国内腹腔镜和开腹手术治疗早期卵巢癌的临床效果的Meta分析

Clinical Effects of Laparoscopy versus Laparotomy in Treatment of Early-Stage Ovarian Cancer in China:a Meta-Analysis

目的:评估腹腔镜手术治疗早期卵巢癌的可行性及安全性。方法:通过Pubmed、Embase、Medline、Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据、维普资讯等检索2000年1月—2014年3月发表的有关比较腹腔镜手术与开腹手术治疗早期卵巢癌的文献。根据筛选标准选择文献,评估文献质量并提取相关数据,采用RevMan4.2.9软件进行统计分析。结果:共有7篇文献入选,均为临床病例对照研究,共422例患者,其中腹腔镜(laparoscopy,LPS)组192例,开腹(laparotomy,LPT)组230例。Meta分析结果显示,两组手术时间差异无统计学意义[加权均数差(weighted mean difference,WMD)=32.95,95%可信区间(confidence interval,CI):-3.89~69.79,P=0.08],术中出血量差异有统计学意义(WMD=-228.99,95%CI:-368.95^-89.03,P=0.001),淋巴结清扫个数差异无统计学意义(WMD=-1.11,95%CI:-2.30~0.09,P=0.07),术后排气时间差异有统计学意义(WMD=-22.25,95%CI:-28.40^-16.11,P<0.00001),住院天数差异有统计学意义(WMD=-5.52,95%CI:-8.72^-2.32,P=0.0007),术后并发症差异有统计学意义[优势比(odds ratio,OR)=0.31,95%CI:0.16~0.59,P=0.0004]。结论:腹腔镜手术治疗早期卵巢癌创伤小、出血少、恢复快,疗效确切,安全可行,值得在临床推广。国内已有的相关研究均为小样本回顾分析,缺乏对远期疗效的分析,结论还有待多中心、大样本、前瞻性的随机对照试验研究证实。

Objective：To evaluate the feasibility and safety of laparoscopy in treatment of early-stage ovarian cancer.Methods：Original articles about comparison between laparoscopy and laparotomy in treatment of early-stage ovarian cancer,published from Jan.2000 to Mar.2014,were searched via the databases including Pubmed,Embase,Medline,Cochrane Library,CNKI,CBM,Wanfangdata,CQVIP etc.According to the inclusion and exclusion criteria,references were identified and evaluated.And related data were extracted from these articles and analyzed with RevMan4.2.9 software.Results：Totally,seven articles were identified,which were clinical case-control studies.A total of 422 patients with early-stage ovarian cancer were enrolled,including 192 patients in laparoscopy（LPS）group and 230 patients in laparotomy（LPT）group.Between the two groups,the Meta analysis showed no significant difference regarding operation time（WMD=32.95,95%CI：-3.89-69.79,P=0.08）,significant difference regarding intraoperative blood loss（WMD=-228.99,95%CI：-368.95--89.03,P=0.001）,no significant difference regarding number of retrieved lymph nodes（WMD=-1.11,95%CI：-2.30-0.09,P=0.07）,significant difference regarding time of postoperative first flatus（WMD=-22.25,95%CI：-28.40--16.11,P〈0.00001）,significant difference regarding postoperative hospital stay（WMD=-5.52,95%CI：-8.72--2.32,P=0.0007）and significant difference regarding postoperative complications（OR=0.31,95%CI：0.16-0.59,P=0.0004）.Conclusions：Laparoscopy,in the treatment of early-stage ovarian cancer,showed advantages as mini-invasive trauma,little blood loss and fast recovery,so that it was eutherapeutic,safe and feasible.Thus,it could be worthy of popularization in clinical application.These literatures were all retrospective researches with small samples,and lack of analysis on long term efficacy.Therefore,a multicenter,large sample,prospective and randomized controlled trial is needed for further confirmation.