保留盆腔自主神经的根治性子宫切除术治疗宫颈癌疗效的Meta分析  

Effects of Nerve-Sparing Radical Hysterectomy for Cervical Cancer:A Systematic Review

作　　者：袁春燕[1] 丁波[1] 彭丹红[1] 任慕兰[1] 

机构地区：[1]东南大学附属中大医院妇产科,南京210009

出　　处：《循证医学》2014年第6期354-360,共7页The Journal of Evidence-Based Medicine

基　　金：江苏省卫生厅预防医学研究课题资助项目(Y2013067)

摘　　要：目的比较传统的根治性子宫切除术和保留盆腔自主神经的根治性子宫切除术治疗宫颈癌的疗效。方法检索Pub Med、EMBASE、CBMdisc、CNKI和Wanfang数据库,收集符合纳入标准的随机对照试验。运用Stata software(version 11.0)对数据进行统计分析。结果纳入19项临床同期对照试验共计1 862例患者。分析显示,1术后膀胱功能比较:术后残余尿<50 m L及<100 m L的恢复时间分别为加权均数差=-6.62、95%可信区间(-7.00,-6.23)及加权均数差=-5.04、95%可信区间(-6.52,-3.56),膀胱功能紊乱的发生率比较的相对危险度=0.46,95%可信区间(0.29,0.71);2术后肠道功能比较:术后排气及排便时间分别为加权均数差=-12.02,95%可信区间(-16.20,-7.85)及加权均数差=-20.99,95%可信区间(-32.02,-9.96);3术后生存率及2年、4年、5年复发率差异无统计学意义,术后2年复发率比较相对危险度=1.21,95%可信区间(0.73,2.01),P=0.452;4单个研究提示与经腹根治性子宫切除术组相比,保留盆腔自主神经的根治性子宫切除术组患者的直肠功能紊乱、性功能紊乱发生率较低,且保留盆腔自主神经的根治性子宫切除术组术后生活质量较高。结论与传统根治性子宫切除术相比,保留盆腔自主神经的根治性子宫切除术具有术后膀胱、直肠及性功能恢复快的优点;保留盆腔自主神经的根治性子宫切除术提高了患者的生活质量,并不影响患者术后宫颈癌的复发率和生存率。本系统评价的结论需要随访时间更长的大样本随机对照研究加以验证。Objective To study the clinical effects of nerve-sparing radical hysterectomy （NSRH） for cervical cancer compared with radical hysterectomy （RH）. Methods We searched the PubMed, EMBASE, CBMdisc, CNKI and Wanfang Data; hand searched related literatures; and collected both randomized controlled trials and controlled clinical trials comparing NSRH with RH for cervical cancer. Meta-analysis was conducted with the Stata software. Results Nineteen clinical controlled trials involving 1 862 patients were collected. Compared with RH, NSRH was much better for the recovery time of post void residual urine volume （ PVR ） 〈50 mL and〈100 mL , WMD=-6 . 62 , 95%CI （-7.00,-6.23） and WMD=-5.04, 95%CI （-6.52,-3.56） respectively; NSRH has less bladder dysfunction morbidity RR=0.46, 95%CI （0.29, 0.71）; the recovery time of postoperative flatus and bowel movement were much earlier in NSRH than those in the RH group , WMD=-12 . 02 , 95%CI （-16 . 20 ,-7 . 85 ） , WMD=-20 . 99 , 95%CI （-32.02,-9.96） respectively; no significant difference was found in both survival rate and recurrent rate; one trial showed that NSRH led to less rectal and sexual dysfunction, quality of life in NSRH group was significantly higher than that RH. Conclusions Compared with RH, NSRH is related with better postoperative recovery of bladder, rectal and sexual functions, which can improve the quality of postoperative life, but haven’t lower survival rates and higher recurrence rates. In the future, more prospective randomized controlled trials are required for further investigation.

关 键 词：宫颈癌 保留盆腔自主神经 根治性子宫切除术 META分析 

分 类 号：R737.33[医药卫生—肿瘤]