腹腔镜与开腹手术治疗子宫内膜癌临床疗效及安全性的Meta分析

发布时间：2018-03-19 13:28

  本文选题：子宫内膜癌　切入点：腹腔镜手术　出处：《新疆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：评价腹腔镜与开腹手术治疗子宫内膜癌的临床疗效及安全性。方法：计算机检索Cochrane Library、PubMed、EMbase、OVID、CNKI)、万方数据库、维普数据库和中国生物医学数据库中从1998年到2012年9月腹腔镜和开腹手术治疗子宫内膜癌疗效及安全性的随机对照研究,按照纳入和排除标准筛选文献、提取资料,并依据Cochrane Handbook5.1.0的质量评价标准评价纳入研究的方法学质量,用RevMan5.1软件进行Meta分析。结果：共纳入10篇随机对照试验,共6993位患者。Meta分析表明：与开腹手术相比,腹腔镜手术的操作时间长,但腹腔镜手术治疗子宫内膜癌术中出血量少、术前与术后第1天血红蛋白下降值低、术后排气时间和住院时间短,然而,腹腔镜组与开腹组术中清扫盆腔淋巴结和腹主动脉旁淋巴结数目无统计学差异；开腹手术可以降低术中并发症的发生率,如阴道损伤,但是,术中出血量大于500ml的发生率高,术中肠损伤、膀胱损伤、输尿管损伤、动静脉血管损伤发生率无统计学差异,而腹腔镜手术可以降低术后并发症的发生率,如肠梗阻和切口裂开及感染,但,泌尿系感染、组织出血及血肿、术后体温大于38℃、静脉血栓形成、淋巴水肿及囊肿发生率无统计学差异；术后随访3-5年内子宫内膜癌复发率、死亡率和无瘤生存率无统计学差异。结论：腹腔镜手术较开腹手术的操作时间长、术中出血量少、术前与术后第1天血红蛋白下降值低、术后排气时间和住院时间短,术中出血量大于500ml的发生率低,且术后并发症发生率低,如肠梗阻和切口裂开及感染；但开腹手术术中并发症发生率低,如阴道损伤：另外,两种手术方式清扫盆腔淋巴结和腹主动脉旁淋巴结数目、术中肠损伤、膀胱损伤、输尿管损伤、动静脉血管损伤发生率、术后泌尿系感染、组织出血及血肿、术后体温大于38℃、静脉血栓形成、淋巴水肿及囊肿发生率、术后随访3-5年子宫内膜癌复发率、死亡率和无瘤生存率相似。然而,上述结论仍不能取代高质量、大样本、多中心的随机双盲对照研究的结果。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of laparoscopy and laparotomy in the treatment of endometrial carcinoma. From 1998 to September 2012, a randomized controlled study on the efficacy and safety of laparoscopy and laparotomy in the treatment of endometrial carcinoma was carried out in Weip database and Chinese biomedical database. According to the criteria of inclusion and exclusion, the literature was selected and the data were extracted. According to the quality evaluation standard of Cochrane Handbook5.1.0, the Meta analysis was carried out with RevMan5.1 software. Results: ten randomized controlled trials were included, and 6993 patients. Meta analysis showed that compared with open surgery, there were 6 993 patients. The operative time of laparoscopic surgery is long, but the bleeding amount is less during laparoscopic surgery for endometrial carcinoma, the decrease of hemoglobin is low before and 1 day after operation, the time of exhaust and hospitalization is short after operation, however, There was no significant difference in the number of pelvic lymph nodes and para-aortic lymph nodes between laparoscopy group and laparotomy group, the incidence of intraoperative complications such as vaginal injury was reduced by laparotomy, but the incidence of intraoperative bleeding greater than 500ml was high. There was no significant difference in the incidence of intestinal injury, bladder injury, ureteral injury and arteriovenous injury. Laparoscopic surgery could reduce the incidence of postoperative complications, such as intestinal obstruction, incision rupture and infection, but urinary tract infection. Tissue hemorrhage and hematoma, body temperature greater than 38 鈩，

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