腹腔鏡與開腹手術比較治療子宮內膜癌療效與安全性的Meta分析_《中國循證醫學雜志》

作者：

王迪 ,  馬彩玲 , 葉遠征 , Srijana Sharma

新疆醫科大學第一附屬醫院婦科（烏魯木齊 830054）;

關鍵詞：

子宮內膜癌腹腔鏡手術開腹手術 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20130104

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目的　系統評價腹腔鏡與開腹手術比較治療子宮內膜癌的療效及安全性。
方法　計算機檢索The Cochrane Library、PubMed、EMbase、Ovid、WanFang Data、VIP 和CNKI數據庫，收集腹腔鏡和開腹手術比較治療子宮內膜癌療效及安全性的隨機對照試驗，檢索時限從1998.1～2012.9，由兩名評價者按照納入與排除標準選擇試驗、提取資料和評價質量后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入10個隨機對照試驗，共6 993例患者。Meta分析結果顯示與開腹手術相比，腹腔鏡手術治療子宮內膜癌術中出血量更少、術前與術后第1天血紅蛋白下降值更低、術后排氣時間和住院時間更短、術后并發癥發生率更低。但腹腔鏡的手術時間更長、術中并發癥發生率更高。此外，兩組在術中清掃盆腔淋巴結數目、術中清掃腹主動脈旁淋巴結數目及術后隨訪3～5年子宮內膜癌復發率和死亡率方面，其差異均無統計學意義。
結論　腹腔鏡手術較開腹手術術中出血量更少、術前與術后第1天血紅蛋白下降值更低、術后排氣時間和住院時間更短、術后并發癥發生率更低；但開腹手術的術中并發癥發生率比腹腔鏡手術組低且手術時間短；兩種手術方式在清掃盆腔淋巴結和腹主動脈旁淋巴結數目及術后隨訪3～5年子宮內膜癌復發率和死亡率方面相似。由于納入研究數量有限且方法學質量不高，本研究結果尚需更多高質量的隨機對照試驗進一步證實。

引用本文： 王迪,馬彩玲,葉遠征,Srijana Sharma. 腹腔鏡與開腹手術比較治療子宮內膜癌療效與安全性的Meta分析. 中國循證醫學雜志, 2013, 13(5): 596-604. doi: 10.7507/1672-2531.20130104 復制

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9.	Tozzi R, Malur S, Koehler C, et al. Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy? Gynecol Oncol, 2005, 97(1): 4-9.
10.	Zullo F, Palomba S, Falbo A, et al. Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial. Am J Obstet Gynecol, 2009, 200(3): 296.e1-9.
11.	Malzoni M, Tinelli R, Cosentino F, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol, 2009, 112(23): 26-133.
12.	Walker JL, Piedmonte MR, Spirtos N, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. Journal of Clinical Oncology, 2009, 27(32): 5331-5336.
13.	Janda M, Gebski V, Brand A, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol, 2010, 11(6): 772-780.
14.	Mourits MJE, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in earlystage endometrial cancer: a randomised trial.Lancet Oncol, 2010, 11(6): 763-771.
15.	Obermair A, Janda M, Baker J, et al. Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: Results from a randomised controlled trial. A European Journal of Cancer, 2012, 48(21): 1147-1153.
16.	Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. Journal of Clinical Oncology, 2012, 30(7): 695-700.
17.	陳曉虹. 腹腔鏡與開腹手術治療子宮內膜癌的臨床對比分析. 中國微創外科雜志, 2007, 7(3): 210-212.
18.	Langebrekke A, Ister O, Hallqvist AC. Comparison of laparoscopy and laparotomy in patients with endometrial cancer. J Am Assoc Gynecol Laparosc, 2002, 9(3): 152-157.

1. 豐有吉, 沈鏗, 馬丁, 等. 婦產科學. 第2版. 北京: 人民衛生出版社, 2010: 334-338.
2. Siegel R, Naishadham D, Jemel A. Cancer statistics. CA Cancer J Clin, 2012, 62(1): 10-29.
3. 劉元姣, 曹來英. 新編婦產科疾病診療學. 北京: 人民衛生出版社, 2002: 701-702.
4. Barwijuk A, Jankowska S. Is laparoscopic or abdominal ysterectomy with bilateral salp ingooophorectomy more efficient in operative treatment of endometrial cancer? J Obstet Gynaecol, 2005, 25(7): 703-705.
5. Lurain JR. Uterine Cancer. Philadelphia: Lippincott Williams & Wilkins, 2007: 1368-1369.
6. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochranehand-book.org.
7. Review Manager (RevMan) [Computer program]. Version 5.0 for Windows. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
8. Zullo F, Palomba S, Russo T, et al. A prospective randomized comparison between laparoscopic and laparotomic approaches in women with early stage endometrial cancer: a focus on the quality of life. Am J Obstet Gynecol, 2005, 193(4): 1344-1352.
9. Tozzi R, Malur S, Koehler C, et al. Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy? Gynecol Oncol, 2005, 97(1): 4-9.
10. Zullo F, Palomba S, Falbo A, et al. Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial. Am J Obstet Gynecol, 2009, 200(3): 296.e1-9.
11. Malzoni M, Tinelli R, Cosentino F, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol, 2009, 112(23): 26-133.
12. Walker JL, Piedmonte MR, Spirtos N, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. Journal of Clinical Oncology, 2009, 27(32): 5331-5336.
13. Janda M, Gebski V, Brand A, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol, 2010, 11(6): 772-780.
14. Mourits MJE, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in earlystage endometrial cancer: a randomised trial.Lancet Oncol, 2010, 11(6): 763-771.
15. Obermair A, Janda M, Baker J, et al. Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: Results from a randomised controlled trial. A European Journal of Cancer, 2012, 48(21): 1147-1153.
16. Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. Journal of Clinical Oncology, 2012, 30(7): 695-700.
17. 陳曉虹. 腹腔鏡與開腹手術治療子宮內膜癌的臨床對比分析. 中國微創外科雜志, 2007, 7(3): 210-212.
18. Langebrekke A, Ister O, Hallqvist AC. Comparison of laparoscopy and laparotomy in patients with endometrial cancer. J Am Assoc Gynecol Laparosc, 2002, 9(3): 152-157.

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腹腔鏡與開腹手術比較治療子宮內膜癌療效與安全性的Meta分析

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《中國循證醫學雜志》

腹腔鏡與開腹手術比較治療子宮內膜癌療效與安全性的Meta分析

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