腹腔镜和开腹在早期卵巢癌全面分期手术中疗效的Meta分析

Laparoscopic and Laparotomy in Staging Operation of Early-stage Ovarian Cancer: A Meta-analysis

目的比较腹腔镜(LPS)与开腹(LPT)在早期卵巢癌全面分期手术中的疗效。方法计算机检索Pub Med、EMBase、Cochrane Library、万方数据库、中国生物医学文献数据库、中国知网1990-01-01至2014-02-12有关LPS和LPT在早期卵巢癌全面分期手术中疗效的文献。采用Rev Man 5.2.9软件对手术时间、术中失血量、淋巴结切除数、术中肿瘤破裂发生率、术后肛门排气时间、手术并发症发生率、术后疼痛评分(VAS)、术后住院时间、术后复发率和术后病死率进行分析。结果共纳入18篇临床对照研究(CCT)文献,包括434例LPS患者和788例LPT患者,文献质量较好。LPS组较LPT组术中失血量少〔MD=-207.86,95%CI(-285.87,-129.86),P<0.05〕,术后肛门排气时间早〔MD=-25.26,95%CI(-31.07,-19.45),P<0.05〕,手术并发症发生率低〔OR=0.30,95%CI(0.20,0.45),P<0.05〕,术后疼痛轻〔MD=-2.84,95%CI(-4.39,-1.29),P<0.05〕,住院时间短〔MD=-4.14,95%CI(-4.63,-3.66),P<0.05〕,而两组手术时间、淋巴结切除数、术中肿瘤破裂率、术后复发率、病死率间差异无统计学意义(P>0.05)。结论 LPS下早期卵巢癌全面分期手术创伤小、恢复快,远期效果与LPT手术相比无明显差异。

Objective To compare the effects of laparoscopic（LPS）and laparotomy（LPT）on early ovarian cancer in staging operation. Methods PubMed,EMBase,Cochrane Library,Wan - fang database,Chinese Biomedical Abstracts database,China National Knowledge Infrastructure were retrieved for literatures on the effects of LPS,LPT on early ovarian cancer in staging operation from 1990 - 01 - 01 to 2014 - 02 - 12. RevMan 5. 2. 9 software was used to analyze the operative time,intraoperative blood loss,number of lymph node dissection,incidence of intraoperative tumor rupture,postoperative anal exhaust time,incidence of surgical complications,postoperative pain scores（VAS）,hospital stay,recurrence rate,mortality. Results A total of 18 controlled clinical studies were enrolled including 434 LPS patients and 788 LPT patients. The blood loss was less in LPS group than in LPT group〔MD = - 207. 86,95% CI（ - 285. 87, - 129. 86）,P 〈 0. 05〕,anal exhaust time earlier〔MD = - 25. 26,95% CI（ - 31. 07, - 19. 45）,P 〈 0. 05〕,surgical complication incidence lower〔 OR = 0. 30, 95% CI（0. 20,0. 45）,P 〈 0. 05〕,pains fewer〔 MD = - 2. 84,95% CI（ - 4. 39, - 1. 29）,P 〈 0. 05〕,hospital stay shorter〔MD = - 4. 14,95% CI（ - 4. 63, - 3. 66）,P 〈 0. 05〕,but there were no significant difference in surgical time, number of lymph node dissection,intraoperative tumor rupture,postoperative recurrence rate,mortality between two groups（P＆gt; 0. 05）. Conclusion Laparoscopic staging operation of early ovarian cancer with small surgical traumas and quick recovery is not remarkably different from LPT.