Objective To assess the safety and effectiveness of laparoscopic hysterectomy (LH) for women with benign gynecological diseases. Methods Such databases as CENTRAL (The Cochrane Library, Issue 5, 2012), MEDLINE, EMbase, CNKI, WanFang Data, VIP and CBM were searched from the date of their establishment to May 2012, meanwhile the relevant gray literature was also retrieved to identify the randomized controlled trials (RCTs) about LH versus abdominal hysterectomy (AH) for benign gynecological diseases. The literature was screened according to the inclusion and exclusion criteria by two reviewers independently, and the methodology quality was evaluated after extracting the data, then RevMan 5.1 software was used for meta-analysis. Results A total of 22 RCTs involving 3 304 patients were included. The results of meta-analysis showed that, compared with AH, LH was shorter in the time of both hospital stay (MD=–2.31, 95%CI –3.03 to –1.60, Plt;0.000 01) and postoperative recovery (MD=−13.86, 95%CI −17.70 to −10.03, Plt;0.000 01), and lower in the incidences of both postoperative fever and other nonspecific infections (OR=0.72, 95%CI 0.54 to 0.95, P=0.02), but it was higher in the incidence rate of intraoperative urinary systematic injuries (OR=2.41, 95%CI 1.21 to 4.82, P=0.012), and longer in the operation time (MD=20.27, 95%CI 3.95 to 36.59, P=0.03). There were no significant differences between the two groups in the incidence of complications such as intraoperative intestinal injuries, vessel injuries, postoperative fistulizaion, postoperative urethral dysfunction, postoperative vaginal infection, etc. (Pgt;0.05). Conclusion This systematic review shows when treating benign gynecological diseases, LH is superior to AH in shortening the time of hospital stay and postoperative recovery, and in decreasing the incidence of operative fever and other nonspecific infections, but it results in a higher incidence of intraoperative urinary systematic injuries and longer operative time. Because there is no result regarding to the postoperative long-term life quality, so it expects to be further proved by more high quality RCTs.
Objective To assess the efficacy and safety of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in treatment of early cervical cancer. Methods Such databases as CBM (1960 to September 2011), CENTRAL (1966 to September 2011), MEDLINE (1966 to September 2011), The Cochrane Library, EMbase (1974 to September 2011) and CNKI (1994 to September 2011) were searched on computer, and relevant magazines were also searched manually. Data were extracted and the quality was assessed after including studies according to exclusive criteria, then meta-analysis was conducted using RevMan 5.1 software. Results Total 7 studies involving 506 cases were selected, of which 255 cases were in the LNSRH group and the other 251 cases were in the laparoscopic radical hysterectomy (LRH) group. There were no differences between the two groups in age, body mass index, clinical stage, pathological type and histological grade. The results of meta-analysis showed that: a) The operative time of LNSRH was longer than LRH, with significant difference (P=0.02). But there was no significant difference in intraoperative bleeding between the two groups (P=0.69); b) The length of dissected parametrium of LNSRH was shorter than LRH with significant difference (P=0.02). But there was no significant difference in the length of dissected vagina (P=0.69); and c) The functional recovery of the bladder in the LNSRH group was better than LRH (Plt;0.000 01). Conclusion LNSRH is safe and feasible in effectively alleviating the postoperative dysfunction of the bladder in early cervical cancer as well as in improving the quality of life for patients. It is regarded as a new model of operation. Because it has just been put into practice within a short time, and there is lack of multi-center, large-sample, prospective controlled studies at present, so its radical effectiveness, long-term recurrence rate, survival rate, etc. have not yet been confirmed. More high quality studies are needed to provide important data of comparison between LNSRH and LRH.
Objective To evaluate the clinical effect and safety of nerve sparing radical hysterectomy(NSRH) for cervical cancer compared with radical hysterectomy (RH). Methods We searched the Cochrane Library (Issue 2, 2010), MEDLINE (1960 to March, 2010), EMbase (1960 to March, 2010), CBM (1960 to March, 2010), VIP (1960 to March, 2010) and CNKI (1960 to March, 2010), and hand searched related literatures. With a defined search strategy, both randomized controlled trials and controlled clinical trials of comparing NSRH with RH for cervical cancer were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated by Cochrane’s evaluation criterion. Meta-analysis was conducted with the Cochrane collaboration’s RevMan 4.2.2 software. Results Nine controlled clinical trials involving 742 patients were identified. The meta-analysis showed that: a) There was statistical significance in postoperative recovery of bladder function between two groups; compared with RH, NSRH was much better in aspects of the recovery time of post void residual urine volume (PVR) (WMD= – 5.80, 95%CI – 6.22 to – 5.37), the bladder dysfunction morbidity (RR=0.43, 95%CI (0.26 to 0.75), and the urodynamic study; b) The operation time of NSRH was longer than that of RH with a significant difference (WMD=37.23, 95%CI 12.84 to 61.61); c) There was no significant difference between two groups in bleeding amount (WMD=19.66, 95%CI – 51.57 to 90.90); d) There was no significant difference between two groups in both survival rate and recurrent rate (RR=0.79, 95%CI 0.17 to 3.58); e) There was no significant difference between two groups in resection extension and pathologic outcome, such as, infiltration around uterus and vessels; f) One trail showed a significant difference between two groups that NSRH seldom led to anorectal and sexual dysfunction. Conclusions Compared with RH, NSRH can quickly improve the postoperative recovery of bladder, anorectal and sexual functions, but haven’t larger quantity of operative bleeding, larger resection extension, lower survival rates and higher recurrence rates except longer operation time. NSRH can improve the quality of postoperative life and is safe. However, the trails available for this systematic review were limited, as well as non-randomized controlled trails. Some outcomes were only included by one trail. So there is no confirmed conclusion about these. The prospective randomized controlled trials are required for further investigation.
Objective To compare and assess the effectiveness between total vaginal hysterectomy (TVH), Laproscopical hysterectomy (LH) and minilaporotomy hysterectomy (MiniLPT). Methods We searched CBM, CKNJ, MEDLINE, EMbase, Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED to screen randomized controlled trials (RCTs) comparing one surgical approach to another of extrafascial hysterectomy (between TVH, LH and miniLPT) which were done to those women with benign gynecological diseases. As to economy assessment, studies of cost-effective analysis were also included. Those observational studies reporting rare or important long-term outcome were also included. The quality of the included studies was evaluated by GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system and principle of Cochrane Reviewer Handbook 4.2.3 RCT. Results Finally, we identified 12 trials including 10 RCTs, 1 retrospective cohort study and 1 respective cohort study. Cost-effective analy- sis showed when in indication of VH, TVH was more cost-effective than LH. When TVH was less but still accessible, metaanalysis showed TVH had significant advantages than the other two approaches in many sides. Compared with LH arm, operation time was shorter at a WMD 47.2 min and 95%CI 32.2 to 62.3 min, blood loss was less at a WMD 158.7 ml and 95%CI – 190.9 to – 126.4 ml, hospital stay was shorter at a WMD 23.9 h and 95%CI – 25.4 to – 13.9 h, and the first stool or to break wind was quicker at a WMD – 8.1 h and 95%CI – 10.8 to – 5.3 h in TVH arm. But on the other side, the incidence rates of bad wound healing (such as vaginal cuff infection, abdominal wall infection, wound dehiscence, etc.), of secondary infection (such as UTI, URI, unknown infection, etc.), and of febrility were less common in LH arm than those in TVH arm with no significant difference. Meanwhile, ratio of sexual hypofunction, declined marital life quality and worse body image were more in TVH arm than those in LH arm, implying LH arm provided a better post-operation sexual life recovery. Operation time was longest in miniLPT arm at a WMD 37.0 h and 95%CI 13.5 to 60.5 h and blood loss was most at a WMD 208.5 ml and 95%CI 141.4 to 375.7 ml, too. The febrility rate was also the most common in miniLPT arm at a Peto OR 3.8 and 95% CI 1.1 to 12.6. The differences were significant. Conclusion TVH is the least invasive approach and better in cost-effectiveness when accessible. However, when inaccessible, the limitations remain unclear, depending on surgeons’ own techniques and experience as well as patients’ individual conditions. LH does better in improving quality of life and body image. Cost-effectiveness of LH may become much better by reducing blood loss during operation through improving techniques or instruments of hemostasis. Limited application of non-reproducible instrument or cost and promotion of their recycle may help a lot in bringing down LH operation cost, too. Owing to limited studies, the advantage of miniLPT should be evaluated more precisely by its technical development and more penetrating researches. There are huge gaps in standardized high-quality RCTs, performance and research of long-term outcomes and health economy comparing different approaches to total hysterectomy in China.
摘要:目的: 分析凶险型前置胎盘的临床特点, 预防产后出血和子宫切除的发生。 方法 :对11例凶险型前置胎盘与75例普通型前置胎盘的病例进行回顾性分析。 结果 :凶险型组与普通型组发生产前出血的量差异无统计学意义(Pgt;0.05);在发生胎盘植入、产后出血的量差异有统计学意义(Plt;0.05);子宫切除的发生率差异有统计学意义(Plt;0.05)。 结论 :凶险型前置胎盘对孕产妇有极大的威胁,应努力做好凶险型前置胎盘产后出血的抢救,减少子宫切除的发生。Abstract: Objective: To assess the clinical feature of dangerous placenta praevia in order to prevent postpartum hemorrhage and intrapartal hysterectomy. Methods : Retrospective analysis was done between the 11 cases of dangerous placenta praevia and ordinary placenta praevia . Results : There were no significant difference in blood volume antepartum (Pgt;0.05); There was significant difference in placenta increta and postpartum hemorrhage (Plt;0.05). Conclusion : Dangerous placenta praevia have great threat to gravid and puerperant, we should try our best to rescue postpartum hemorrhage about dangerous placenta praevia and reduce the incidence of intrapartal hysterectomy.