根治性宫颈切除术治疗早期小病灶宫颈癌安全性的系统评价

Safety of Radical Trachelectomy for Small Early Stage Cervical Carcinoma: A Meta-Analysis

目的:系统评价根治性宫颈切除术治疗早期宫颈癌生存率、复发率及其术后并发症和妊娠情况。方法:应用EndNote软件全面检索Pubmed(1973-2010)数据库,对符合纳入标准的随机对照试验,采用RevMan 4.3软件进行Meta分析。对于无对照临床研究资料,采用同质合并分析。结果:共纳入5篇临床对照研究和14篇无对照临床研究,Meta分析结果显示根治性宫颈切除与全子宫切除治疗早期宫颈癌的生存率差异无统计学意义(P=0.08),而且复发率差异也没有统计学意义(P=0.37),但全子宫切除术后并发症显著高于根治性宫颈切除组(P=0.008)。临床病例系列研究文献统计结果显示早期宫颈癌患者接受根治性宫颈切除术治疗后总的妊娠率达到61%,而复发率仅为2%。结论:根治性宫颈切除治疗早期宫颈癌与全子宫切除术具有相似的肿瘤学结果,术后大部分患者都能成功妊娠。根治性宫颈切除术对于年轻的有生育要求的早期宫颈癌患者是一个安全有效的选择。

als and fourteen uncontrolled clinical trials were included. The meta-analysis results showed that the survival rate of radical trachelectomy for small early stage cervical carcinoma was not signifi cantly different from that of radical hysterectomy （P= 0.08, OR = 0. 57, 95 % 121= 0. 30-1. 08 ） . The difference of recurrence rate between the two groups was not statistically significant （P = 0. 37, OR = 1.47, 95 % CI= 0. 63-3. 45）. But the morbidity after radical trachelectomy was significantly less than that after radical hysterectomy （P = 0. 008, OR = 0. 55, 95 % CI = 0. 35-0.86）. Fourteen uncontrolled trials and two controlled trials involving 694 patients were included to evaluate the pregnancy outcomes after radical traehelectomy. In all, the total pregnance rate was 61%, and the recurrence rate was 2%. Conclusion： Radical trachelectomy appears to have a similar oncologic outcome to radical hysterectomy. It seems to be the procedure of choice for women with small early stage cervical cancer wishing to preserve fertility.