for postoperative gas and hospital stay, lower incidence of postoperative complications. But laparotomy shows lower incidences of intraoperative complications, and shorter operation time. Both operations are similar in the number of pelvic and para-aortic lymph nodes removed during operation, as well as the postoperative recurrence and mortality rates in 3-5 year follow-up. For quantity limitation and low methodological quality of included studies, this conclusion still needs to be further proved

关 键 词：子宫内膜癌 腹腔镜手术 开腹手术 META分析 系统评价 随机对照试验 

分 类 号：R737.33[医药卫生—肿瘤]