本文選題：子宮良性腫瘤　切入點：腹腔鏡子宮切除術(shù)　出處：《廣西醫(yī)科大學(xué)》2014年博士論文

【摘要】：子宮良性腫瘤腹腔鏡子宮切除術(shù)后近、遠期療效的臨床研究 目的：比較腹腔鏡全子宮切除術(shù)(LH)與開腹全子宮切除術(shù)(AH)治療子宮良性腫瘤的近、遠期療效。 方法：回顧性分析2007-2011年廣西壯族自治區(qū)23家三甲醫(yī)院收治的3895例子宮良性腫瘤患者臨床資料，其中LH組2539例，AH組1356例。比較兩種術(shù)式的手術(shù)時間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后并發(fā)癥、術(shù)后肛門排氣時間、術(shù)后尿管留置時間、術(shù)后鎮(zhèn)痛劑使用、術(shù)后住院天數(shù)、術(shù)后半年問卷隨訪患者的盆底及性功能情況。 結(jié)果：LH與AH相比，術(shù)中出血量少、術(shù)中術(shù)后并發(fā)癥少、術(shù)后疼痛少、術(shù)后肛門排氣快、術(shù)后留置尿管時間短、術(shù)后住院時間短、術(shù)后半年發(fā)生排便異常（便秘）少以及發(fā)生性功能障礙少。兩組之間統(tǒng)計學(xué)有顯著性差異（P＜0.05）；而手術(shù)時間和術(shù)后發(fā)生尿失禁比較，，兩組之間統(tǒng)計學(xué)無顯著性差異(P＞0.05)。 結(jié)論：現(xiàn)有研究結(jié)果表明，腹腔鏡全宮切除術(shù)治療子宮良性腫瘤是一種安全有效、能改善患者術(shù)后遠期生活質(zhì)量的手術(shù)方法，需要更多的設(shè)計良好、多中心隨機對照研究進一步驗證術(shù)后遠期生活質(zhì)量。 腹腔鏡子宮切除術(shù)治療婦科良性疾病的循證醫(yī)學(xué)研究 目的：系統(tǒng)評價腹腔鏡子宮切除術(shù)治療婦科良性疾病的有效性及安全性。 方法：計算機檢索CENTRAL（Cochrane圖書館2013年第11期）、MEDLINE、EMBASE、CNKI、Wan Fang、VIP、CBM數(shù)據(jù)庫，檢索時間從建庫截止2013年11月，并手工檢索相關(guān)未發(fā)表的灰色文獻，查找腹腔鏡與開腹子宮切除術(shù)比較治療婦科良性疾病的隨機對照試驗。由2位研究者按照納入排除標準篩選文獻、評價質(zhì)量并提取資料后，采用RevMan5.1軟件進行Meta分析。 結(jié)果：納入26個隨機對照試驗，共3069例患者。Meta分析結(jié)果顯示：與開腹組相比，腹腔鏡組具有住院時間短，術(shù)后恢復(fù)正常活動的時間短,術(shù)后血紅蛋白變化值少，術(shù)后次要并發(fā)癥發(fā)生率低，術(shù)后疼痛評分值低的優(yōu)勢，同時具有術(shù)中泌尿道損傷發(fā)生率高，術(shù)后主要遠期并發(fā)癥發(fā)生率高及手術(shù)時間延長的劣勢。 結(jié)論：現(xiàn)有研究顯示，腹腔鏡子宮切除術(shù)治療婦科良性疾病在縮短住院時間及術(shù)后恢復(fù)正常活動時間，降低術(shù)后血紅蛋白變化值、術(shù)后疼痛評分值及術(shù)后次要并發(fā)癥發(fā)生率優(yōu)于傳統(tǒng)開腹手術(shù)，但缺乏術(shù)后長期生活質(zhì)量結(jié)局指標的結(jié)果，期待更多高質(zhì)量的隨機對照試驗以提供更高質(zhì)量的證據(jù)。 1985-2011年廣西婦科惡性腫瘤住院患者流行病學(xué)調(diào)查分析 目的：了解廣西區(qū)近27年間婦科惡性腫瘤住院患者的構(gòu)成特點及變化趨勢。 方法對1985-2011年度廣西區(qū)23家三甲醫(yī)院收治的16123例婦科惡性腫瘤患者的臨床資料進行統(tǒng)計分析。 結(jié)果：(1)順位及構(gòu)成比：順位排在前4位的分別是宮頸癌、卵巢惡性腫瘤、子宮內(nèi)膜癌、妊娠滋養(yǎng)細胞腫瘤。宮頸癌的構(gòu)成比呈上升的趨勢，從1985-1989年度的17.48%上升到至2010-2011年度的56.74%，兩者比較統(tǒng)計學(xué)有顯著性差異（P＜0.01）；妊娠滋養(yǎng)細胞腫瘤呈下降的趨勢，從30.69%下降到1.75%，兩者比較統(tǒng)計學(xué)有顯著性差異（P＜0.01）；而卵巢惡性腫瘤、子宮內(nèi)膜癌、外陰陰道惡性腫瘤、子宮肉瘤等，比較統(tǒng)計學(xué)無顯著性差異（P＞0.05）。(2)好發(fā)年齡：宮頸癌的好發(fā)年齡從≥60歲前移至＜40歲，呈年輕化態(tài)勢；子宮內(nèi)膜癌＜60歲的各年齡段患者構(gòu)成比有所上升，也存在年輕化態(tài)勢；卵巢惡性腫瘤及妊娠滋養(yǎng)細胞腫瘤患者的好發(fā)年齡無明顯改變。（3）地域和職業(yè)分布：卵巢惡性腫瘤和子宮內(nèi)膜癌等其他婦科惡性腫瘤發(fā)病地域城鎮(zhèn)高于農(nóng)村，而妊娠滋養(yǎng)細胞腫瘤農(nóng)村高于城鎮(zhèn)；前10年宮頸癌患者主要集中于城鎮(zhèn)，構(gòu)成比67.1%，后10年卻主要集中在農(nóng)村，構(gòu)成比52.6%。(4)手術(shù)病理分期或臨床分期：宮頸癌、子宮內(nèi)膜癌、外陰陰道惡性腫瘤、子宮肉瘤和輸卵管癌大部分為早期患者（I-II期），分別占66.3%、67.3%、51.4%、73.7%及67.9%；而卵巢惡性腫瘤及妊娠滋養(yǎng)細胞腫瘤多數(shù)為中晚期（III-IV期）患者，分別占56.2%及53.1%。 結(jié)論：（1）應(yīng)重點加強對宮頸癌的普查防治工作，同時也要加大對其他婦科腫瘤的防治力度。（2）加大對卵巢惡性腫瘤及妊娠滋養(yǎng)細胞腫瘤相應(yīng)腫瘤標志物、新的診治方法的發(fā)現(xiàn)和研究力度，提高早期診治率。 子宮內(nèi)膜癌腹腔鏡手術(shù)治療近、遠期療效的臨床研究 目的：比較腹腔鏡與開腹手術(shù)治療子宮內(nèi)膜癌的近、遠期療效，并探討患者的預(yù)后影響因素。 方法：回顧性分析2007-2011年廣西壯族自治區(qū)6家三甲醫(yī)院收治的567例子宮內(nèi)膜癌患者臨床資料，按術(shù)式的不同分為腹腔鏡組266例，開腹組301例，比較兩種術(shù)式的手術(shù)時間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后并發(fā)癥、術(shù)后肛門排氣時間、術(shù)后尿管留置時間、術(shù)中淋巴結(jié)切除數(shù)目、術(shù)后住院天數(shù)、術(shù)后半年盆底功能障礙、術(shù)后半年性功能障礙、復(fù)發(fā)率、無瘤生存率及總生存率。采用Kaplan-Meier法描繪生存曲線、計算生存率，生存分析的檢驗采用Log-rank檢驗；對可能影響子宮內(nèi)膜癌預(yù)后的因素采用Cox回歸模型進行單因素及多因素分析。 結(jié)果：腹腔鏡組與開腹組相比，手術(shù)時間延長、術(shù)中失血量少、術(shù)后腸道功能恢復(fù)快、留置尿管時間短、術(shù)后住院天數(shù)減少、術(shù)后尿潴留發(fā)生少以及術(shù)后腹部傷口愈合不良發(fā)生少，兩組之間統(tǒng)計學(xué)有顯著性差異（P＜0.05）。術(shù)中淋巴結(jié)切除數(shù)目、術(shù)中并發(fā)癥總例數(shù)、術(shù)后并發(fā)癥總例數(shù)、術(shù)后半年盆底功能障礙、術(shù)后半年性功能障礙、復(fù)發(fā)率、無瘤生存率和總生存率，兩組相比較均無顯著性差異(P＞0.05)。單因素及多因素分析示病理類型和手術(shù)病理分期是獨立的預(yù)后因素。 結(jié)論：腹腔鏡手術(shù)治療子宮內(nèi)膜癌具有和開腹手術(shù)相似的術(shù)后遠期生活質(zhì)量及腫瘤生存預(yù)后，是一種較為安全有效的治療方法。需要更多的設(shè)計良好、多中心、前瞻性隨機對照研究長期隨訪，進一步驗證腹腔鏡治療的術(shù)后遠期生活質(zhì)量和生存預(yù)后。 子宮內(nèi)膜癌腹腔鏡手術(shù)治療的循證醫(yī)學(xué)研究 目的：系統(tǒng)評價子宮內(nèi)膜癌腹腔鏡手術(shù)治療的有效性及安全性。 方法：計算機檢索CENTRAL（Cochrane圖書館2013年第11期）、MEDLINE, EMBASE,PUBMED, CNKI、Wan Fang、VIP、CBM數(shù)據(jù)庫，檢索時間從建庫截止2013年11月，并手工檢索相關(guān)未發(fā)表的灰色文獻，查找比較腹腔鏡與開腹手術(shù)治療子宮內(nèi)膜癌的隨機對照試驗。由2位研究者按照納入排除標準篩選文獻、評價質(zhì)量并提取資料后，采用RevMan5.1軟件進行Meta分析。 結(jié)果：納入9個隨機對照試驗，共3616例子宮內(nèi)膜癌患者。Meta分析結(jié)果顯示：與開腹組相比，腹腔鏡組具有縮短住院時間及降低術(shù)后并發(fā)癥的優(yōu)勢，同時具有手術(shù)時間延長，增加術(shù)中并發(fā)癥的劣勢，兩組在3年總生存率、3年無瘤生存率、3年復(fù)發(fā)率及盆腔淋巴結(jié)切除數(shù)目方面，其差異均無統(tǒng)計學(xué)意義(P＞0.05)。 結(jié)論：現(xiàn)有研究顯示，腹腔鏡手術(shù)治療子宮內(nèi)膜癌在縮短住院時間及減少術(shù)后并發(fā)癥方面優(yōu)于開腹手術(shù)，但缺乏術(shù)后長期結(jié)局指標特別是生活質(zhì)量的評價結(jié)果，期待更多高質(zhì)量的隨機對照試驗以提供更高質(zhì)量的證據(jù)。 早期宮頸癌腹腔鏡治療近、遠期療效的臨床研究 目的：比較腹腔鏡與開腹手術(shù)治療早期宮頸癌的近、遠期療效，并探討患者的預(yù)后影響因素。 方法：回顧性分析2007-2011年廣西壯族自治區(qū)6家三甲醫(yī)院收治的1091例臨床分期IA1-IIB期宮頸癌患者的臨床資料，按術(shù)式不同分為腹腔鏡組455例，開腹組636例，比較兩種術(shù)式的手術(shù)時間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后并發(fā)癥、術(shù)后肛門排氣時間、術(shù)后尿管留置時間、術(shù)中淋巴結(jié)切除數(shù)目、術(shù)中左右宮旁和陰道組織切除長度、術(shù)后住院天數(shù)、術(shù)后半年盆底功能障礙、術(shù)后半年性功能障礙、復(fù)發(fā)率、無瘤生存率及總生存率。采用Kaplan-Meier法描繪生存曲線、計算生存率，生存分析的檢驗采用Log-rank檢驗；對可能影響宮頸癌預(yù)后的因素采用Cox回歸模型進行單因素及多因素分析。 結(jié)果：腹腔鏡組與開腹組相比手術(shù)時間長，但術(shù)中失血量少、術(shù)后腸道功能恢復(fù)快、留置尿管時間短、術(shù)后住院天數(shù)減少、術(shù)后并發(fā)癥發(fā)生少、術(shù)后腹部傷口愈合不良發(fā)生少、術(shù)中宮旁和陰道組織切除長度多、術(shù)后尿失禁發(fā)生少及術(shù)后性功能障礙發(fā)生少，兩組之間統(tǒng)計學(xué)有顯著性差異（P＜0.05）。術(shù)中淋巴結(jié)切除數(shù)目、術(shù)中并發(fā)癥總例數(shù)、術(shù)后發(fā)生排便異常、復(fù)發(fā)率、無瘤生存率和總生存率，兩組相比均無顯著性差異(P＞0.05)。單因素及多因素分析示宮頸間質(zhì)侵潤深度和淋巴結(jié)狀態(tài)是獨立的預(yù)后因素。 結(jié)論：腹腔鏡手術(shù)治療早期宮頸癌能改善患者術(shù)后遠期生活質(zhì)量，具有和開腹手術(shù)相似的腫瘤生存預(yù)后，是一種較為安全有效的治療方法。需要更多的設(shè)計良好、多中心、前瞻性隨機對照研究進一步驗證腹腔鏡治療的術(shù)后遠期生活質(zhì)量和生存預(yù)后。 早期宮頸癌腹腔鏡手術(shù)治療的循證醫(yī)學(xué)研究 目的：系統(tǒng)評價早期宮頸癌腹腔鏡手術(shù)治療的有效性及安全性。 方法：計算機檢索CENTRAL（Cochrane圖書館2013年第11期）、MEDLINE, EMBASE,PUBMED, CNKI、Wan Fang、VIP、CBM數(shù)據(jù)庫，檢索時間從建庫截止2013年11月，并手工檢索相關(guān)未發(fā)表的灰色文獻，查找比較腹腔鏡與開腹手術(shù)治療早期宮頸癌的隨機對照試驗（RCTs）和對照臨床試驗（CCTs）。由2位研究者按照納入排除標準篩選文獻、評價質(zhì)量并提取資料后，采用RevMan5.1軟件進行Meta分析。 結(jié)果：納入1個隨機對照試驗（RCT）和5個對照臨床試驗(CCTs)，共322例早期宮頸癌患者。Meta分析結(jié)果顯示：與開腹手術(shù)相比，腹腔鏡手術(shù)具有縮短住院時間及減少術(shù)中出血量的優(yōu)勢，同時具有手術(shù)時間延長的劣勢，兩組在3年總生存率、3年復(fù)發(fā)率、術(shù)中術(shù)后并發(fā)癥及盆腔淋巴結(jié)切除數(shù)目方面，其差異均無統(tǒng)計學(xué)意義(P＞0.05)。 結(jié)論：現(xiàn)有研究顯示，腹腔鏡手術(shù)治療早期宮頸癌在縮短住院時間及減少術(shù)中出血方面優(yōu)于開腹手術(shù)，但缺乏術(shù)后長期結(jié)局指標特別是生活質(zhì)量的評價結(jié)果，期待更多高質(zhì)量的隨機對照試驗以提供高質(zhì)量的證據(jù)。
[Abstract]:A clinical study on the long-term effect of laparoscopic hysterectomy for benign uterine tumors
Objective: To compare the near and long-term effect of laparoscopic total hysterectomy (LH) and open hysterectomy (AH) for the treatment of benign uterine tumors.
Methods: a retrospective analysis of 2007-2011 the Guangxi Zhuang Autonomous Region 23 hospitals treated 3895 cases of benign uterine tumors in patients with clinical data, including 2539 cases of LH group, AH group of 1356 cases. The two groups were compared operative time, intraoperative blood loss, intraoperative complications, postoperative complications, postoperative anal exhaust time, indwelling catheter the postoperative time, postoperative analgesic use, postoperative hospital stay, pelvic floor and sexual function questionnaire for half a year follow-up of patients after the surgery.
Results: LH compared with AH, less bleeding, less postoperative complications, less postoperative pain, postoperative exhaust fast, postoperative indwelling catheter time, postoperative hospitalization time is short, half a year after operation occurred abnormal defecation (constipation) and sexual dysfunction between the two groups. There was statistically significant difference (P < 0.05); and compare the operation time and postoperative urinary incontinence, no statistically significant difference between the two groups (P > 0.05).
Conclusion: the present results suggest that laparoscopic hysterectomy for uterine benign tumor is a safe and effective, can improve the postoperative quality of life in long-term operation method, the need for more well-designed, multicenter randomized controlled study to further verify the long-term postoperative quality of life.
The evidence-based medicine study of laparoscopic hysterectomy for benign gynecologic diseases
Objective: To evaluate the efficacy and safety of laparoscopic hysterectomy in the treatment of benign gynecologic diseases.
Methods: We searched CENTRAL (Cochrane Library in 2013 eleventh), MEDLINE, EMBASE, CNKI, Wan, Fang, VIP, CBM database, retrieved from the database by the end of November 2013, and a hand search of grey literature relevant unpublished, find the laparoscopic and open resection of uterine surgery for randomized controlled trials of benign gynecologic diseases by 2. The researchers screened the literature according to the inclusion and exclusion criteria, quality assessment and data extraction, Meta analysis was carried out by RevMan5.1 software.
Results: a total of 26 randomized controlled trials, a total of 3069 cases of.Meta patients compared with the laparotomy group, laparoscopic group has shorter hospitalization time, postoperative recovery time, postoperative hemoglobin change value less postoperative secondary low complication rate, postoperative pain score low advantage, at the same time intraoperative urinary tract injury with high incidence of major postoperative complications, prolong operation time and high rate of disadvantage.
Conclusion: the present study shows that laparoscopic hysterectomy for treatment of gynecological benign diseases in the normal activity time shorten the hospitalization time and postoperative hemoglobin change decreased after operation, postoperative pain score and postoperative secondary complications than traditional open surgery, but the lack of long-term life quality of postoperative outcome results, expect more randomized controlled trials of high quality to provide high quality evidence.
Epidemiological investigation and analysis of hospitalized patients with gynecologic malignant tumors in Guangxi in the past 1985-2011 years
Objective: to understand the composition and trend of the hospitalized patients with gynecologic malignant tumors in Guangxi in the last 27 years.
Methods the clinical data of 16123 patients with gynecologic malignancies in 23 third class hospitals in Guangxi District in 1985-2011 were analyzed.
Results: (1) the sequence and proportion of cis position: in the top 4 were cervical cancer, ovarian cancer, endometrial cancer, gestational trophoblastic tumor. Cervical cancer than a rising trend, from the year 1985-1989 rose to 17.48% to 2010-2011 year 56.74%, two comparison statistics there was significant difference (P < 0.01); gestational trophoblastic tumor decreased, decreased from 30.69% to 1.75%, two groups have statistically significant difference (P < 0.01); and ovarian cancer, endometrial cancer, vulvovaginal malignant tumor, sarcoma of uterus, compared with no statistically significant difference (P > 0.05). (2) good age: cervical cancer diagnosed at the age of over 60 years from the forward to the < 40 years old, had a younger trend; endometrial carcinoma under 60 years of age with constituent ratio increased, there are also young situation; ovarian malignant tumor and pregnancy. A cell tumor patients good age had no obvious change. (3) region and occupation distribution: ovarian cancer and endometrial cancer and other gynecological malignant tumor incidence area of urban higher than rural, and gestational trophoblastic tumor in rural areas than in towns; 10 years ago the cervical cancer patients were mainly concentrated in the town, after accounting for 67.1%. The 10 year is mainly concentrated in rural areas, accounting for 52.6%. (4): surgical pathological or clinical staging of cervical cancer, endometrial cancer, vulvovaginal malignant tumor, sarcoma of uterus and fallopian tube cancer most patients in the early stage (stage I-II), accounted for 66.3%, 67.3%, 51.4%, 73.7% and 67.9%; and malignant ovarian tumor and the majority of gestational trophoblastic tumor in advanced stage (stage III-IV) were respectively 56.2% and 53.1%.
Conclusion: (1) should focus on strengthening the work of the census on prevention and treatment of cervical cancer, but also to increase the other gynecological cancer prevention efforts. (2) increase of ovarian malignant tumor and gestational trophoblastic tumor with corresponding tumor markers, and found the new methods for the diagnosis and treatment of research efforts, improve the early diagnosis rate.
Clinical study on the long-term effect of laparoscopic surgery for endometrial carcinoma
Objective: To compare the near and long term effects of laparoscopy and laparotomy in the treatment of endometrial carcinoma, and to explore the prognostic factors of the patients.
Methods: a retrospective analysis of 2007-2011 the Guangxi Zhuang Autonomous Region 6 hospitals treated 567 cases of endometrial cancer patients with clinical data, according to the different operation for 266 cases of laparoscopic group, 301 cases in the laparotomy group, the two groups were compared operative time, intraoperative blood loss, intraoperative complications, postoperative complications, anal the postoperative exhaust time, postoperative catheter indwelling time, the number of lymph nodes removed during surgery, postoperative hospital stay, postoperative half year pelvic floor dysfunction, sexual dysfunction, the rate of postoperative recurrence, disease-free survival and overall survival rate. Survival curve was calculated by using Kaplan-Meier method to calculate the survival rate, survival analysis using Log-rank test inspection; on the factors that may affect the prognosis of endometrial cancer Cox regression model was used for univariate and multivariate analysis.
Results: compared with the laparoscopic group and laparotomy group. The operation time, intraoperative blood loss, postoperative intestinal function recovery time, indwelling catheter time, postoperative hospitalization days reduced, postoperative urinary retention and less postoperative abdominal wound healing occurred less, there was significant difference statistically between the two groups (P < 0.05). The number of lymph nodes removed during surgery, intraoperative complications, postoperative complications, the total number of cases, the first half of half a year after the operation of pelvic floor dysfunction, sexual dysfunction, the rate of postoperative recurrence, disease-free survival and overall survival rate, compared with the two groups showed no significant difference (P > 0.05). Univariate and multivariate analysis showed that pathological type and surgical pathological staging were independent prognostic factors.
Conclusion: laparoscopic surgery in the treatment of endometrial cancer with open surgery and similar long-term postoperative life quality and prognosis of tumor, is a safe and effective therapeutic method. The need for more well-designed, multicenter, long-term follow-up of a prospective randomized controlled study, further validation of laparoscopic treatment of postoperative and long-term quality of life the prognosis.
Evidence-based medicine study of laparoscopic surgery for endometrial carcinoma
Objective: To evaluate the efficacy and safety of laparoscopic surgery for endometrial carcinoma.
Methods: We searched CENTRAL (Cochrane Library in 2013 eleventh), MEDLINE, EMBASE, PUBMED, CNKI, Wan, Fang, VIP, CBM database, retrieved from the database by the end of November 2013, and a hand search of grey literature relevant unpublished, randomized controlled trials for comparison of laparoscopic and open surgery in the treatment of endometrial cancer by 2. The researchers screened the literature according to the inclusion and exclusion criteria, quality assessment and data extraction, Meta analysis was carried out by RevMan5.1 software.
Results: a total of 9 randomized controlled trials, a total of 3616 cases of.Meta patients with endometrial cancer compared with the laparotomy group, laparoscopic group can shorten the hospitalization time and reduce the advantage of postoperative complications, and has prolonged the operative time, intraoperative complications increased disadvantage, two groups in the 3 year overall survival rate for 3 years. 3 years disease-free survival rate, recurrence rate and pelvic lymphadenectomy number, the differences were not statistically significant (P > 0.05).
Conclusion: the present study shows that laparoscopic surgery in treatment of endometrial cancer to shorten the hospitalization time and reduce postoperative complications than open surgery, but the lack of long-term postoperative outcomes especially life quality evaluation results, look forward to more high quality randomized controlled trials to provide high quality evidence.
Clinical study of early laparoscopic treatment for early cervical cancer
Objective: To compare the near and long term effects of laparoscopy and laparotomy in the treatment of early cervical cancer, and to explore the prognostic factors of the patients.
Methods: a retrospective analysis of the clinical data of 1091 cases of 2007-2011 years from 6 tertiary hospitals in the Guangxi Zhuang Autonomous Region were stage IA1-IIB cervical cancer patients, according to the different operative methods were divided into laparoscopic group 455 cases, 636 cases in the laparotomy group, the two groups were compared operative time, intraoperative blood loss, intraoperative complications, postoperative complications, postoperative anal exhaust time, postoperative catheter indwelling time, the number of lymph nodes removed during surgery, intraoperative left parametrial and vaginal tissue resection length, postoperative hospital stay, postoperative half year pelvic floor dysfunction, sexual dysfunction, the rate of postoperative recurrence, disease-free survival and overall survival. The survival curves were depicted by Kaplan-Meier method to calculate the survival rate, survival analysis test using Log-rank test; the factors that may affect the prognosis of cervical cancer Cox regression model was used for univariate and multivariate analysis.
Results: laparoscopic group and laparotomy group compared to the operation for a long time, but less intraoperative blood loss, postoperative intestinal function recovery time, indwelling catheter time, postoperative hospitalization days reduced, reducing postoperative complications, low incidence of adverse abdominal wound healing after surgery, intraoperative uterine and vaginal tissue resection length. Postoperative urinary incontinence and sexual dysfunction after operation occurred less statistically between the two groups had significant difference (P < 0.05). The number of lymph nodes removed during surgery, intraoperative complications, postoperative defecation, recurrence rate, disease-free survival rate and overall survival rate, compared to the two groups there was no significant difference (P > 0.05). Univariate and multivariate analysis showed that cervical stromal invasion depth and lymph node status were independent prognostic factors.
Conclusion: laparoscopic surgery in the treatment of early cervical cancer patients can improve the long-term postoperative quality of life, and has a laparotomy similar tumor prognosis, which is a safe and effective treatment method. The need for more well-designed, multicenter, prospective randomized study to further validate the laparoscopic treatment of postoperative and long-term quality of life the prognosis.
Evidence based study of laparoscopic surgery for early cervical cancer
Objective: To evaluate the efficacy and safety of laparoscopic surgery for early cervical cancer.
Methods: We searched CENTRAL (Cochrane Library in 2013 eleventh), MEDLINE, EMBASE, PUBMED, CNKI, Wan, Fang, VIP, CBM database, retrieved from the database by the end of November 2013, and a hand search of grey literature relevant unpublished, randomized controlled trials for comparison of laparoscopic and open surgery for early stage cervical carcinoma (RCTs) and controlled clinical trials (CCTs). By 2 researchers according to inclusion and exclusion criteria, literature screening, quality assessment and data extraction, Meta analysis was carried out by RevMan5.1 software.
Results: a total of 1 randomized controlled trials (RCT) and 5 controlled clinical trials (CCTs) were included in the study. A total of 322 patients with early cervical cancer were analyzed by.Meta. Results showed that compared with laparotomy, laparoscopic surgery has the advantage of shortening hospitalization time and reducing intraoperative blood loss, and having hand time.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R737.33

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