腹腔镜手术治疗子宫内膜癌的系统评价

Laparoscopy versus laparotomy for endometrial cancer:system review

目的系统评价腹腔镜与开腹手术在子宫内膜癌治疗中的疗效及安全性。方法检索Cochrane Library、PubMed、EMbase、Ovid、CBM、万方、维普及CNKI等数据库1990年1月至2013年9月比较腹腔镜和开腹手术治疗所有期别的子宫内膜癌的随机对照试验，采用RevMan5．1软件进行Meta分析。结果最终纳入13个随机对照试验，共7317例患者。Meta分析结果：两组术后随访3～5年子宫内膜癌患者总生存率、复发率以及清扫盆腔淋巴结数目无明显差别。与开腹手术相比，腹腔镜手术治疗子宫内膜癌术中出血量更少（P=0．0001），住院时间更短（P〈0．00001），总并发症（P〈0．00001）、术后并发症（P〈0．00001）发生率更低。但腹腔镜组的术中并发症发生率高于开腹组（p=0．03）、手术时间较开腹组长（P=0．004）。结论与开腹手术相比，腹腔镜在子宫内膜癌的治疗中更有优势，尤其在总并发症和住院时间等方面优势更明显。

Objective To evaluate the clinical efficacy and safety of laparoscopy versus laparotomy for treatment of en- dometrial cancer. Methods The databases such as Cochrane Library,PubMed,EMbase,Ovid,CBM, WanFang Data, VIP Information and CNKI were searched to collect the randomized control trials （RCTs） between January 1990 and Sep- tember 2013. The software of meta-analysis was RevMan 5.1. Results A total 13 RCTs include 7640 patients. There was no significant difference between laparoscopic and laparotomic approaches to endometrial cancer in 3-5 years over- all survival, recurrence at 3-5 years follow-up, and the number of pelvic node yield. The benefits of laparoscopic surgery versus laparotomy were lesser amount of intraoperative bleeding （P= 0.0001）, shorter length of hospital stay （P〈0.00001）, lower rates of total complications （P〈0.00001） and postoperative complications （P〈0.00001）. Disadvantages were higher rates of intraoperative complications （P=0.03） and longer duration of surgical procedures （P= 0.004）. Conclusion Com- pared with laparotomy, laparoscopic surgery seems to be beneficial in women with endometrial cancer, in particular as to- tal comolications and length of hosoital stay.