Risk Assessment Of Urinary Injury After Extensive Hysterectomy For Early Cervical Cancerby Laparoscopicr And Transabdominal Surgery

Research background:as is known to all,Abdominal radical hysterectomy(ARH)combined with pelvic lymphadenectomy(APL)has been used as the standard treatment for patients with early cervical cancer(stages IA2 to IIA).With the development of laparoscopy in recent years,laparoscopic technology has become the first choice for early cervical cancer.However,Laparoscopic radical hysterectomy(LRH)is difficult and wide-ranging.With LRH being widely used and popularized in clinic in recent years,the incidence of urinary system injury caused by operation is increasing.Although there are many clinical case-control studies on laparoscopic surgery and transabdominal surgery for complications caused by early cervical cancer,large randomized clinical randomized controlled trials are currently difficult to complete.Therefore,the meta-analysis method is used to systematically evaluate the urinary system damage caused by Abdominal radical hysterectomy+ Abdominal pelvic lymphadenectomy and Laparoscopic radical hysterectomy + Laparoscopic pelvic lymphadenectomy(LPL),which provides a more credible basis for clinicians to rationally choose the surgical treatment of early cervical cancer.Objective:Meta-analysis was used to compare the risk of urinary tract injury after Laparoscopic radical hysterectomy and Abdominal radical hysterectomy.Method:Through the computer to comprehensively retrieve foreign related databases such as EMbase,MEDLINE and domestic related databases such as CNKI,CBM,Wanfang Data and Vip,etc.The search period is controlled from January 2002 to January 2019,and the language is limited to English and Chinese.Manually search journals of related categories and clinical treatment literature on early cervical cancer in Nanchang University Medical Library until December 2018.Collect randomizedcontrolled trials(RCT),cohort studies and clinical controlled trials(CCT)published in foreign journals on LRH and ARH complicated with urinary system injury.According to the objective of this study,the inclusion and exclusion criteria are reasonably formulated,and the retrieved documents are strictly screened.The quality of literature was evaluated and selected,and the related data were extracted.Rev man5.3 software was used to process and analyze the finished data.Result:This study included 4 randomized design trials,22 retrospective studies and 6prospective non-randomized controlled trials(23 studies on intraoperative urinary complications and 23 studies on postoperative urinary complications).A total of 5173 patients with early cervical cancer were included,including 2649 cases in LRH group and 2524 cases in ARH group.Meta-analysis results: The OR for total urinary tract injury during surgery was 1.29(95% CI: 0.89 to 1.86),the difference was not statistically different between groups LRH group and ARH;the OR for post-operative urinary complications was 1.68(95% CI: 1.11-2.55),the OR for postoperative urinary retention was 1.27(95% CI: 1.04 to 1.54),the difference was statistically different between groups LRH group and ARH;The OR for intraoperative and postoperative total urinary tract injury was 1.48(95% CI: 1.10 to 1.99),the OR for intraoperative and postoperative total bladder was 1.85(95% CI: 1.12 to 3.06),the difference was statistically different between groups LRH group and ARH;The OR for intraoperative and postoperative total ureteral injury was 1.54(95%CI:0.91 to 2.60),the difference was not statistically different between groups LRH group and ARH.Conclusion:Laparoscopic radical hysterectomy is associated with an increased risk of postoperative urinary tract injury and total urinary tract injury,The incidence of bladder injury and postoperative urinary retention was higher than that of the open group.However,more large samples and multi-center high-quality RCTs are needed for further verification.