| The First PartObjective In this study,the efficacy of laparoscopic radical hysterectomy(LRH)and abdominal radical hysterectomy(ARH)in the treatment of early cervical cancer was compared by means of a meta-analysis.Methods Systemic retrieve the seven electronic database of laparoscopic surgery and open surgery for the treatment of early cervical cancer study,set time limits for between January 2000 and December 2020,is set to the Chinese and English languages,select the relevant type of contrastive study,a randomized controlled study,prospective studies,such as literature,using Stata 12.0 software Meta analysis was carried out on the extracted data.Results A total of 25 literatures were included,with a total number of 4473 cases.Meta-analysis results showed that:Compared with ARH,LRH was significantly higher in operative duration[SMD=1.00,95%CI=0.62-1.38,P<0.001],transfusion rate[OR=0.52,95%CI＝0.40-0.66,P<0.001],number of lymph nodes dissection[SMD=-0.15,95%CI=-0.29-0.01,P=0.031],length of hospital stay[SMD=-1.58,95%CI＝-2.12-1.03],P<0.001]and overall survival[SMD=-0.78,95%CI=-1.36--0.21,P=0.008].There was no statistically significant difference in complications[OR=1.14,95%CI=0.68-1.93,P=0.617].Conclusion This study showed that compared with ARH,LRH has the advantages of lower blood transfusion rate,more lymph node dissection,shorter hospital stay and longer overall survival,although the operation time of LRH is longer.Restricted by the quality and quantity of the included studies,whether the long-term efficacy of LRH is superior to ARH still needs to be further verified by more high-quality,large-sample randomized controlled clinical studies.The Second PartObjective In this study,by comparing the surgical status of LRH and ARH in the treatment of early cervical cancer,the survival outcome was analyzed,so as to provide a reference for the formulation of clinical treatment plan.Methods Selection in January 2009-December 2018 at the records of 418 patients with early cervical cancer yichang area as the research object,the performer are one person,in accordance with the surgical method is divided into LRH(181 cases)and ARH(237 cases),to observe and compare the preoperative general information(age,clinical stage,with or without neoadjuvant chemotherapy),intraoperative data(operation time,blood loss,blood transfusion amount,resection of lymph node number),the postoperative situation(whether supplementation,with and without postoperative complications,hospitalization days,histologic type),survival outcome(1,3,5 year disease-free survival and overall survival).Univariate and multivariate factors were used to analyze the prognostic factors of cervical cancer patients.Results(1)On the premise of comparability of basic preoperative data between the two groups,the operative time of LRH and ARH were(216.5±44.8 min)and(191.0±34.8 min),respectively,P<0.05.The intraoperative blood loss of LRH and ARH were(239.5±157.1 ml)and(418.3±230.6 ml),respectively,P<0.05.LRH transfusion accounted for 54 cases(29.8%),and ARH transfusion accounted for 107 cases(45.1%),P<0.05.The number of lymph nodes excised by LRH and ARH was(24.4±2.97)and(18.8±2.59),respectively,P<0.05.(2)The total length of hospital stay for LRH and ARH were(19.6q6.The complications of LRH and ARH were 26 cases and 28 cases,respectively,P>0.05.Postoperative supplementary therapy for LRH and ARH were 88 and 131,respectively,P>0.05.Cervical cancer radical surgery complications,LRH adjacent viscera injury in 7 cases(26.9%),nerve injury in 2 cases(7.7%),deep vein thrombosis in 2 cases(7.7%),poor wound healing in 1 case(3.8%),urinary retention and urinary tract infections in 8 cases(30.7%),pelvic lymphocele 6 cases(23.1%),P>0.05;There were 6 cases of ARH adjacent organ injury(21%),4 cases of deep vein thrombosis(14%),5 cases of poor wound healing(18%),9 cases of urinary retention or urinary tract infection(32%),4 cases of pelvic lymphocyst(14%)(P>0.05).(3)The 1-year,3-year and 5-year disease-free survival rates of Lrhl were 92.3%,80.1%and 71.8%,respectively,and the 1-year,3-year and 5-year disease-free survival rates of ARHI were 89%,81%and 73.8%,respectively,P<0.05.The 1-year,3-year and 5-year overall survival rates of LrhI were 92.8%,82.9%and 77.9%,respectively,and the 1-year,3-year and 5-year overall survival rates of ARHI were 91.1,84.8%and 78.9%,respectively,P>0.05.(4)The univariate analysis on the prognosis of cervical cancer patients showed that age,clinical stage,pathological type and lymph node metastasis were related to prognosis(P<0.05),while LRH and ARH were not related to prognosis(P>0.05).Multivariate analysis showed that age,clinical stage,pathological type and lymph node metastasis were independent risk factors for prognosis of patients with cervical cancer(P<0.05).Conclusion(1)Compared with ARH,LRH has less blood loss,lower blood transfusion rate,more lymph node excision and fewer hospital days,but LRH is longer than ARH.(2)The 1-year disease-free survival rate of LRH was higher than that of ARH,but the 3-year and 5-year disease-free survival rate of LRH was lower than that of ARH;Overall Survival Rates were similar for LRH and ARH1,3,AND 5 YEARS.(3)Age,clinical stage,pathological type and lymph node metastasis affected the prognosis,while the surgical method and the presence of neoadjuvant chemotherapy had no significant correlation with the prognosis.Therefore,in the treatment of early cervical cancer patients,LRH is a relatively safe and worthy of promotion. |
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