Zhang Sichen, Wang Shaowei, Lv Aiming, Huang Shuai
Department of Obstetrics and Gynecology, Beijing Hospital, Beijing, China.
Int J Gynecol Cancer. 2016 Oct;26(8):1497-502. doi: 10.1097/IGC.0000000000000794.
The aim of this study was to compare intraoperative and short-term postoperative outcomes and recurrence of laparoscopically assisted radical vaginal hysterectomy (LARVH) to abdominal radical hysterectomy (ARH) in the treatment of early-stage cervical cancer.
A search of PubMed, EMBASE, and Cochrane library search trial (central) databases was conducted from database inception through December 2015. We included studies comparing surgical approaches with radical hysterectomy (LARVH vs ARH) in women with stages IA1 to IIB cervical cancer. Outcomes included blood loss, operative time, number of lymph nodes retrieved, intraoperative complications, hospital stay, and prognosis.
Seven studies were included (4 prospective cohort studies and 3 case control studies) enrolling 794 women; 349 women were treated by LARVH, and 445 were treated by ARH. Laparoscopically assisted radical vaginal hysterectomy was associated with less blood loss (weight mean difference [WMD], -237.45; 95% confidence interval [CI], -453.42 to -21.47), wound-related complications (odds ratio, 0.17; 95% CI, 0.05-0.61), shorter hospital stay (WMD, -2.01; 95% CI, -2.52 to -1.51), and longer operative time (WMD, 48.95; 95% CI, 42.08 to 55.82) versus ARH. Laparoscopically assisted radical vaginal hysterectomy was comparable with ARH in number of lymph nodes retrieved, urinary-related complications, rectal injury, lymphedema, and all prognosis indicators.
The evidence suggests that LARVH is superior to ARH with lower blood loss, less wound-related complications, and shorter hospital stay. Laparoscopically assisted radical vaginal hysterectomy and ARH seem equivalent in number of lymph nodes retrieved, urinary-related complications, rectal injury, lymphedema, and prognosis.
本研究旨在比较腹腔镜辅助根治性阴道子宫切除术（LARVH）与腹式根治性子宫切除术（ARH）在治疗早期宫颈癌时的术中及术后短期结局和复发情况。
从数据库建立至2015年12月，对PubMed、EMBASE和Cochrane图书馆检索试验（中心）数据库进行了检索。我们纳入了比较IA1至IIB期宫颈癌女性患者根治性子宫切除术的手术方式（LARVH与ARH）的研究。结局指标包括失血量、手术时间、获取的淋巴结数量、术中并发症、住院时间和预后。
纳入7项研究（4项前瞻性队列研究和3项病例对照研究），共794名女性；349名女性接受LARVH治疗，445名接受ARH治疗。与ARH相比，腹腔镜辅助根治性阴道子宫切除术的失血量更少（加权平均差[WMD]，-237.45；95%置信区间[CI]，-453.42至-21.47）、伤口相关并发症更少（比值比，0.17；95%CI，0.05 - 0.61）、住院时间更短（WMD，-2.01；95%CI，-2.52至-1.51），但手术时间更长（WMD，48.95；95%CI，42.08至55.82）。在获取的淋巴结数量、泌尿系统相关并发症、直肠损伤、淋巴水肿和所有预后指标方面，腹腔镜辅助根治性阴道子宫切除术与ARH相当。
证据表明，LARVH优于ARH，具有失血量更少、伤口相关并发症更少和住院时间更短的优势。腹腔镜辅助根治性阴道子宫切除术和ARH在获取的淋巴结数量、泌尿系统相关并发症、直肠损伤、淋巴水肿和预后方面似乎相当。
