腹腔镜腹膜外入路与经腹膜入路腹主动脉旁淋巴结切除术有效性及安全性的Meta分析

The efficacy and safety of extraperitoneal and transperitoneal laparoscopic para-aorticlymphadenectomy:A Meta-analysis

目的:通过Meta分析比较妇科恶性肿瘤行腹腔镜下腹膜外入路与经腹膜入路腹主动脉旁淋巴结切除术的有效性及安全性。方法:检索2009年08月至2019年08月发表的关于妇科恶性肿瘤行腹腔镜腹膜外与经腹膜腹主动脉旁淋巴结切除术的前瞻性随机对照研究或设计良好的非随机对照研究。检索数据库包括PubMed、Embase、Cochrane Library、Ovid、Central、中国知网、万方数据库、中国医学文献数据库。提取数据,采用Review Manager 5.3软件分析数据。结果:共检索到文献270篇,最终纳入10篇。比较发现,妇科恶性肿瘤行腹腔镜腹主动脉旁淋巴结切除术,腹膜外入路组与经腹膜入路组手术时间、切除的淋巴结数目、中转开腹率、输血率、术中总并发症发生率、术后总并发症发生率等结局指标差异均无统计学意义,腹膜外入路组术中出血量、住院时间、术后淋巴囊肿发生率均小于经腹膜入路组,分别为[95%CI(-85.36~-8.91),P=0.02]、[95%CI(-1.77~-0.14),P=0.02]、[95%CI(0.34~0.87),P=0.01],差异有统计学意义。结论:妇科恶性肿瘤行腹腔镜腹主动脉旁淋巴结切除术,腹膜外入路和经腹膜入路均具有良好的手术有效性和安全性,值得临床推广应用。

Objective:To compare the efficacy and safety of extraperitoneal and transperitoneal laparoscopic para-aortic lymphadenectomy for gynecologic malignancies by Meta-analysis.Method:Prospective randomized controlled studies or well-designed non-randomized controlled studies about extraperitoneal and transperitoneal laparoscopic para-aortic lymphadenectomy for gynecologic malignancies published between August 2009 and August 2019 were retrieved.The search databases included PubMed,Embase,Cochrane Library,Ovid,Central,cnki,Wanfang and Chinese medical literature databases.Extract the data and use Review Manager 5.3 software to analyze the data.Results:Through retrieval,a total of 270 articles were retrieved,and 10 articles were finally included.By comparison,no statistically significant difference between transperitoneal approach group and extraperitoneal approach group were observed in the duration of surgery,resection of lymph node number,conversion rates to laparotomy,blood transfusion rate,intraoperative complications and postoperative complications about laparoscopic para-aortic lymphadenectomy for gynecologic malignancies.Extraperitoneal approach group in intraoperative blood loss,hospital stay,postoperative peritoneal lymphatic cyst incidence were less than the transperitoneal approach group,respectively[95%CI(-85.36~-8.91),P=0.02],[95%CI(-1.77~-0.14),P=0.02],[95%CI(0.34~0.87),P=0.01],and the difference was statistically significant.Conclusion:Both the extraperitoneal approach have good efficacy and safety about laparoscopic para-aortic lymphadenectomy for gynecologic malignancies with transperitoneal approach,worthy of clinical popularization.