保留盆腔神经的广泛性子宫切除术治疗宫颈癌疗效及安全性荟萃分析  

Nerve-sparing radical hysterectomy in the treatment of cervical cancer: a Meta- analysis of the efficacy and security

作　　者：陈丹[1] 于慧会[2] 史海敏[1] 张新[2] 

机构地区：[1]辽宁中医药大学,辽宁沈阳110033 [2]辽宁省肿瘤医院,辽宁沈阳110042

出　　处：《中国实用妇科与产科杂志》2014年第11期882-888,共7页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：辽宁省科技计划项目(2010225032)

摘　　要：目的评价保留盆腔自主神经的广泛性子宫切除术(nerve-sparing radical hysterectomy,NSRH)治疗宫颈癌的临床疗效和安全性。方法检索大型数据库中近11年发表的关于NSRH与传统广泛性子宫切除术(radical hysterectomy,RH)临床疗效比较的前瞻性同期对照试验。并按Cochrane系统评价方法提取有效数据进行Meta分析。结果 NSRH与RH相比,其术后留置尿管时间[加权均数差(weighted mean difference,WMD)=-6.73,95%可信区间(CI)-7.39^-6.06]、残余尿量<50 m L时间(WMD=-7.80,95%CI-11.93^-3.67)、首次排气时间(WMD=-12.05,95%CI-15.87^-8.24)、首次排便时间(WMD=-24.99,95%CI-26.87^-23.11)、住院天数(WMD=-4.00,95%CI-4.60^-3.40)均明显减少,宫旁切除长度明显减小(WMD=-0.10,95%CI-0.15^-0.06),手术总时间延长(WMD=30.74,95%CI 16.66~44.82);而在淋巴结活检数、术中出血量、术后总体复发率等方面比较差异无统计学意义。结论 NSRH治疗早期宫颈癌具备安全性和可行性,在缩短膀胱功能恢复时间、肠道功能恢复时间及住院时间等方面有一定优势。Objective To estimate the clinical efficacy and security of nerve-sparing radical hysterectomy（NSRH） in the treatment of cervical cancer.Methods Large databases were searched in recent 11 years for studies which were prospective controlled trials comparing clinical efficacy of NSRH with that of radical hysterectomy（RH） in treating cervical cancer. A comprehensive quantitative analysis was performed by Meta-analysis method.Results Meta-analysis results showed that the pooled WMDs values of cervical cancer for the highest versus lowest of Indwelling catheter time levels were-6.73,95%CI-7.39^-6.06;the time of residual urine volume 〈50 m L levels was-7.80,95%CI-11.93^-3.67;the first exhaust time was-12.05,95%CI-15.87^-8.24;the first defecation time was-24.99,95%CI-26.87^-23.11;days of hospitalization were-4.00, 95%CI-4.60^-3.40;uterine resection length was-0.10,95%CI-0.15^-0.06;these all significantly reduced.The total operation time was 30.74,95%CI16.66~ 44.82,which was lengthened. No significant differences were found in the number of lymph nodes, bleeding volume, postoperative overall recurrence rate.Conclusion NSRH is safe and feasible in treatment of early stage cervical cancer,alleviating the postoperative dysfunction of the bladder and intestinal tract,shorting the hospitalization days.

关 键 词：保留盆腔自主神经的广泛性子宫切除术 根治性子宫切除术 宫颈癌 META分析 

分 类 号：R713.44[医药卫生—妇产科学]