Clinical efficacy and safety of nerve-sparing radical hysterectomy for cervical cancer: a systematic review and meta-analysis.
Clinical efficacy and safety of nerve-sparing radical hysterectomy for cervical cancer: a systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0094116
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Ou TY
中科院分区：
文献类型：
--
作者：
Long Y;Yao DS;Pan XW;Ou TY
保留神经的根治性子宫切除术（NSRH）的术后发病率可能低于根治性子宫切除术（RH）。我们的目的是通过系统评价和荟萃分析，比较腹部或腹腔镜NSRH和RH治疗宫颈癌的临床疗效和安全性。系统检索PubMed、EMBASE、科克伦图书馆和中国国家知识基础设施数据库中的所有相关研究。数据由两名审查员独立提取。进行了一项荟萃分析来比较这两种技术的术中和术后结果。总共确定了17项临床试验。荟萃分析显示，尽管腹部或腹腔镜NSRH的手术时间明显长于RH，但基于开腹或腹腔镜的NSRH被证明对术后膀胱功能恢复更有效。NSRH还与较低的膀胱功能障碍发病率和较少的术后并发症有关。两项腹部试验和一项腹腔镜研究进一步表明，NSRH与肛门/直肠功能恢复时间较短相关。相比之下，基于剖腹手术或腹腔镜的RH和NSRH在切除范围、复发率、存活率、失血量和术中并发症频率方面相似。荟萃分析显示，腹部NSRH与RH在住院时间方面无显著差异，而一项试验表明腹腔镜NSRH后的住院时间短于相应的RH。NSRH可能是治疗早期宫颈癌的可靠技术。现有证据表明，在术后盆腔器官功能恢复和术后并发症方面，其优于RH，而两种技术的临床安全性和切除范围相似。这些结果应该被认为是初步的，因为它们是基于相对较少的对照试验，其中大多数是非随机的。这些发现应该在更大的、精心设计的研究中得到验证。
Nerve-sparing radical hysterectomy (NSRH) may be associated with lower postoperative morbidity than radical hysterectomy (RH). We aimed to compare the clinical efficacy and safety of abdominal or laparoscopic NSRH and RH for treating cervical cancer through systematic review and meta-analysis. PubMed, EMBASE, The Cochrane Library and the Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to compare intra- and postoperative outcomes for the two techniques. A total of 17 clinical trials were identified. Meta-analysis showed that although operating time was significantly longer for abdominal or laparoscopic NSRH than for RH, NSRH based on laparotomy or laparoscopy proved more effective for postoperative recovery of bladder function. NSRH was also associated with lower bladder dysfunction morbidity and fewer postoperative complications. Two abdominal trials and one laparoscopic study further suggested that NSRH was associated with shorter time to recovery of anal/rectal function. In contrast, RH and NSRH based on laparotomy or laparoscopy were similar in terms of extent of resection, recurrence rate, survival rate, blood loss and frequency of intraoperative complications. The meta-analysis showed that abdominal NSRH was not significantly different from RH in length of hospital stay, while one trial suggested that length of hospital stay was shorter after laparoscopic NSRH than after the corresponding RH. NSRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than RH for postoperative recovery of pelvic organ function and postoperative morbidity, while the two techniques involve similar clinical safety and extent of resection. These results should be considered preliminary since they are based on a relatively small number of controlled trials, most of which were non-randomized. The findings should be verified in larger, well-designed studies.
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