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目的:评价腹腔镜辅助的阴式根治性子宫切除术(laparoscopic assisted radical vaginal hysterectomy,LARVH)的临床效果。方法:采用RevMVan4.2.2软件,对符合入选标准的8篇文献进行了固定或随机效应模型Meta分析。结果:与常规经腹根治性子宫切除术(radical abdominal hysterectomy)组相比,腹腔镜辅助的阴式根治性子宫切除术(laparoscopic assisted rad-ical vaginal hysterectomy,LARVH)组手术时间长〔WMD=36.67,95%CI(16.36,56.98)〕,具有术中出血量少、住院时间短、术后并发症少等优点〔合并统计量分别为WMD=-255.12,95%CI(-419.90,-90.35);WMD=-3.79,95%CI(-5.19,-2.39);OR=0.21,95%CI(0.05,0.87)〕,而在复发率和术中并发症发生率上则无统计学差异(P=0.73,P=0.68)。结论:Meta分析表明,与常规经腹根治性子宫切除术相比,腹腔镜辅助的阴式根治性子宫切除术安全可行,能缩短住院时间,减少术中出血量,降低术后各种近期并发症的发生率,虽然延长手术时间,但不会增加手术复发率和术中并发症的发生率,可作为临床优先选择的术式。但由于纳入的研究存在选择偏倚和测量偏倚的可能性,势必会影响结果的论证强度,需要更多高质量的随机双盲对照试验来进一步证实。
Objective: To evaluate the clinical effect of laparoscopic assisted radical vaginal hysterectomy (LARVH). Methods: Using RevMVan 4.2.2 software, eight articles that met the inclusion criteria were analyzed by either fixed or random effects model Meta analysis. Results: Compared with conventional radical hysterectomy, laparoscopic assisted radical vaginal hysterectomy (LARVH) had longer operation time [WMD = 36.67 , 95% CI (16.36,56.98)], with the advantages of less intraoperative blood loss, shorter hospital stay and fewer postoperative complications [WMD = -255.12,95% CI (-419.90, -90.35, ; WMD = -3.79,95% CI (-5.19, -2.39); OR = 0.21,95% CI (0.05,0.87)], but there was no significant difference between the recurrence rate and the incidence of intraoperative complications = 0.73, P = 0.68). Conclusion: Meta-analysis shows that laparoscopic-assisted vaginal radical hysterectomy is safe and feasible compared with conventional radical hysterectomy, which can shorten the length of hospital stay, reduce the amount of intraoperative blood loss, and reduce the various postoperative complications The incidence of disease, while prolonging the operation time, but will not increase the recurrence rate and the incidence of intraoperative complications, can be used as a clinical priority surgical approach. However, due to the possibility of bias in selection and measurement bias in the studies included, the intensity of the argumentation will inevitably affect the outcome and more high-quality, randomized, double-blind controlled trials are needed to confirm this.