CAJ | 학술논문

目的：比较传统的根治性子宫切除术和保留盆腔自主神经的根治性子宫切除术治疗宫颈癌的疗效。方法检索PubMed、EMBASE、CBMdisc、CNKI和Wanfang 数据库，收集符合纳入标准的随机对照试验。运用Stata software （ version 11．0）对数据进行统计分析。结果纳入19项临床同期对照试验共计1862例患者。分析显示，①术后膀胱功能比较：术后残余尿＜50 mL及＜100 mL的恢复时间分别为加权均数差＝－6．62、95％可信区间（－7．00，－6．23）及加权均数差＝－5．04、95％可信区间（－6．52，－3．56），膀胱功能紊乱的发生率比较的相对危险度＝0．46，95％可信区间（0．29，0．71）；②术后肠道功能比较：术后排气及排便时间分别为加权均数差＝－12．02，95％可信区间（－16．20，－7．85）及加权均数差＝－20．99，95％可信区间（－32．02，－9．96）；③术后生存率及2年、4年、5年复发率差异无统计学意义，术后2年复发率比较相对危险度＝1．21，95％可信区间（0．73，2．01），P＝0．452；④单个研究提示与经腹根治性子宫切除术组相比，保留盆腔自主神经的根治性子宫切除术组患者的直肠功能紊乱、性功能紊乱发生率较低，且保留盆腔自主神经的根治性子宫切除术组术后生活质量较高。结论与传统根治性子宫切除术相比，保留盆腔自主神经的根治性子宫切除术具有术后膀胱、直肠及性功能恢复快的优点；保留盆腔自主神经的根治性子宫切除术提高了患者的生活质量，并不影响患者术后宫颈癌的复发率和生存率。本系统评价的结论需要随访时间更长的大样本随机对照研究加以验证。
목적：비교전통적근치성자궁절제술화보류분강자주신경적근치성자궁절제술치료궁경암적료효。방법검색PubMed、EMBASE、CBMdisc、CNKI화Wanfang 수거고，수집부합납입표준적수궤대조시험。운용Stata software （ version 11．0）대수거진행통계분석。결과납입19항림상동기대조시험공계1862례환자。분석현시，①술후방광공능비교：술후잔여뇨＜50 mL급＜100 mL적회복시간분별위가권균수차＝－6．62、95％가신구간（－7．00，－6．23）급가권균수차＝－5．04、95％가신구간（－6．52，－3．56），방광공능문란적발생솔비교적상대위험도＝0．46，95％가신구간（0．29，0．71）；②술후장도공능비교：술후배기급배편시간분별위가권균수차＝－12．02，95％가신구간（－16．20，－7．85）급가권균수차＝－20．99，95％가신구간（－32．02，－9．96）；③술후생존솔급2년、4년、5년복발솔차이무통계학의의，술후2년복발솔비교상대위험도＝1．21，95％가신구간（0．73，2．01），P＝0．452；④단개연구제시여경복근치성자궁절제술조상비，보류분강자주신경적근치성자궁절제술조환자적직장공능문란、성공능문란발생솔교저，차보류분강자주신경적근치성자궁절제술조술후생활질량교고。결론여전통근치성자궁절제술상비，보류분강자주신경적근치성자궁절제술구유술후방광、직장급성공능회복쾌적우점；보류분강자주신경적근치성자궁절제술제고료환자적생활질량，병불영향환자술후궁경암적복발솔화생존솔。본계통평개적결론수요수방시간경장적대양본수궤대조연구가이험증。
Objective To study the clinical effects of nerve-sparing radical hysterectomy (NSRH) for cervical cancer compared with radical hysterectomy (RH). Methods We searched the PubMed, EMBASE, CBMdisc, CNKI and Wanfang Data; hand searched related literatures; and collected both randomized controlled trials and controlled clinical trials comparing NSRH with RH for cervical cancer. Meta-analysis was conducted with the Stata software. Results Nineteen clinical controlled trials involving 1 862 patients were collected. Compared with RH, NSRH was much better for the recovery time of post void residual urine volume ( PVR ) <50 mL and <100 mL , WMD=-6 . 62 , 95%CI (-7.00,-6.23) and WMD=-5.04, 95%CI (-6.52,-3.56) respectively; NSRH has less bladder dysfunction morbidity RR=0.46, 95%CI (0.29, 0.71); the recovery time of postoperative flatus and bowel movement were much earlier in NSRH than those in the RH group , WMD=-12 . 02 , 95%CI (-16 . 20 ,-7 . 85 ) , WMD=-20 . 99 , 95%CI (-32.02,-9.96) respectively; no significant difference was found in both survival rate and recurrent rate; one trial showed that NSRH led to less rectal and sexual dysfunction, quality of life in NSRH group was significantly higher than that RH. Conclusions Compared with RH, NSRH is related with better postoperative recovery of bladder, rectal and sexual functions, which can improve the quality of postoperative life, but haven’t lower survival rates and higher recurrence rates. In the future, more prospective randomized controlled trials are required for further investigation.