【摘要】：目的：評(píng)價(jià)腹腔鏡在早期卵巢癌全面分期手術(shù)中的安全性、有效性，為臨床實(shí)踐提供可靠依據(jù)。 方法：計(jì)算機(jī)檢索Ovid、EMbase、PubMed、CBM、CNKI、萬方期刊全文數(shù)據(jù)庫等。以 ovarian cancer‖, ovarian carcinoma‖, earlystage‖, laparoscopy‖, stagingsurgery‖, staging laparoscopy‖,為英文檢索詞，以 腹腔鏡、開腹手術(shù)、分期手術(shù)、早期卵巢癌、卵巢癌、腹腔鏡分期手術(shù)‖為中文檢索詞進(jìn)行檢索。按照納入標(biāo)準(zhǔn)與排除標(biāo)準(zhǔn)收集相關(guān)文獻(xiàn)，由倆名評(píng)價(jià)員分別獨(dú)立閱讀檢索文獻(xiàn)的題目和摘要后，刪除顯著不滿足納入標(biāo)準(zhǔn)的文獻(xiàn)后，對(duì)于滿足納入標(biāo)準(zhǔn)的文獻(xiàn)進(jìn)行全文閱讀，確定最終是否真正被納入，倆名評(píng)價(jià)員交叉核對(duì)。如遇分歧，通過請(qǐng)教統(tǒng)計(jì)學(xué)專業(yè)人員解決。數(shù)據(jù)的統(tǒng)計(jì)分析使用Cochrane協(xié)作網(wǎng)提供的RevMan5.2軟件進(jìn)行。 結(jié)果：根據(jù)入選及排除標(biāo)準(zhǔn)共納入文獻(xiàn)12篇，其中中文文獻(xiàn)7篇，英文文獻(xiàn)5篇，均采用平行設(shè)計(jì)，且均為非隨機(jī)對(duì)照研究。共納入753例早期卵巢癌患者，腹腔鏡組314例，開腹組439例。所納入文獻(xiàn)均對(duì)受試者特征如年齡、體重指數(shù)、臨床分期等進(jìn)行描述且無統(tǒng)計(jì)學(xué)差異。Meta分析的結(jié)果顯示：腹腔鏡組手術(shù)時(shí)間長(zhǎng)、但術(shù)中出血量少、術(shù)后腸功能恢復(fù)快、住院時(shí)間短、圍手術(shù)期并發(fā)癥少，兩組比較有統(tǒng)計(jì)學(xué)意義（手術(shù)時(shí)間：WMD=38.2795%CI：10.03～66.51,P=0.008；術(shù)中出血量：WMD=㧟223.29，95%CI：㧟324.09～㧟123.09，P＜0.0001；術(shù)后排氣時(shí)間：SMD=㧟1.79，95%CI：㧟2.30～㧟1.29，P＜0.00001；術(shù)后住院時(shí)間：WMD=㧟4.87，95%CI：㧟6.70～㧟3.05，，P＜0.00001；圍手術(shù)期并發(fā)癥：OR=0.43，95%CI：0.26～0.71，P=0.0009；）；而復(fù)發(fā)率、盆腔淋巴結(jié)、腹主動(dòng)脈旁淋巴結(jié)切除數(shù)目相比差異無統(tǒng)計(jì)學(xué)意義（術(shù)后復(fù)發(fā)率：OR=0.54，95%CI：0.18～1.57，P=0.26；盆腔淋巴結(jié)切除個(gè)數(shù)：WMD=㧟1.80，95%CI：㧟3.91～0.32,P=0.10；腹主動(dòng)脈旁淋巴結(jié)切除個(gè)數(shù)：WMD=1.22，95%CI：-0.81～3.24，P=0.24）。 結(jié)論：腹腔鏡是一個(gè)治療早期卵巢癌手術(shù)效果較滿意，安全、有效的選擇，且具有創(chuàng)傷小、住院時(shí)間短、圍手術(shù)期并發(fā)癥少的優(yōu)點(diǎn)，目前RCT(randomizedcontrolled trials,隨機(jī)對(duì)照試驗(yàn))較少，多中心研究的前瞻性的隨機(jī)對(duì)照試驗(yàn)更少，故本研究所得出的結(jié)論尚需更多高質(zhì)量研究進(jìn)一步鑒證。
[Abstract]:Objective: to evaluate the safety and efficacy of laparoscopy in the early stage operation of ovarian cancer, and to provide reliable basis for clinical practice. Methods: the full text database of Ovid,EMbase,PubMed,CBM,CNKI, Wanfang periodical was searched by computer. Ovarian cancer, ovarian carcinoma, earlystage, laparoscopy, stagingsurgery, staging laparoscopy were used as English key words. The Chinese key words were laparoscopy, open surgery, staging operation, early ovarian cancer and laparoscopic staging operation. The relevant documents were collected according to the inclusion criteria and exclusion criteria. After the two evaluators read the titles and abstracts of the retrieval documents independently, after deleting the documents that did not meet the inclusion criteria, they read the full text of the documents that met the inclusion criteria. To determine whether or not they are actually included, the two evaluators cross check. In the event of disagreement, by consulting a statistical professional to resolve. The statistical analysis of the data is carried out by RevMan5.2 software provided by the Cochrane Cooperative Network. Results: according to the criteria of inclusion and exclusion, 12 articles were included, of which 7 were in Chinese and 5 in English. All of them were designed in parallel design and were all non-randomized controlled studies. A total of 753 cases of early ovarian cancer were included, including 314 cases in laparoscopic group and 439 cases in open group. The results of Meta analysis showed that the laparoscopic group had a long operation time, but less blood loss during the operation, and the intestinal function recovered quickly after operation, and there was no significant difference between the two groups in terms of age, body mass index and clinical stage. The duration of hospitalization was short and the complications were less in perioperative period. There was significant difference between the two groups (operative time: WMD=38.2795%CI:10.03~66.51,P=0.008;). Intraoperative bleeding volume: WMD=?223.29,95%CI:?324.09~?123.09,P < 0.0001, postoperative exhaust time: SMD=?1.79,95%CI:?2.30~?1.29,P < 0.00001; Postoperative hospitalization time: WMD=?4.87,95%CI:?6.70~?3.05,P < 0.00001; perioperative complications: OR=0.43,95%CI:0.26~0.71,P=0.0009;); However, there was no significant difference in the recurrence rate, pelvic lymph nodes, and the number of para-aortic lymphadenectomies (postoperative recurrence rate: OR=0.54,95%CI:0.18~1.57,P=0.26;). Pelvic lymph node resection number: WMD=?1.80,95%CI:?3.91~0.32,P=0.10; abdominal aorta lymph node resection number: WMD=1.22,95%CI:-0.81~3.24,P=0.24). Conclusion: laparoscopy is a satisfactory, safe and effective choice in the treatment of early ovarian cancer. It has the advantages of less trauma, shorter hospital stay and less perioperative complications. At present, RCT (randomizedcontrolled trials, randomized controlled trial is less. There are fewer prospective randomized controlled trials in multicenter studies, so the findings of this study need to be further corroborated by high-quality studies.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.31

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