腹腔镜和开腹手术治疗中国老年宫颈癌疗效的Meta分析*

Comparison of laparoscopic versus laparotomic operation for cervical carcinoma in elderly Chinese women: a meta-analysis*

摘要:

目的??比较腹腔镜与开腹手术治疗中国老年宫颈癌的疗效。方法?计算机检索中国生物医学文摘数据库（CBM）、万方全文数据库（wanfangdata）、中国知网全文数据库（CNKI）、维普中文期刊数据库（VIP）和PubMed，根据入选标准筛选文献。从文献提取数据，采用RevMan 5.2.9软件进行统计学分析。结果?最终纳入符合标准的文献10篇，均为临床对照研究（CCT），无随机对照研究（RCT）。腹腔镜手术组与开腹手术组患者年龄、体重、肿瘤分期等基本特征无明显差异。与开腹手术相比，腹腔镜手术组手术时间长（MD=32.60，95%CI：5.65～59.55，P =0.020），术中失血量少（MD=-94.01，95%CI：-130.65～-57.37，P =0.000），清除淋巴结数量少（MD= 1.69，95%CI：0.67～2.72，P =0.001），术后排气时间早（MD =-17.09，95%CI：-21.19～-12.98，P =0.000），住院时间短（MD =-4.30，95%CI：-5.57～-3.02，P =0.000），差异有统计学意义。而术后留置尿管时间（MD=-0.67，95%CI：-1.92～0.58，P =0.290）、手术并发症发生率（OR =0.62，95%CI：0.27～1.42，P =0.260），差异无统计学意义。结论?腹腔镜手术具有创伤小、恢复快等优势，并不增加手术并发症发生率，是治疗中国老年宫颈癌的理想术式。

Abstract:

Objective?To compare the curative effect of laparoscopic and laparotomic operation for elderly Chinese women with cervical cancer.?Methods?The randomized controlled trials (RCT) and case controlled trials (CCT) were collected by searches of WanFang database, CNKI, VIP, China Biology Medicine (CBM) , PubMed. Data were extracted from these trials and data analysis was performed by RevMan 5.2.9.?Results?There were no RCTs, however, a total of 10 CCTs met the inclusion criteria and had data extracted for this review. The baseline characteristics of the laparoscopic group were similar to those of the laparotomic group. Comparing to laparotomic group, the laparoscopic group have longer operation time (MD =32.60, 95%CI: 5.65~59.55, P = 0.020), less amount of bleeding (MD = -94.01, 95%CI: -130.65 ~ -57.37, P = 0.000), smaller number of lymph node dissection (MD = 1.69, 95%CI: 0.67 ~ 2.72, P = 0.001), earlier anus exhaustion (MD=-17.09, 95%CI: -21.19 ~ -12.98, P = 0.000) and shorter hospital stays (MD = -4.30, 95%CI: -5.57 ~ -3.02, P = 0.000). There was significant difference between the two groups. But there was no statistical significance in postoperative indwelling catheter time (MD = -0.67, 95%CI: -1.92 ~ 0.58, P = 0.290) and surgical complications incidence (OR=0.62, 95%CI: 0.27 ~ 1.42, P = 0.260) between the two groups.?Conclusion?Laparoscopic management has the advantages of less traumatic and recovered quickly, and did not increase the incidence of complications. Laparoscopic operation is an ideal procedure for elderly Chinese women with cervical carcinoma.