目的：重新评价腹腔镜（laparoscopy，LPS）与开腹（laparotomy，LPT）应用于早期卵巢癌全面分期手术的疗效。方法：检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库（CBM）、万方、知网（CNKI）、维普等数据库，查找建库至2015年9月2日期间关于LPS与LPT应用于早期卵巢癌全面分期手术疗效比较的相关文献。采用RevMan 5.3软件对相关数据进行统计学分析。结果：最终纳入26篇临床病例对照研究（CCT）共1456例患者，其中LPS组661例，LPT组795例。2组研究对象在年龄、体质量指数（BMI）或体质量、肿瘤分型或分期等方面差异均无统计学意义。Meta分析结果显示：与LPT组相比，LPS组术中失血量少、输血率低、淋巴结切除总数少、术后肛门排气及下床活动时间早、疼痛轻、术后住院时间短、术后并发症发生率低、切口愈合不良发生率低、随访时间短、术后复发率及病死率低，差异均有统计学意义；与LPT组相比，LPS组手术时间长、腹主动脉旁淋巴结切除数多，差异有统计学意义；而盆腔淋巴结切除数、术中并发症、术中脏器损伤、肿瘤破裂发生率、术后辅助化疗率2组相比差异无统计学意义。结论：与LPT相比，LPS下早期卵巢癌全面分期手术具有创伤小、视野清晰、出血少、疼痛轻、恢复快等优点；未发现在盆腔淋巴结切除数、术中并发症、术中脏器损伤、肿瘤破裂发生率、术后辅助化疗率方面的优势；复发率及病死率则需要进一步研究证实；符合目前肿瘤根治性治疗兼顾微创的趋势，值得临床推广。%Objective:To revaluate the effect of laparoscopic (LPS) and laparotomy (LPT) for early ovarian cancer on comprehensive staging operation. Methods: We performed a systematic literature search using the databases of PubMed, Embase, Cochrane Library, Chinese Biomedical Abstracts database, Wan -fang database, China National Knowledge Infrastructure and CQVIP etc. The literatures published before Sep 2 nd, 2015, referring to the effects of LPS and LPT for early ovarian cancer on comprehensive staging operation were included. Meta-analysis was performed by RevMan 5.3 software. Resruts: A total of 26 studies involving 1 456 cases were selected, of which 661 cases were performed laparoscopy and 795 cases were performed laparotomy. No statistically significant differences were observed between LPS group and LPT group in age, body mass index, clinical stage and histological type. Compared with LPT group, LPS group had less intraoperative blood loss, blood transfusions, total number of lymph nodesexcised, hospital stay, postoperative complications and follow-up period, earlier anus exhaustion and postoperative recovery, milder pain, better wound healing, lower postoperative recurrence rate and death of disease, more paraaortic lymph nodes excised, whereas longer operation time. No statistically significant differences were observed between groups in pelvic lymph nodes excised, intraoperative complications, intraoperative organ injuries, intraoperative tumor rupture, postoperative chemotherapy. Conclusions: Laparoscopy, as a mini-invasive technique, showed advantages in the treatment of early-stage ovarian cancer, with better intraoperative visualization, less blood loss, milder pain, earlier recovery. And no disadvantage has been found in pelvic lymph nodesexcised, intraoperative complications, intraoperative organ injuries, intraoperative tumor rupture. Furthermore, postoperative chemotherapy rate, the postoperative recurrence rate and death rate of disease requires further study. Comprehensive staging operation for early ovarian cancer under laparoscope is worthy to be popularized.
展开▼
