腹腔鏡手術治療早期卵巢癌有效性與安全性的Meta分析
發(fā)布時間：2018-11-08 16:56
【摘要】：目的：評價腹腔鏡在早期卵巢癌全面分期手術中的安全性、有效性，為臨床實踐提供可靠依據。 方法：計算機檢索Ovid、EMbase、PubMed、CBM、CNKI、萬方期刊全文數據庫等。以 ovarian cancer‖, ovarian carcinoma‖, earlystage‖, laparoscopy‖, stagingsurgery‖, staging laparoscopy‖,為英文檢索詞，以 腹腔鏡、開腹手術、分期手術、早期卵巢癌、卵巢癌、腹腔鏡分期手術‖為中文檢索詞進行檢索。按照納入標準與排除標準收集相關文獻，由倆名評價員分別獨立閱讀檢索文獻的題目和摘要后，刪除顯著不滿足納入標準的文獻后，對于滿足納入標準的文獻進行全文閱讀，確定最終是否真正被納入，倆名評價員交叉核對。如遇分歧，通過請教統計學專業(yè)人員解決。數據的統計分析使用Cochrane協作網提供的RevMan5.2軟件進行。 結果：根據入選及排除標準共納入文獻12篇，其中中文文獻7篇，英文文獻5篇，均采用平行設計，且均為非隨機對照研究。共納入753例早期卵巢癌患者，腹腔鏡組314例，開腹組439例。所納入文獻均對受試者特征如年齡、體重指數、臨床分期等進行描述且無統計學差異。Meta分析的結果顯示：腹腔鏡組手術時間長、但術中出血量少、術后腸功能恢復快、住院時間短、圍手術期并發(fā)癥少，兩組比較有統計學意義（手術時間：WMD=38.2795%CI：10.03～66.51,P=0.008；術中出血量：WMD=㧟223.29，95%CI：㧟324.09～㧟123.09，P＜0.0001；術后排氣時間：SMD=㧟1.79，95%CI：㧟2.30～㧟1.29，P＜0.00001；術后住院時間：WMD=㧟4.87，95%CI：㧟6.70～㧟3.05，，P＜0.00001；圍手術期并發(fā)癥：OR=0.43，95%CI：0.26～0.71，P=0.0009；）；而復發(fā)率、盆腔淋巴結、腹主動脈旁淋巴結切除數目相比差異無統計學意義（術后復發(fā)率：OR=0.54，95%CI：0.18～1.57，P=0.26；盆腔淋巴結切除個數：WMD=㧟1.80，95%CI：㧟3.91～0.32,P=0.10；腹主動脈旁淋巴結切除個數：WMD=1.22，95%CI：-0.81～3.24，P=0.24）。 結論：腹腔鏡是一個治療早期卵巢癌手術效果較滿意，安全、有效的選擇，且具有創(chuàng)傷小、住院時間短、圍手術期并發(fā)癥少的優(yōu)點，目前RCT(randomizedcontrolled trials,隨機對照試驗)較少，多中心研究的前瞻性的隨機對照試驗更少，故本研究所得出的結論尚需更多高質量研究進一步鑒證。
[Abstract]:Objective: to evaluate the safety and efficacy of laparoscopy in the early stage operation of ovarian cancer, and to provide reliable basis for clinical practice. Methods: the full text database of Ovid,EMbase,PubMed,CBM,CNKI, Wanfang periodical was searched by computer. Ovarian cancer, ovarian carcinoma, earlystage, laparoscopy, stagingsurgery, staging laparoscopy were used as English key words. The Chinese key words were laparoscopy, open surgery, staging operation, early ovarian cancer and laparoscopic staging operation. The relevant documents were collected according to the inclusion criteria and exclusion criteria. After the two evaluators read the titles and abstracts of the retrieval documents independently, after deleting the documents that did not meet the inclusion criteria, they read the full text of the documents that met the inclusion criteria. To determine whether or not they are actually included, the two evaluators cross check. In the event of disagreement, by consulting a statistical professional to resolve. The statistical analysis of the data is carried out by RevMan5.2 software provided by the Cochrane Cooperative Network. Results: according to the criteria of inclusion and exclusion, 12 articles were included, of which 7 were in Chinese and 5 in English. All of them were designed in parallel design and were all non-randomized controlled studies. A total of 753 cases of early ovarian cancer were included, including 314 cases in laparoscopic group and 439 cases in open group. The results of Meta analysis showed that the laparoscopic group had a long operation time, but less blood loss during the operation, and the intestinal function recovered quickly after operation, and there was no significant difference between the two groups in terms of age, body mass index and clinical stage. The duration of hospitalization was short and the complications were less in perioperative period. There was significant difference between the two groups (operative time: WMD=38.2795%CI:10.03~66.51,P=0.008;). Intraoperative bleeding volume: WMD=?223.29,95%CI:?324.09~?123.09,P < 0.0001, postoperative exhaust time: SMD=?1.79,95%CI:?2.30~?1.29,P < 0.00001; Postoperative hospitalization time: WMD=?4.87,95%CI:?6.70~?3.05,P < 0.00001; perioperative complications: OR=0.43,95%CI:0.26~0.71,P=0.0009;); However, there was no significant difference in the recurrence rate, pelvic lymph nodes, and the number of para-aortic lymphadenectomies (postoperative recurrence rate: OR=0.54,95%CI:0.18~1.57,P=0.26;). Pelvic lymph node resection number: WMD=?1.80,95%CI:?3.91~0.32,P=0.10; abdominal aorta lymph node resection number: WMD=1.22,95%CI:-0.81~3.24,P=0.24). Conclusion: laparoscopy is a satisfactory, safe and effective choice in the treatment of early ovarian cancer. It has the advantages of less trauma, shorter hospital stay and less perioperative complications. At present, RCT (randomizedcontrolled trials, randomized controlled trial is less. There are fewer prospective randomized controlled trials in multicenter studies, so the findings of this study need to be further corroborated by high-quality studies.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.31
本文編號：2319114
[Abstract]:Objective: to evaluate the safety and efficacy of laparoscopy in the early stage operation of ovarian cancer, and to provide reliable basis for clinical practice. Methods: the full text database of Ovid,EMbase,PubMed,CBM,CNKI, Wanfang periodical was searched by computer. Ovarian cancer, ovarian carcinoma, earlystage, laparoscopy, stagingsurgery, staging laparoscopy were used as English key words. The Chinese key words were laparoscopy, open surgery, staging operation, early ovarian cancer and laparoscopic staging operation. The relevant documents were collected according to the inclusion criteria and exclusion criteria. After the two evaluators read the titles and abstracts of the retrieval documents independently, after deleting the documents that did not meet the inclusion criteria, they read the full text of the documents that met the inclusion criteria. To determine whether or not they are actually included, the two evaluators cross check. In the event of disagreement, by consulting a statistical professional to resolve. The statistical analysis of the data is carried out by RevMan5.2 software provided by the Cochrane Cooperative Network. Results: according to the criteria of inclusion and exclusion, 12 articles were included, of which 7 were in Chinese and 5 in English. All of them were designed in parallel design and were all non-randomized controlled studies. A total of 753 cases of early ovarian cancer were included, including 314 cases in laparoscopic group and 439 cases in open group. The results of Meta analysis showed that the laparoscopic group had a long operation time, but less blood loss during the operation, and the intestinal function recovered quickly after operation, and there was no significant difference between the two groups in terms of age, body mass index and clinical stage. The duration of hospitalization was short and the complications were less in perioperative period. There was significant difference between the two groups (operative time: WMD=38.2795%CI:10.03~66.51,P=0.008;). Intraoperative bleeding volume: WMD=?223.29,95%CI:?324.09~?123.09,P < 0.0001, postoperative exhaust time: SMD=?1.79,95%CI:?2.30~?1.29,P < 0.00001; Postoperative hospitalization time: WMD=?4.87,95%CI:?6.70~?3.05,P < 0.00001; perioperative complications: OR=0.43,95%CI:0.26~0.71,P=0.0009;); However, there was no significant difference in the recurrence rate, pelvic lymph nodes, and the number of para-aortic lymphadenectomies (postoperative recurrence rate: OR=0.54,95%CI:0.18~1.57,P=0.26;). Pelvic lymph node resection number: WMD=?1.80,95%CI:?3.91~0.32,P=0.10; abdominal aorta lymph node resection number: WMD=1.22,95%CI:-0.81~3.24,P=0.24). Conclusion: laparoscopy is a satisfactory, safe and effective choice in the treatment of early ovarian cancer. It has the advantages of less trauma, shorter hospital stay and less perioperative complications. At present, RCT (randomizedcontrolled trials, randomized controlled trial is less. There are fewer prospective randomized controlled trials in multicenter studies, so the findings of this study need to be further corroborated by high-quality studies.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.31
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