摘要
目的比较保留盆腔神经的根治性子宫切除术(NSRH)和传统根治性子宫切除术(RH)的疗效和安全性。方法计算机检索Cochrane图书馆(2010年第2期)、MEDLINE(1960～2010.3)、EMbase(1960～2010.3)、CBM(1960～2010.3)、VIP(1960～2010.3)、清华同方数据库(1960～2010.3),并手工检索与宫颈癌治疗相关的文献,收集符合标准的随机对照试验和临床对照试验。数据提取和文献质量评价由两名评价员独立进行。采用Cochrane协作网提供的RevMan4.2.2软件对数据进行统计分析。结果未获得随机对照试验,共纳入9个临床同期对照试验,共742例。结果显示:①术后膀胱功能的恢复:残余尿恢复的时间[WMD=–5.80,95%CI(–6.22,–5.37)]、膀胱功能紊乱的发生率[RR=0.43,95%CI(0.26,0.75)]、尿流动力学测定NSRH组均优于传统的RH组,其差异有统计学意义;②手术时间:NSRH组长于RH组,其差异有统计学意义[WMD=37.23,95%CI(12.84,61.61)];③术中出血量:两组比较无明显统计学差异[WMD=19.66,95%CI(–51.57,90.90)];④术后生存率和复发率两组差异无明显统计学意义[RR=0.79,95%CI(0.17,3.58)];⑤两组手术切除范围及术后病理的相关情况,如宫旁浸润、脉管浸润等无明显统计学差异;⑥单个研究显示NSRH组的直肠功能紊乱和性功能紊乱的发生率比RH组低,差异有统计学意义。结论保留盆腔神经的根治性子宫切除术与传统根治性子宫切除术相比,具有术后膀胱、直肠、性功能恢复快的优点。NSRH除手术时间长于RH外,术中出血量、术后复发率、生存率和手术切除范围两者无明显差别,有利于提高病人的生活质量,不明显影响手术的安全性。但本系统评价纳入研究均为非随机对照试验。纳入病例数较少,一些结局指标仅单个研究报道。因此,目前还无法得到以上结论的确切疗效,有必要设计和开展大样本前瞻性随机对照研究来进一步验证。
Objective To evaluate the clinical effect and safety of nerve sparing radical hysterectomy（NSRH） for cervical cancer compared with radical hysterectomy （RH）. Methods We searched the Cochrane Library （Issue 2, 2010）, MEDLINE （1960 to March, 2010）, EMbase （1960 to March, 2010）, CBM （1960 to March, 2010）, VIP （1960 to March, 2010） and CNKI （1960 to March, 2010）, and hand searched related literatures. With a defined search strategy, both ran-domized controlled trials and controlled clinical trials of comparing NSRH with RH for cervical cancer were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated by Cochrane’s evaluation criterion. Meta-analysis was conducted with the Cochrane collaboration’s RevMan 4.2.2 software. Results Nine controlled clinical trials involving 742 patients were identified. The meta-analysis showed that： a） There was statistical significance in postoperative recovery of bladder function between two groups; compared with RH, NSRH was much better in aspects of the recovery time of post void residual urine volume （PVR） （WMD= – 5.80, 95%CI – 6.22 to – 5.37）, the bladder dysfunction morbidity （RR=0.43, 95%CI （0.26 to 0.75）, and the urodynamic study; b） The operation time of NSRH was longer than that of RH with a significant difference （WMD=37.23, 95%CI 12.84 to 61.61）; c） There was no signi cant difference between two groups in bleeding amount （WMD=19.66, 95%CI – 51.57 to 90.90）; d） There was no significant difference between two groups in both survival rate and recurrent rate （RR=0.79, 95%CI 0.17 to 3.58）; e） There was no signi cant difference between two groups in resection extension and pathologic outcome, such as, in ltration around uterus and vessels; f） One trail showed a signi cant difference between two groups that NSRH seldom led to ano-rectal and sexual dysfunction. Conclusions Compared with RH, NSRH can quickly improve the postoperative recovery of bladder, anorectal and sexual functions, but haven’t larger quantity of operative bleeding, larger resection extension, lower survival rates and higher recurrence rates except longer operation time. NSRH can improve the quality of postop-erative life and is safe. However, the trails available for this systematic review were limited, as well as non-randomized controlled trails. Some outcomes were only included by one trail. So there is no confirmed conclusion about these. The prospective randomized controlled trials are required for further investigation.
出处
《中国循证医学杂志》
CSCD
2010年第10期1205-1212,共8页
Chinese Journal of Evidence-based Medicine
