腹腔鏡手術分期和治療宮頸癌療效與安全性的系統評價_《中國循證醫學雜志》

作者：

楊婧 ¹ , 呂東昊 ¹ , 何佳 ² , 劉洪倩 ¹ ,  石鋼 ¹

1. 四川大學華西第二醫院婦產科（成都 610041）；2. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

宮頸腫瘤腹腔鏡隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20100454

視頻：

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目的　系統評價腹腔鏡手術在宮頸癌分期、治療上的療效和安全性。
方法　計算機檢索CochraneLibrary、MEDLINE、EMbase 和中國生物醫學文獻數據庫，檢索時限為建庫至2009 年底。按納入與排除標準選擇文獻、評價質量、提取數據。用RevMan 5.0.22 軟件進行Meta 分析。
結果　共納入2 個RCT，共200 例患者。Meta 分析結果顯示，腹腔鏡手術可使宮頸癌患者術后肛門排氣時間提前［MD= –18.20，95%CI（–22.20，–14.20），P lt;0.001］，術后疼痛減輕［MD= –1.30，95%CI（–1.86，–0.74），P lt;0.001］和總住院日縮短［MD= –1.30，95%CI（– 1.59，– 1.01），P lt;0.001］。目前尚缺乏證據支持腹腔鏡手術在手術時間、淋巴結活檢數目、術中失血量和術后并發癥方面優于開腹手術。
結論　腹腔鏡手術分期和治療宮頸癌可縮短患者術后胃腸道功能恢復時間、縮短總住院日、減輕術后疼痛，但在術后并發癥、手術時間、淋巴結活檢數目、術中失血量等手術學指標上與開腹手術相比并無明顯優勢。但由于納入研究數量少且質量不高，論證強度較弱，尚需開展更多高質量研究做進一步研究。

引用本文： 楊婧,呂東昊,何佳,劉洪倩,石鋼. 腹腔鏡手術分期和治療宮頸癌療效與安全性的系統評價. 中國循證醫學雜志, 2010, 10(5): 592-596. doi: 10.7507/1672-2531.20100454 復制

1.	Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J Buon, 2009, 14(4): 587-592.
2.	Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5): 576-578.
3.	Querleu D. Radical hysterectomies by the Schauta-Amreich and Schauta-Stoeckel techniques assisted by celioscopy. J Gynecol Obstet Biol Reprod (Paris), 1991, 20(5): 747-748.
4.	Nezhat CR, Burrell MO, Nezhat FR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol, 1992, 166(3): 864-865.
5.	Fagotti A, Fanfani F, Longo R, et al. Which role for pre-treatment laparoscopic staging? Gynecol Oncol, 2007, 107(Suppl 1): S101-105.
6.	Quer leu D, Leblanc E, Cas telain B. Laparoscopic pelvi c lymphadenectomy in the staging of early carcinoma of the cervix. Am J Obstet Gynecol, 1991, 164(2): 579-581.
7.	Goff BA, Muntz HG, Paley PJ, et al. Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol, 1999, 74(3): 436-442.
8.	K?hler C, Klemm P, Schau A, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol, 2004, 95(1): 52-61.
9.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
10.	Panici PB, Plotti F, Zullo MA, et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol, 2006, 103(3): 859-864.
11.	Lai CH, Huang KG, Hong JH, et al. Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol, 2003, 89(1): 160-167.
12.	Ramirez PT, Soliman PT, Schmeler KM, et al. Laparoscopic and robotic techniques for radical hysterectomy in patients with earlystage cervical cancer. Gynecol Oncol, 2008, 110(3 Suppl 2): S21-24.

1. Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J Buon, 2009, 14(4): 587-592.
2. Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5): 576-578.
3. Querleu D. Radical hysterectomies by the Schauta-Amreich and Schauta-Stoeckel techniques assisted by celioscopy. J Gynecol Obstet Biol Reprod (Paris), 1991, 20(5): 747-748.
4. Nezhat CR, Burrell MO, Nezhat FR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol, 1992, 166(3): 864-865.
5. Fagotti A, Fanfani F, Longo R, et al. Which role for pre-treatment laparoscopic staging? Gynecol Oncol, 2007, 107(Suppl 1): S101-105.
6. Quer leu D, Leblanc E, Cas telain B. Laparoscopic pelvi c lymphadenectomy in the staging of early carcinoma of the cervix. Am J Obstet Gynecol, 1991, 164(2): 579-581.
7. Goff BA, Muntz HG, Paley PJ, et al. Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol, 1999, 74(3): 436-442.
8. K?hler C, Klemm P, Schau A, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol, 2004, 95(1): 52-61.
9. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
10. Panici PB, Plotti F, Zullo MA, et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol, 2006, 103(3): 859-864.
11. Lai CH, Huang KG, Hong JH, et al. Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol, 2003, 89(1): 160-167.
12. Ramirez PT, Soliman PT, Schmeler KM, et al. Laparoscopic and robotic techniques for radical hysterectomy in patients with earlystage cervical cancer. Gynecol Oncol, 2008, 110(3 Suppl 2): S21-24.

《中國循證醫學雜志》

腹腔鏡手術分期和治療宮頸癌療效與安全性的系統評價

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《中國循證醫學雜志》

腹腔鏡手術分期和治療宮頸癌療效與安全性的系統評價

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