腹腔镜与开腹手术比较治疗交界性卵巢肿瘤术后复发的Meta分析

Effect of Laparoscopy versus Laparotomy on Recurrence for Borderline Ovarian Tumors: A Meta-analysis

目的系统评价腹腔镜和开腹手术比较对交界性卵巢肿瘤复发的影响。方法计算机检索Pub Med、The Cochrane Library(2015年11期)、Web of Science、EMbase、CNKI、Wan Fang Data和CBM数据库,搜集腹腔镜和开腹手术比较对交界性卵巢肿瘤复发影响的研究文献,检索年限均从建库至2015年11月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入19个队列研究。NOS量表评分结果显示,10个研究总分<7分,9个研究总分≥7分。Meta分析结果显示:虽然腹腔镜组总术后复发率高于开腹组[OR=1.75,95%CI(1.05,2.91),P=0.03],但在保守手术[OR=1.22,95%CI(0.71,2.08),P=0.47]和根治手术[OR=4.38,95%CI(0.85,22.68),P=0.08]两个亚组中,两组术后复发率差异无统计学意义。此外,腹腔镜手术组的肿块直径明显小于开腹手术组[MD=–6.88,95%CI(–8.15,–5.61),P<0.000 01];且术中肿块破裂发生率较开腹手术组高[OR=3.99,95%CI(2.54,6.26),P<0.000 01]。结论腹腔镜手术治疗交界性卵巢癌时,因对肿块径线要求较高,且有增加术中肿瘤破裂率及术后复发的潜在风险,应谨慎考虑应用范围。受纳入研究的质量及纳入病例数限制,腹腔镜在交界性卵巢癌中的运用需更多高质量、大样本研究进一步验证。

Objective To systematically review the effect of laparoscopy versus laparotomy for borderline ovarian tumors （BOTs） on postoperative recurrence. Methods We searched PubMed, The Cochrane Library （Issue 11, 2015）, EMbase, Web of Science, CNKI, WanFang Data and CBM databases from inception to Nov. 2015, to collect relevant clinical studies comparing laparoscopy and laparotomy for BOTs. Two reviewer independently screened literature, extracted data and assessed the risk of bias of include studies by using NOS scale. Then, meta-analysis was performed by using RevMan 5.3 software. Results Nineteen cohort studies were included. The scores of NOS scale showed that 10 studies were 〈7 points, while the other 9 studies were 〉7 points. The results of meta-analysis showed that： the recurrence rate of tumor （OR=1.75, 95%CI 1.05 to 2.91, P=0.03） in the laparoscopy group was higher than that in the laparotomy group, but no significant differences were found in further subgroup analysis according to type of operations （conservative surgery： OR=1.22, 95%CI 0.71 to 2.08, P=0.47; non-conservative surgery： OR=4.38, 95%CI 0.85 to 22.68, P=0.08）. The diameter of tumor in the laparoscopy group was significant smaller than that in the laparotomy group （MD= -6.88, 95%CI -8.15 to -5.61, P〈0.000 01）, and the rate of rupture of tumor in the laparoscopy group was significant higher than that in the laparotomy group （OR=3.99, 95%CI 2.54 to 6.26, P〈0.000 01）. Conclusion Current evidence shows, compared with laparotomy, laparoscopy has similar effect on postoperative recurrence and smaller diameter of tumor, but laparoscopy could increase the rate of rupture of tumor. Due to the limited quality and sample size of included studies, more high quality and large sample size studies are need to prove the above conclusion.