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中国癌症防治杂志

中国癌症防治杂志 ›› 2016, Vol. 8 ›› Issue (4): 239-245.doi: 10.3969/j.issn.1674-5671.2016.04.09

• 循证医学 • 上一篇    下一篇

腹腔镜与开腹手术治疗子宫内膜癌疗效的系统评价

  

  1. 广西医科大学附属肿瘤医院妇瘤科 区域性高发肿瘤早期防治研究教育部重点实验室；广西柳州市工人医院妇产科
  • 出版日期:2016-08-25 发布日期:2016-09-12
  • 通讯作者: 李力 lili@gxmu.net.cn
  • 基金资助:

    广西自然科学基金资助项目（2014GXNSFAA118147）；广西卫计委科研课题（Z2015626）；广西柳州市科技局科研课题（2015J030508）

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

  • Online:2016-08-25 Published:2016-09-12

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486

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被引次数

9

摘要：

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、PubMed、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RevMan 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。

关键词: 子宫肿瘤, 子宫内膜癌, 腹腔镜手术, 开腹手术, 随机对照试验, 系统评价, 疗效, 生活质量

Abstract:

Objective To compare the efficacy and safety of laparoscopy 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 Unpublished and grey literature，reference lists in relevant articles，gynecological cancer handbooks and conference abstracts were also searched.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 rate of post-operative complications（OR=0.62，95%CI 0.52 to 0.73，P＜0.001），but it was inferior to laparotomy in terms of higher rate of intra-operative complications（OR=1.35，95%CI 1.05 to 1.74，P=0.02） and longer surgical time （MD＝32.73，95%CI16.34 to 49.13，P＜0.01）. The two approaches 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.

Key words: Uterine neoplasm, Endometrial cancer, Laparoscopy, Laparotomy, Randomized controlled trial, Systematic review, Efficacy, Quality of life