根治性宫颈切除术治疗早期宫颈癌的循证评价

Evidence-based evaluation of radical trachelectomy for treatment of early cervical cancer

目的分析早期宫颈癌患者行根治性宫颈切除术（RT）和根治性全子宫切除术（RH）后5年无瘤生存率及5年总生存率（即以病人从确诊后再经治疗生存5年的病人数占同期病人总数的百万分比衡量疗效），术中和术后并发症、输血率及RT后的妊娠结局。方法应用电子计算机检索PubMed数据库，Cochrane图书馆（2014）、ISI Web of Knowledge、OVID、web．science、Ebsco-medline、超星Medalink、万方、CNKI等数据库并辅以手工检索相关期刊，截止2014年9月，共搜集相关文献325篇，对符合纳入标准的病例对照试验，分为实验组RT和对照组RH，并采用RevMan5．2软件进行Meta分析，对于无对照临床研究资料，采用描述性合并分析。结果共纳入8篇病例对照研究和45篇无对照临床研究，Meta分析结果显示RT与RH治疗早期宫颈癌的5年无瘤生存率（OR=0．94，95％CI：0．5—1．78，P=0．85）、5年总生存率（OR=0．67，95％CI：0．27—1．67，P=0．39）及术后并发症（OR=0．65，95％CI：0．41-1．02，P=0．06）差异均无统计学意义，输血率（OR=0．33，95％CI：0．21—0．51，P=0．00001）和术中并发症（OR=1．95，95％CI：1．09—3．47，P=0．02）差异均有统计学意义，即输血率较RH低，术中并发症较RH高。无对照临床病例研究文献统计学结果显示行RT后，尝试妊娠例数为504人，妊娠434例次，活产309例次，即妊娠率为86％，活产率为71％。结论RT对于有生育要求的年轻早期宫颈癌患者是一个安全有效的选择，在根除病灶的同时，又保留了患者的生育能力，且提高改善了早期宫颈癌年轻患者的生存质量。

Objective To evaluate 5-year recurrence-free survival rate, 5-year overall survival rate, intra- and post-operative complications, blood transfusion rate and the pregnancy outcomes of radical trachelectomy （ RT ） and radical hysterectomy （ RH ） for patients with early cervical cancer. Methods PubMed database, Cochrane library, ISI Web of Knowledge, OVID, Web science, Ebsco medline, super star Medalink, Wangfang data and CNKI database were searched combined with hand searching. Up to September 2014, 325 relevant articles ware collected. Case-control studies recruited were divided into experimental group RT and control group RH, and Rev Man 5.2 software was used for Meta-analysis. Descriptive analysis was used for no controlled clinical research data. Results Eight articles of case-control studies and 45 articles without controlled clinical studies were selected. Meta-analysis results showed that there were no significance differences between RT and RH in 5-year recurrence-free survival rate （ OR = 0.94,95 % CI：0. 50 - 1.78, P = 0.85 ） , 5-year overall survival rate （ OR = 0. 67, 95% CI： 0. 27-1.67,P = 0.39 ） and postoperative complications （ OR = 0. 65,95% CI： 0. 41 - 1.02, P=0.6）, but that the differences in blood transfusion rate （OR = 0. 33,95% CI：O. 21 -0.51, P = 0. 00001 ） and intra-operative complications （OR = 1.95, 95% CI： 1.09 -3.47, P = 0.02） were significant. Blood transfusion rate was higher and intra-operative complication was lower with RH. Statistical results on literatures about no controlled clinical researches showed that after RT 504 cases attempted pregnancy with 434 pregnancy times. There were 309 live births with pregnancy rate of 86% and live birth rate of 71%. Conclusion RT is a safe and effective choice for young patients with early cervical cancer and fertility requirements. It can remove lesions and keep patient＇ s fertility, and it improves the quality of life of vounK patients with early cervical cancer.