Departments of Obstetrics and Gynecology (Drs. Wu, Ye, He, and Zhu) and Urology (Dr. Lv), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University and Shanghai Key Laboratory of Gynecologic Oncology (Drs. Wu, Ye, He, and Zhu), Shanghai, China.
Departments of Obstetrics and Gynecology (Drs. Wu, Ye, He, and Zhu) and Urology (Dr. Lv), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University and Shanghai Key Laboratory of Gynecologic Oncology (Drs. Wu, Ye, He, and Zhu), Shanghai, China..
J Minim Invasive Gynecol. 2019 Mar-Apr;26(3):417-426.e6. doi: 10.1016/j.jmig.2018.10.012. Epub 2018 Oct 22.
It is widely accepted that nerve-sparing radical hysterectomy is associated with less postoperative morbidity compared with radical hysterectomy, whereas clinical safety is similar in the 2 procedures. However, there is insufficient evidence to compare these procedures performed via a laparoscopic approach. We performed a systematic review and meta-analysis of studies to compare the clinical efficacy and the rate of bladder dysfunction, including urodynamic assessment, in laparoscopic nerve-sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH). Thirty articles including a total of 2743 participants were analyzed. Operating times were shorter (MD, 29.88 minutes; 95% confidence interval [CI], 11.92-47.83 minutes) and hospital stays were longer (MD, -1.56 days; 95% CI, -2.27 to -0.84 days) in the LRH group compared with the LNSRH group. In addition, blood loss and the number of resected lymph nodes were not significantly different between the 2 groups. However, resected parametrium length (MD, -0.02 cm; 95% CI, -0.05 to -0.00 cm) and vaginal cuff width (MD, -0.06 cm; 95% CI, -0.09 to -0.04) were smaller in the LNSRH group. Furthermore, LNSRH tended to result in more satisfactory micturition (odds ratio, 2.90; 95% CI, 2.01-4.19), shorter catheterization time (MD, -7.20 days; 95% CI, -8.10 to -6.29 days), and shorter recovery to normal postvoid residual urine time (MD, -7.71 days; 95% CI, -8.92 to -6.50 days). Other bladder dysfunction symptoms, including urinary retention, nocturia, dysuria, urinary incontinence, and frequency/urgency were more frequent in the LRH group. Furthermore, LNSRH achieved better results in urodynamic assessments (all p < .05). In conclusion, LNSRH was associated with lower rates of impaired bladder function and a shorter extent of resection compared with LRH. Clinical applications involving LNSRH should be explored with caution.
人们普遍认为，与根治性子宫切除术相比，保留神经的根治性子宫切除术术后发病率较低，而这两种手术的临床安全性相似。然而，目前还没有足够的证据来比较这两种通过腹腔镜进行的手术。我们对比较腹腔镜下保留神经的根治性子宫切除术（LNSRH）和腹腔镜根治性子宫切除术（LRH）的临床疗效和膀胱功能障碍（包括尿动力学评估）的研究进行了系统评价和荟萃分析。共分析了 30 篇文章，共计 2743 名参与者。LRH 组的手术时间更短（MD，29.88 分钟；95%置信区间[CI]，11.92-47.83 分钟），住院时间更长（MD，-1.56 天；95%CI，-2.27 至-0.84 天）。此外，两组间出血量和切除淋巴结数量无显著差异。然而，LNSRH 组切除的宫旁组织长度（MD，-0.02cm；95%CI，-0.05 至-0.00cm）和阴道残端宽度（MD，-0.06cm；95%CI，-0.09 至-0.04cm）较小。此外，LNSRH 组排尿更满意（优势比，2.90；95%CI，2.01-4.19）、导尿管留置时间更短（MD，-7.20 天；95%CI，-8.10 至-6.29 天）、恢复正常残余尿量时间更短（MD，-7.71 天；95%CI，-8.92 至-6.50 天）。其他膀胱功能障碍症状，包括尿潴留、夜尿、排尿困难、尿失禁和尿频/尿急，在 LRH 组更为常见。此外，LNSRH 在尿动力学评估中取得了更好的结果（均 p<0.05）。总之，与 LRH 相比，LNSRH 与膀胱功能障碍发生率较低和切除范围较小有关。涉及 LNSRH 的临床应用应谨慎探索。
