Geetha Puliyath, Nair M Krishnan
Department of Obstetrics and Gynaecology, SUT Academy of Medical Sciences, Post Vencode, Vattappara, Trivandrum, India.
J Minim Access Surg. 2012 Jul;8(3):67-73. doi: 10.4103/0972-9941.97584.
Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome.
Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH) and comparing the results with abdominal radical hysterectomy (ARH).
Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31(st) 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy.
Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected.
Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes.
Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH.
Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may reduce the complications rate.
在过去二十年中，大量研究表明早期宫颈癌微创手术在不影响肿瘤学结局的情况下具有可行性。
进行系统的文献综述和荟萃分析，旨在评估腹腔镜和机器人根治性子宫切除术（LRH和RRH）的结局，并将结果与腹式根治性子宫切除术（ARH）进行比较。
检索了Medline、PubMed、Embase、Cochrane图书馆及参考文献列表，以查找截至2011年1月31日发表的文章，使用的检索词为根治性子宫切除术、腹腔镜根治性子宫切除术、机器人根治性子宫切除术、宫颈癌的手术治疗及根治性子宫切除术的并发症。
选择报告了开放式、腹腔镜及机器人手术方法根治性子宫切除术结局指标的研究。
两名独立的评审员选择研究、提取数据并制成表格，获得了手术及肿瘤学结局的汇总估计值。
三种类型的RH研究的平均样本量、年龄和体重指数相似。三种类型的RH研究的平均手术时间相当。与LRH和RRH相比，ARH的平均失血量和输血率显著更高。RRH的住院时间明显少于其他两种方法。三种类型的RH研究中获得的平均淋巴结数量、淋巴结转移及切缘阳性情况相似。与其他两种方法相比，接受ARH的患者术后感染发病率显著更高，LRH的膀胱切开术发生率更高。
微创手术尤其是机器人根治性子宫切除术可能是宫颈癌手术治疗的更好且安全的选择。腹腔镜手术方法并非没有并发症。然而，外科医生的经验可能会降低并发症发生率。
