摘要
目的评价改良腹式广泛宫颈切除术(MART)与全腹腔镜广泛宫颈切除术(TLRT)治疗早期宫颈癌(Ⅰa1~Ⅰb2)的疗效和安全性。方法计算机检索PubMed、EMbase、Web of Science、中国学术期刊数据库(万方)、中国期刊全文数据库(CNKI),检索时间从数据库建立至2021年11月,中文检索词为“早期宫颈癌”“改良腹式手术”“改良腹式广泛宫颈切除术”“腹腔镜手术”“全腹腔镜广泛宫颈切除术”,英文检索词为“emergycy”“early cervical cancer”“modified abdominal surgery”“total laparoscopic cervical resection”,所有检索采取主题词和自由词相结合方式检索,由2名评价员进行独立筛选文献、提取资料和评价纳入研究的方法学质量,采用RevMan 5.4软件进行Meta分析。结果初检纳入文献50篇,最终纳入文献10篇,包括6篇随机对照试验(RCT)和4篇队列研究,患者711例。Meta分析结果显示,全腹腔镜组手术时间长于改良腹式组[MD=–44.49,95%CI(-48.08,-40.90),P<0.00001],术中出血量少于改良腹式组[MD=2.34,95%CI(1.81,2.88),P<0.00001];两组术中盆腔淋巴结清扫数目比较差异无统计学意义;全腹腔镜组切除宫旁组织长度短于改良腹式组[MD=1.19,95%CI(0.17,2.21),P=0.02],术后妊娠率高于改良腹式组[OR=0.60,95%CI(0.41,0.88),P=0.009];两组术后膀胱功能障碍率比较差异无统计学意义;全腹腔镜手术组子宫动脉损伤率高于改良腹式组[OR=-0.17,95%CI(-0.25,-0.08),P<0.0001];两组术后引流量比较差异无统计学意义;全腹腔镜手术组术后住院时间短于改良腹式组[MD=3.85,95%CI(3.34,3.81),P<0.00001];两组术中转子宫切除率、术后宫颈粘连率比较差异无统计学意义。结论TLRT治疗早期宫颈癌术中出血量少、住院时间及切除宫旁组织长度短,术后妊娠率高,但MART手术时间短,子宫动脉损伤率低,临床需根据早期宫颈癌患者具体情况选择术式。
Objective To evaluate the efficacy and safety of modified abdominal radical trachelectomy(MART)ands total laparoscopic radical trachelectomy(TLRT)in the treatment of early-stage cervical cancer(Ⅰa1-Ⅰb2).Methods A computerized search was conducted on The databas-es of PubMed,EMbase,Web of Science,China Academic Journal Database(Wanfang),and China National Knowledge Infrastructure(CNKI)were searched by computer from the establishment of the databases to November 2021,the Chinese search terms were"early stage cervical cancer""modi-fied abdominal surgery""modified abdominal radical trachelectomy""laparoscopic surgery""total laparoscopic radical trachelectomy",the English search terms were"emergycy""early cervical cancer""modified abdominal surgery""total laparoscopic cervical resection",all searches were con-ducted by a combination of subject and free word searches by two evaluators who independently screened the literature,extracted information and evaluated the methodological quality of the included studies,RevMan 5.4 software was used for Meta-analysis.Results A total of 50 articles were included in the initial screening,and 10 articles were finally included,including 6 randomized controlled trials(RCT)and 4 cohort studies,with 711 pa-tients.Meta-analysis showed that the operation time in the total laparoscopic group was longer than that in the modified abdominal group(MD=–44.49,95%CI[–48.08,–40.90],P<0.00001),and intraoperative bleeding was less than that in the modified abdominal group(MD=2.34,95%CI[1.81,2.88],P<0.00001);there was no statistically significant difference in the number of intraoperative pelvic lymph node clearance between the two groups;and the length of resected parametrial tissues in the total laparoscopic group was shorter than that in the modified abdominal group(MD=1.19,95%CI[0.17,2.21],P=0.02),and the postoperative pregnancy rate was higher than that in the modified abdominal group(OR=0.60,95%CI[0.41,0.88],P=0.009);there was no statistically significant difference in the rate of postoperative bladder dysfunction between the two groups;the rate of uterine artery injury in the total laparoscopy group was higher than that in the modified abdominal group(OR=-0.17,the 95%CI[-0.25,-0.08],P<0.0001);there was no statistically significant difference in the postoperative drainage rate between the two groups;the postoperative hospitalization time in the total laparoscopic surgery group was shorter than that in the modified abdominal group(MD=3.58,95%CI[3.34,3.81],P<0.00001);there was no statistically significant difference in the intraoperative conversion hysterectomy rate and postoperative cervical adhesion rate between the two groups.Conclusion TLRT treatment of early-stage cervical cancer has less intraoperative bleeding,shorter hospitalization time and length of resected paracervical tissues,and higher postoperative pregnancy rate,but MART has shorter surgery time,and low rate of uterine artery injury,and the clinical needs to choose the surgical procedure according to the specific conditions of patients with early-stage cervical cancer.
作者
王兴强
钱小龙
马驰
宋艳萍
马雪静
刘志杰
WANG Xingqiang;QIAN Xiaolong;MAChi;SONG Yanping;MAXuejing;LIU Zhijie(First Clinical Medical College of Gansu University of Traditional Chinese Medicine,Lanzhou,Gansu,730000,China;Department of Gynecological Oncology,Gansu Provincial Maternity and Child-care Hospital,Lanzhou,Gansu,730000,China;Department of Gynecological Intensive Care Unit,Zhangye Second People's Hospital,Zhangye,Gansu,734000,China)
出处
《当代医学》
2023年第34期1-10,共10页
Contemporary Medicine
关键词
早期宫颈癌
改良腹式广泛宫颈切除术
全腹腔镜广泛宫颈切除术
Early cervical cancer
Modified bdominal radical trachelectomy
Total laparoscopic radical trachelectomy
