Nerve-sparing radical hysterectomy in the treatment of cervical cancer: a Meta-analysis of the efficacy and security.

doi:10.7504/fk2014100115

Abstract

Abstract:

Abstract： Objective To estimate the clinical efficacy and security of nerve-sparing radical hysterectomy(NSRH) in the treatment of cervical cancer.Methods Large databases were searched in recent 11 years for studies which were prospective controlled trials comparing clinical efficacy of NSRH with that of radical hysterectomy(RH) in treating cervical cancer. A comprehensive quantitative analysis was performed by Meta-analysis method.Results Meta-analysis results showed that the pooled WMDs values of cervical cancer for the highest versus lowest of Indwelling catheter time levels were－6.73,95%CI-7.39~-6.06;the time of residual urine volume <50 mL levels was－7.80,95%CI－11.93~－3.67;the first exhaust time was－12.05,95%CI－15.87~－8.24;the first defecation time was－24.99,95%CI－26.87~－23.11;days of hospitalization were－4.00, 95%CI－4.60~－3.40;uterine resection length was－0.10,95%CI－0.15~－0.06;these all significantly reduced.The total operation time was 30.74,95%CI16.66~ 44.82,which was lengthened. No significant differences were found in the number of lymph nodes, bleeding volume, postoperative overall recurrence rate.

Key words: nerve-sparing radical hysterectomy, radical hysterectomy, cervical cancer, Meta-analysis

摘要：

目的评价保留盆腔自主神经的广泛性子宫切除术(nerve-sparing radical hysterectomy,NSRH)治疗宫颈癌的临床疗效和安全性。方法检索大型数据库中近11年发表的关于NSRH与传统广泛性子宫切除术(radical hysterectomy,RH)临床疗效比较的前瞻性同期对照试验。并按Cochrane系统评价方法提取有效数据进行Meta分析。结果 NSRH与RH相比，其术后留置尿管时间[加权均数差（weighted mean difference,WMD）=－6.73,95%可信区间（CI）－7.39~－6.06]、残余尿量<50 mL时间(WMD=－7.80,95%CI－11.93~－3.67)、首次排气时间(WMD =－12.05,95%CI －15.87~－8.24)、首次排便时间(WMD =－24.99,95%CI －26.87 ~－23.11)、住院天数(WMD =－4.00,95%CI －4.60 ~－3.40)均明显减少，宫旁切除长度明显减小(WMD =－0.10,95%CI －0.15 ~－0.06)，手术总时间延长(WMD =30.74,95%CI 16.66~44.82)；而在淋巴结活检数、术中出血量、术后总体复发率等方面比较差异无统计学意义。结论 NSRH治疗早期宫颈癌具备安全性和可行性，在缩短膀胱功能恢复时间、肠道功能恢复时间及住院时间等方面有一定优势。

关键词: 保留盆腔自主神经的广泛性子宫切除术, 根治性子宫切除术, 宫颈癌, Meta分析

CLC Number:

R711.74

CHEN Dan,YU Hui-hui*,SHI Hai-min,ZHANG Xin*.. Nerve-sparing radical hysterectomy in the treatment of cervical cancer: a Meta-analysis of the efficacy and security.[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2014100115.

陈丹1,于慧会2,史海敏1,张新2. 保留盆腔神经的广泛性子宫切除术治疗宫颈癌疗效及安全性荟萃分析[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2014100115.

References

［1］    Jema A,Bray F,Center MM,et al. Global cancer statistics［J］.CA Cancer J Clin,2011, 61(2):69-90.

［2］   Benedetti-Panici P,Zullo MA, Plotti F,et al. Long-term bladder function in patients with locally advanced cervical carcinoma treated with neoadjuvant chemotherapy and type 3-4 radical hysterectomy［J］. Cancer,2004,100(10):2110-2117.

［3］   Moher D,Liberati A,Tetzlaff J,et al. Preferred reporting items for systematic reviews and Meta-analyses: the PRISMA statement ［J］. Int J Surg,2010,8(8):336-341.

［4］   陈勇,李燕,徐惠成,等.腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析［J］.中华妇产科杂志,2009,44(5):359-363.

［5］    李艳,梁志清,陈勇,等.腹腔镜下保留盆腔神经丛的根治性子宫切除术的临床观察［J］.重庆医学,2009,38(15):1910-1912.

［6］    刘青,李培全,刘开江,等.腹腔镜下保留盆腔神经功能的宫颈癌根治术近期疗效的比较研究［J］.中国微创外科杂志,2010,l0(12):1082-1085.

［7］   Liang Z,Chen Y,Xu H,et al. Laparoscopic nerve-sparing radical hysterectomy with fascia space dissection technique for cervical cancer:description of technique and outcomes［J］. Gynecol Oncol,2010,119(2):202-207.

［8］   Skr?t-Magier?o J,Naróg M,Kruczek A,et al. Radical hysterectomy during the transition period from traditional to nerve-sparing technique［J］. Gynecol Oncol,2010, 116 (3):502-505.

［9］    龙颖,姚德生,高琨,等.保留盆腔自主神经的根治性子宫切除术治疗宫颈癌的临床研究［J］.临床肿瘤学杂志,2010,15(12):1083-1088.

［10］    宋晶晶.腹腔镜下保留神经的根治性子宫切除术的近期临床疗效［D］.新疆医科大学,2011.

［11］   朱前勇,郭伟平,申沛,等.腹腔镜下系统保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌38例［J］.重庆医学,2011,40(21):2128-2130.

［12］    杜绍敏,廖琪,李秀岩,等.保留盆腔自主神经的宫颈癌根治性手术临床观察［J］.中国伤残医学,2011,19(3):64-65.

［13］    卢艳.腹腔镜下保留盆腔自主神经在宫颈癌根治性子宫切除术中的循证医学与临床硏究［D］.广西医科大学,2012.

［14］    罗岳西,伍燕,刘先平,等.腹腔镜下宫颈癌根治术保留盆腔自主神经的近期疗效观察［J］.西部医学,2012,24(12):2365-2367.

［15］    Chen C, Li W, Li F, et al. Classical and nerve-sparing radical hysterectomy:an evaluation of the nerve trauma in cardinal ligament［J］. Gynecol Oncol,2012,125(1): 245-251.

［16］    杨慧云,吴海峰,黎世平,等.保留盆腔植物神经广泛性子宫切除术临床研究［J］.中国妇幼保健,2012,27(25):4014-4015.

［17］    唐修武,孙云,倪观太,等.保留盆腔神经宫颈癌根治术与传统宫颈癌根治术的比较研究［J］.中国临床药理学与治疗学,2013,18(10):1148-1154.

［18］    李静瑜.保留盆腔自主神经的根治性子宫切除术治疗宫颈癌的效果［J］.中国老年学杂志,2013,33(19):4699-4700.

［19］    真酌,李慧玲,吕丽,等.腹腔镜下保留神经的广泛子宫切除术治疗宫颈癌52例临床效果分析［J］.中国医药科学,2013,3(15):215-216.

［20］    苏全玲.腹腔镜下子宫颈癌保留盆腔自主神经子宫切除术的可行性研究［J］.中国医学创新,2014,11(4):32-33.

［21］    周昌仙.系统保留盆腔自主神经的广泛性子宫切除术对子宫颈癌及子宫内膜癌患者术后膀胱和直肠功能的影响［J］.中国实用神经疾病杂志,2014,17(2):77-79.

［22］    王慧,郭艳江,梁东海,等.腹腔镜下保留盆腔神经功能宫颈癌根治术的疗效分析［J］.中国中医药指南,2014,12(8):7-8.

［23］    van den Tillaart SA,Kenter GG,Peters AA,et al. Nerve-sparing radical hysterectomy:local recurrence rate,feasibility,and safety in cervical cancer patients stage IA to IIA［J］. Int J Gynecol Cancer, 2009, 19(1):39-45.

［24］   Kavallaris A,Homemann A,Chalvatzas N,et al. Laparoscopic nerve-sparing radical hysterectomy:description of the technique and patients 70 outcome［J］. Gynecol Oncol,2010,119(2):198-201．

［25］    Puntambekar SP,Patil A,Joshi SN,et al. Preservation of autonomic nerves in laparoscopic total radical hysterectomy［J］. J Laparoendosc Adv Surg Tech A,2010,20 (10):813-819.

［26］   Charoenkwan K,Srisomboon J,Suprasert P,et al. Nerve-sparing class III radical hysterectomy:a modified technique to spare the pelvic autonomic nerves without compromising radicality［J］. Int J Gynecol Cancer,2006,16(4):1705-1712.

［27］    吴鸣,马水清,谭先杰,等.腹腔镜下保留盆腔自主神经广泛性子宫切除术［J］.中国实用妇科与产科杂志,2013,29(12):936-939.

（2014-06-20收稿    2014-08-10修回）

[1]	. [J]. Chinese Journal of Practical gynecology ang obstetric, 2022, 38(6): 634-641.
[2]	. [J]. Chinese Journal of Practical gynecology ang obstetric, 2022, 38(5): 524-528.
[3]	. [J]. Chinese Journal of Practical gynecology ang obstetric, 2022, 38(4): 434-442.
[4]	. [J]. Chinese Journal of Practical gynecology ang obstetric, 2022, 38(1): 66-72.
[5]	CHEN Chun-lin, LI Zhi-qiang. Several issues that need attention in quality control of surgical treatment for cervical cancer. [J]. Chinese Journal of Practical gynecology ang obstetric, 2022, 38(1): 22-24.
[6]	. [J]. Acta Metallurgica Sinica, 2021, 37(6): 660-664.
[7]	. [J]. Acta Metallurgica Sinica, 2021, 37(4): 467-467.
[8]	. [J]. Acta Metallurgica Sinica, 2021, 37(2): 185-188.
[9]	LU An-wei，ZHOU Li. Standardization of C1 radical hysterectomy for cervical cancer. [J]. Acta Metallurgica Sinica, 2021, 37(1): 48-51.
[10]	. [J]. Acta Metallurgica Sinica, 2021, 37(1): 82-86.
[11]	ZHAO Jian，GUO Wen-wen. Recommendations for cervical cancer screening and management of cervical lesions in young women aged 21-24. [J]. Acta Metallurgica Sinica, 2020, 36(7): 608-612.
[12]	LI Qiao，YIN Ru-tie. Cervical cancer screening and management of cervical lesions in elderly women. [J]. Acta Metallurgica Sinica, 2020, 36(7): 615-617.
[13]	. [J]. Acta Metallurgica Sinica, 2020, 36(6): 531-535.
[14]	Eiji Kobayashi. Laparoscopic radical hysterectomy in Japan：perspectives from the Japan Gynecologic Oncology Group. [J]. Acta Metallurgica Sinica, 2020, 36(4): 324-325.
[15]	Pedro T.Ramirez. [J]. Acta Metallurgica Sinica, 2020, 36(4): 303-307.