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目的比较保留盆腔神经的根治性子宫切除术(NSRH)和传统根治性子宫切除术(RH)的疗效和安全性。方法计算机检索Cochrane图书馆(2010年第2期)、MEDLINE(1960～2010.3)、EMbase(1960～2010.3)、CBM(1960～2010.3)、VIP(1960～2010.3)、清华同方数据库(1960～2010.3),并手工检索与宫颈癌治疗相关的文献,收集符合标准的随机对照试验和临床对照试验。数据提取和文献质量评价由两名评价员独立进行。采用Cochrane协作网提供的RevMan4.2.2软件对数据进行统计分析。结果未获得随机对照试验,共纳入9个临床同期对照试验,共742例。结果显示:①术后膀胱功能的恢复:残余尿恢复的时间[WMD=–5.80,95%CI(–6.22,–5.37)]、膀胱功能紊乱的发生率[RR=0.43,95%CI(0.26,0.75)]、尿流动力学测定NSRH组均优于传统的RH组,其差异有统计学意义;②手术时间:NSRH组长于RH组,其差异有统计学意义[WMD=37.23,95%CI(12.84,61.61)];③术中出血量:两组比较无明显统计学差异[WMD=19.66,95%CI(–51.57,90.90)];④术后生存率和复发率两组差异无明显统计学意义[RR=0.79,95%CI(0.17,3.58)];⑤两组手术切除范围及术后病理的相关情况,如宫旁浸润、脉管浸润等无明显统计学差异;⑥单个研究显示NSRH组的直肠功能紊乱和性功能紊乱的发生率比RH组低,差异有统计学意义。结论保留盆腔神经的根治性子宫切除术与传统根治性子宫切除术相比,具有术后膀胱、直肠、性功能恢复快的优点。NSRH除手术时间长于RH外,术中出血量、术后复发率、生存率和手术切除范围两者无明显差别,有利于提高病人的生活质量,不明显影响手术的安全性。但本系统评价纳入研究均为非随机对照试验。纳入病例数较少,一些结局指标仅单个研究报道。因此,目前还无法得到以上结论的确切疗效,有必要设计和开展大样本前瞻性随机对照研究来进一步验证。
Objective To compare the efficacy and safety of radical hysterectomy (NSRH) and traditional radical hysterectomy (RH) for pelvic nerve preservation. Methods Cochrane Library (2010-2), MEDLINE (1960-2010), EMbase (1960-2010.3), CBM (1960-2010.3), VIP (1960-2010.3) and Tsinghua Tongfang Database (1960-2010.3) , And manually searched for articles related to cervical cancer treatment, and collected randomized controlled trials and controlled trials that met the criteria. Data extraction and literature quality evaluation were conducted independently by two reviewers. Data were statistically analyzed using RevMan 4.2.2 software provided by the Cochrane Collaboration. Results No randomized controlled trials were included, a total of 9 clinical control trials were included, a total of 742 cases. The results showed that: ①Postoperative recovery of bladder function: the time of recovery of residual urine [WMD = -5.80,95% CI (-6.22, -5.37)], the incidence of bladder dysfunction [RR = 0.43,95% CI , 0.75)]. Urodynamics in NSRH group was superior to that in the traditional RH group, and the difference was statistically significant. ②Operation time: The NSRH group was longer in RH group, with significant difference [WMD = 37.23, 95% CI (12.84,61.61)]; ③ intraoperative blood loss: no statistically significant difference between the two groups [WMD = 19.66,95% CI (-51.57,90.90]]; ④ postoperative survival and recurrence rate was no significant difference between the two groups Statistical significance [RR = 0.79,95% CI (0.17, 3.58)]; ⑤The surgical resection range and postoperative pathological correlation between the two groups, such as uterine infiltration, vascular invasion and other no statistically significant differences; ⑥ a single study The incidence of rectal dysfunction and sexual dysfunction in NSRH group was lower than that in RH group, the difference was statistically significant. Conclusions Radical hysterectomy, which preserves pelvic nerves, has the advantage of recovering bladder, rectum and sexual function faster than traditional radical hysterectomy. In addition to the operation time longer than RH, NSRH had no significant difference in intraoperative blood loss, postoperative recurrence rate, survival rate and surgical resection range, which was beneficial to improve the quality of life of patients without significantly affecting the safety of surgery. However, the systematic reviews included in the study were non-randomized controlled trials. The number of included cases is small, with some outcome measures reported only in a single study. Therefore, the exact effect of the above conclusions can not be obtained so far, so it is necessary to design and carry out large sample prospective randomized controlled studies to further verify.