1 1 1 5 The Journal of Evidence-Based Medicine Oct. 1 Vol.1 No.5 Meta 1 (1. 5455;. 531) [ ] + Cochrane MEDLINE EMBASE PubMed CBMdisc Meta 8 3 5 + + [ ] ; ;Meta [ ] R737.33 [ ] A [ ] 1671-5144(1)5-37-7 Efficacy and Prognosis of Laparoscopic Radical Hysterectomy for Early Stage Cervical Cancer:A Meta-Analysis CHEN Yan-li 1 LI Li (1. The Fourth Affiliated Tumor Hospital of Guangxi Medical University Guangxi Liuzhou 5455 China;. Affiliated Tumor Hospital of Guangxi Medical University Nanning 531 China) Abstract: Objective To evaluate the clinical effect on the treatment and the prognosis of laparoscopic radical hysterectomy(lrh) and pelvic lymphadenectomy(lpl) for patient with early cervical cancer. Methods The following electronic databases were searched: CBMdisc MEDLINE PubMed EMBASE and Cochrane Library. All eligible literatures were assessed for quality. All data were performed by a meta-analysis. Results There were 8 literatures that met the inclusion criteria including three prospective non-randomized controlled trials and five retrospective casecontrol studies but with no RCTs. Comparing with abdominal radical hysterectomy (ARH) + abdominal pelvic lymphadenectomy (APL) LRH+LPL had several advantages such as decreasing the recovery time of bowel the blood loss during operation postoperative hospital stays and complications of postoperation. But there was no difference in the recurrence rate and complications of intraoperation between LRH+LPL and ARH+APL. Conclusion LRH+LPL is a safe and effective alternative to conventional abdominal surgery for stage b- a cervical cancer. Because the quality of all the included literatures is low the conclusion is needed to be further assessed by rigorously designed and randomized double-blind controlled trials. Key words: cervical cancer; laparoscopy radical hysterectomy; evidence-based medicine; meta-analysis 8 [ ] (1981-) [ ] Tel:771-53143; E-mail:lili@gxmu. edu.cn
38 1 1 5 3 4 5 6 7 (abdominal radical hysterectomyarh) 5 95% 5 73% 1.3 [1] 9 1.3.1 : PubMed EMBASE MEDLINE (laparoscopy Cochrane radical hysterectomylrh) (evidence-based medicine reviewsebmr) : : / 1.3. :laparoscopy / laparoscopiccervix / cervical [-4 ] cancer / carcinomaradical hysterectomy laparotomy : 1.3.3 199-9 1.4 1 1.1 [6] 1.1.1 Jadad ( A ~ A 1~3 4~5 ) 1.5 + Cochrane RevMan5. FIGO (Federation International of Gynecology and Meta (odds Obstetrics ) ratioor) 95% 1.1. (randomized controlled trialrct) (P>.1 I 1.1.3 : + 5%) / : + /.1 1.1.4 9 :15 5 (5 11 8 5 RCT3 5 )3 4 :1 1 1. ; (confidence intervalci) (weight mean differencewmd) 95%CI χ 5%) Meta ; (P.1I > 8
. Meta 39 1 Lee [7] Nam 4 [] Zakashansky 7 [8] Li 7 [9] Frumovitz 7 [1] Sobiczewki 9 [11] 9 [1] 6 [13] LRH ARH 3 3 47 96 3 3 9 35 35 54 58 55 97 8 11 FIGO LRH ARH LRH ARH 3 47 8 7 35 45 3 A 18 1 5 3 96 8 35 54 55 4 A 13 4 4 7 7 36 19 81 15 5 43 7 3 11 11 9 8 1 1 5 76 1 5 33 74 9 5 9 1 1 3 A B. Jadad 8 Meta WMD =4.495% CI 4.63~64.P=. 1 1 LRH ARH.3.3.1.4. 8 6 Meta WMD=-19.195%CI -3.6~-79.64P=. 7 LRH ARH.3. LRH ARH 8.4.3 6 7 6 Meta WMD =.695% CI -3.59 ~4.78P = 3.783 LRH ARH.4.4.1 LRH ARH 1 (min)
31 1 1 5 (ml) 3 ( ).4.4 3 Meta WMD=-.995%CI -3.96~-.63 P=.74 LRH ARH -9.48~-4.14P=.95 LRH ARH LRH ARH.4.5 Meta WMD=-16.8195%CI LRH ARH 4 ( )
.4.6 6 LRH ARH Meta OR=1.8995%CI.86~ 4.15P=.11LRH ARH.4.8 LRH ARH 1 >1 <1.4.7. Meta 311 Meta OR=1.4995%CI.61~ Meta OR=.5195%CI.31~.84P=.8 7 LRH ARH 1 3 3.65P=.39LRH ARH 5 () 6 7
31 1 1 5 LRH ARH 8; 3 LRH ARH Meta OR =3.5195% CI.53 ~3.1P =.19 LRH ARH LRH ARH ; OR=1.7795%CI.79~3.96P=.16 LRH ARH 8 3 199 Nezhat 1 A Meta + Meta 1 Meta ; + Meta ;
. Meta 313 [1] Kokawa K Takekida S Kamiura et al. The incidence treatment and prognosis of cervical carcinoma in young + women: A retrospective analysis of 4975 cases in Japan [J]. Eur J Gynaecol Oncol 131(1):37-43. Meta [] Nam JH Kim JH Kim DY et al. Comparative study of laparoscopic-vaginal radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer [J]. + Gynecol Oncol 49(1):77-83. [3] Sedlacek TV Campion MJ Hutchins RA et al. Laparoscopic radical hysterectomy: A feasibility study [J]. J Am Assoc Gynecol Laparosc 19941(4 Part ):S3. Meta Meta : in patients with cervical cancer [J ]. Surg Endosc 1 15 (3):89-9. radical vaginal hysterectomy (LARVH): Prospective evaluation of patients with cervical cancer [J]. Gynecol Oncol 3 9(3):55-511. 1 [6] Jadad AR Moore A Carroll D et al. Assessing the quality of reports randomized clinical trials: Is blinding necessary? [J]. Control Clin Trials 199617(1):1-1. [7] Lee CL Huang KG Jain S et al Comparison of laparoscopic ( and conventional surgery in the treatment of early cervical ) cancer November [J]. J Am Assoc Gynecol Laparosc 9 (4):481-487. [8] Zakashansky K Chuang L Gretz H et al. A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program [J]. Int J Gynecol Cancer 7 17(5):175-18. [9] Li G Yan X Shang H et al. A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of b - a cervical cancer [J]. Gynecol Oncol 715(1):176-18. [1] Frumovitz M dos Reis R Sun CC et al.comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer [J]. Obstet Gynecol 7 Meta 11(1):96-1. [11] Sobiczewski P Bidzinski M Derlatka P et al. Early cervical cancer managed by laparoscopy and conventional surgery comparison of treatment results [ J ]. Int J Gynecol Cancer 919(8):139-1395. [1] [J]. 93(1):147-141. [13] Meta [J]. 61(1):1-14. [4] [5] [ ] Malur S Possover M Schneider A. Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type Hertel H K hler C Michels W et al. Laparoscopic-assisted.. [ ] 1--5