本文選題：子宮內(nèi)膜癌　切入點：腹腔鏡手術　出處：《新疆醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：評價腹腔鏡與開腹手術治療子宮內(nèi)膜癌的臨床療效及安全性。方法：計算機檢索Cochrane Library、PubMed、EMbase、OVID、CNKI)、萬方數(shù)據(jù)庫、維普數(shù)據(jù)庫和中國生物醫(yī)學數(shù)據(jù)庫中從1998年到2012年9月腹腔鏡和開腹手術治療子宮內(nèi)膜癌療效及安全性的隨機對照研究,按照納入和排除標準篩選文獻、提取資料,并依據(jù)Cochrane Handbook5.1.0的質量評價標準評價納入研究的方法學質量,用RevMan5.1軟件進行Meta分析。結果：共納入10篇隨機對照試驗,共6993位患者。Meta分析表明：與開腹手術相比,腹腔鏡手術的操作時間長,但腹腔鏡手術治療子宮內(nèi)膜癌術中出血量少、術前與術后第1天血紅蛋白下降值低、術后排氣時間和住院時間短,然而,腹腔鏡組與開腹組術中清掃盆腔淋巴結和腹主動脈旁淋巴結數(shù)目無統(tǒng)計學差異；開腹手術可以降低術中并發(fā)癥的發(fā)生率,如陰道損傷,但是,術中出血量大于500ml的發(fā)生率高,術中腸損傷、膀胱損傷、輸尿管損傷、動靜脈血管損傷發(fā)生率無統(tǒng)計學差異,而腹腔鏡手術可以降低術后并發(fā)癥的發(fā)生率,如腸梗阻和切口裂開及感染,但,泌尿系感染、組織出血及血腫、術后體溫大于38℃、靜脈血栓形成、淋巴水腫及囊腫發(fā)生率無統(tǒng)計學差異；術后隨訪3-5年內(nèi)子宮內(nèi)膜癌復發(fā)率、死亡率和無瘤生存率無統(tǒng)計學差異。結論：腹腔鏡手術較開腹手術的操作時間長、術中出血量少、術前與術后第1天血紅蛋白下降值低、術后排氣時間和住院時間短,術中出血量大于500ml的發(fā)生率低,且術后并發(fā)癥發(fā)生率低,如腸梗阻和切口裂開及感染；但開腹手術術中并發(fā)癥發(fā)生率低,如陰道損傷：另外,兩種手術方式清掃盆腔淋巴結和腹主動脈旁淋巴結數(shù)目、術中腸損傷、膀胱損傷、輸尿管損傷、動靜脈血管損傷發(fā)生率、術后泌尿系感染、組織出血及血腫、術后體溫大于38℃、靜脈血栓形成、淋巴水腫及囊腫發(fā)生率、術后隨訪3-5年子宮內(nèi)膜癌復發(fā)率、死亡率和無瘤生存率相似。然而,上述結論仍不能取代高質量、大樣本、多中心的隨機雙盲對照研究的結果。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of laparoscopy and laparotomy in the treatment of endometrial carcinoma. From 1998 to September 2012, a randomized controlled study on the efficacy and safety of laparoscopy and laparotomy in the treatment of endometrial carcinoma was carried out in Weip database and Chinese biomedical database. According to the criteria of inclusion and exclusion, the literature was selected and the data were extracted. According to the quality evaluation standard of Cochrane Handbook5.1.0, the Meta analysis was carried out with RevMan5.1 software. Results: ten randomized controlled trials were included, and 6993 patients. Meta analysis showed that compared with open surgery, there were 6 993 patients. The operative time of laparoscopic surgery is long, but the bleeding amount is less during laparoscopic surgery for endometrial carcinoma, the decrease of hemoglobin is low before and 1 day after operation, the time of exhaust and hospitalization is short after operation, however, There was no significant difference in the number of pelvic lymph nodes and para-aortic lymph nodes between laparoscopy group and laparotomy group, the incidence of intraoperative complications such as vaginal injury was reduced by laparotomy, but the incidence of intraoperative bleeding greater than 500ml was high. There was no significant difference in the incidence of intestinal injury, bladder injury, ureteral injury and arteriovenous injury. Laparoscopic surgery could reduce the incidence of postoperative complications, such as intestinal obstruction, incision rupture and infection, but urinary tract infection. Tissue hemorrhage and hematoma, body temperature greater than 38 鈩，

本文編號：1634470