腹腔镜与开腹手术治疗子宫内膜癌疗效的系统评价

Comparison of laparoscopy and laparotomy for treating endometrial cancer:a systematic review

目的系统评价腹腔镜手术治疗子宫内膜癌的疗效及对生活质量的影响。方法计算机检索Central(Cochrane图书馆2016年第3期)、Medline、Embase、Pub Med、CNKI、万方、VIP、CBM等数据库,检索时间自建库至2016年3月,并手工检索相关未发表的灰色文献,收集比较腹腔镜与开腹手术治疗子宫内膜癌的随机对照试验。由2名评价者按照纳入与排除标准筛选文献、提取资料和评价质量后,采用Rev Man 5.1软件进行Meta分析。结果最终纳入9个随机对照试验,共3 616例子宫内膜癌患者。Meta分析结果显示:与开腹组相比,腹腔镜组可缩短住院时间(MD=-3.42,95%CI:-3.81^-3.03,P<0.001),降低术后并发症(OR=0.62,95%CI:0.52~0.73,P<0.001),但手术时间延长(MD=32.73,95%CI:16.34~49.13,P<0.001),增加术中并发症(OR=1.35,95%CI:1.05~1.74,P=0.02);两组总生存率、无瘤生存率、复发率及术中盆腔淋巴结切除数目的差异均无统计学意义(P>0.05)。腹腔镜组术后生活质量优于开腹组(P<0.05)。结论腹腔镜手术与开腹手术治疗子宫内膜癌的生存预后相当,腹腔镜手术可缩短住院时间、减少术后并发症,术后恢复较快,但手术时间较长,术中并发症增多。

Objective To compare the efficacy and safety of laparoseopy and laparotomy for treating endometrial cancer. Methods The Cochrane Central Register of Controlled Trials （CENTRAL,issue 3） and the databases of Medline,Embase,PubMed,CBM, CNKI, Wan Fang and VIP were searched to identify randomized controlled trials （RCTs） published before March 2016 comparing laparoscopic and laparotomic approaches to treat endometrial cancer of any stage. Unpublished and grey literature,reference lists in relevant articles,gynecological cancer handbooks and conference abstracts were also searched. Two reviewers independently screened the literature according to inclusion and exclusion criteria, and methodological quality was evaluated. Pooled data were meta-analyzed using RevMan 5.1. Results The review included 9 studies involving 3616 endometrial cancer patients. Laparoscopic surgery was superior to laparotomy in terms of shorter hospital stay （MD=-3.42,95%CI -3.81 to -3.03,P〈0.001 ） and lower raie of postoperative complications （0R=0.62,95%CI 0.52 to 0.73,P〈0.001 ）,but it was inferior to laparotomy in terms of higher rate of intraoperative complications （0R=1.35,95%C1 1.05 to 1.74, P=-0.02 ） and longer surgical time （MD=32.73,95%CI 16.34 to 49.13 ,P〈0.01 ）. The two approaehes were similar in terms of overall survival, disease-free survival, recurrence and pelvic node yield（P〉0.05）. Conclusions Laparoscopic surgery may be superior to laparotomy for many women with endometrial cancer, particularly in terms of post-operative complications and length of hospital stay. Additional well-designed RCTs are needed to compare long-term clinical outcomes, particularly quality of life, between the two approaches.