腹腔镜下保留神经宫颈癌根治术的临床疗效与系统评价

Clinical effect and systematic evaluation of laparoscopic radical resection for cervical cancer with nerve sparing

目的探讨腹腔镜下保留神经的宫颈癌根治术(LNSRH)与传统腹腔镜宫颈癌根治术(LRH)治疗宫颈癌的临床疗效。方法计算机检索2004年1月~2017年10月Pubmed、Embase、维普数据库、清华同方数据库、Cochrane图书馆、中国博士论文全文数据库等,所发表的关于我国腹腔镜下保留神经的宫颈癌根治术(LNSRH组)与传统宫颈癌根治术(LRH组)的临床对照研究文献11篇,涉及患者810例,其中LNSRH组患者393例,LRH组患者417例。利用ReviewManager 5.1软件进行Meta分析。结果手术时间(SMD=1.41,95%CI 0.36~2.46)、术后肠道功能恢复时间(SMD=-1.35,95%CI-2.00^-0.70)、术后拔除尿管时间(SMD=-1.21,95%CI-1.62^-0.79)等LNSRH组与LRH组比较差异均有统计学意义(P<0.05);术中出血量(SMD=0.11,95%CI-0.18~0.39)、宫旁组织切除长度(SMD=-0.14,95%CI-0.30^-0.01)、阴道切除长度(SMD=0.04, 95%CI-0.27~0.34)、术中并发症(RR=0.97,95%CI 0.41~2.27)等方面两组比较差异均无明显统计学意义(P>0.05)。结论 LNSRH较LRH相比,能在不牺牲手术根治性的前提下,有效促进患者术后膀胱、肠道功能恢复,提高患者生活质量,具有较好的应用前景。但目前研究样本量较小,远期复发率、生存率等研究不充分,尚需进一步深入研究。

Objective To explore the clinical effect of laparoscopic nerve sparing radical surgery(LNSRH) and traditional laparoscopic radical surgery(LRH) for cervical cancer. Methods From January 2004 to October 2017, PubMed, EMBASE, VIP database, Tsinghua Tongfang database, Cochrane Library, Chinese Doctoral Dissertation Full-text Database, etc. were searched by computer. There were 11 articles about the clinical comparative study of laparoscopic nerve sparing cervical cancer radical surgery(LNSRH group) and traditional cervical cancer radical surgery(LRH group), involving 810 patients, including LNSRH 393 patients in group A and 417 patients in group LRH. The Review Manager 5.1 software was used for Meta analysis. Results The time of operation(SMD=1.41, 95% CI 0.36~2.46), the time of intestinal function recovery(SMD=-1.35, 95% CI-2.00^-0.70), the time of urinary catheter extubation(SMD=-1.21, 95% CI-1.62^-0.79, etc.) were significantly different between LNSRH group and LRH group(P<0.05). There was no significant difference in bleeding volume(SMD=0.11, 95% CI-0.18~0.39), resection length of parauterine tissue(SMD=-0.14, 95% CI-0.30^-0.01), vaginal resection length(SMD=0.04, 95% CI-0.27~0.34), intraoperative complications(RR=0.97, 95% CI 0.41~2.27) between the two groups(P>0.05). Conclusion Compared with LRH, LNSRH can effectively promote the recovery of bladder and intestinal function and improve the quality of life of patients without sacrificing the radical operation. However, the current study sample size is small, the long-term recurrence rate, survival rate and other studies are inadequate, and further study is needed.