中南大学学报(医学版) J Cent South Univ (Med Sci) 2015, 40(7) hp://www.csumed.org 782 腔镜腋窝淋巴结清扫术与传统开放手术治疗乳腺癌的 Meta 分析 丁波泥 1 ,钱立元 1 ,赵于军 2 ,吴唯 1 ,陈学东 1 ( 中南大学湘雅三医院 1. 普外科;2. 移植外科,长沙 410013) [摘要] 目的:对腔镜腋窝淋巴结清扫术和传统开放手术治疗乳腺癌的疗效及临床价值进行评价。方法:按照 Cochrane系统评价的方法,计算机检索Medline,PubMed,Embase,Cochrane图书馆及维普、万方、中国期刊全文数 据库、中国生物医学数据库,并采用手工检索等方法收集所有相关随机对照试验和会议文献。采用Cochrane协作网提 供的软件Revman 5.0进行Meta分析,以获得腔镜腋窝淋巴结清扫术和传统手术治疗乳腺癌的疗效是否有差异的相关证 据。结果:共纳入25项研究,包括3 028例患者。Meta分析结果显示:腔镜腋窝淋巴结清扫术在清扫淋巴结数和肿瘤 复发率上与传统开放手术无明显差异(P>0.05);手术时间比传统开放手术时间长,术中出血量、术后并发症比传统开 放手术少(P<0.05)。结论:作为治疗乳腺癌的一种微创手术方式,腔镜腋窝淋巴结清扫术替代传统开放腋窝淋巴结清 扫术是可行的。 [关键词] 乳腺癌;腔镜;腋窝淋巴结清扫术; Meta分析 Meta-analysis of endoscopic axillary lymph node dissection versus conventional open excision for breast cancer DING Boni 1 , QIAN Liyuan 1 , ZHAO Yujun 2 , WU Wei 1 , CHEN Xuedong 1 (1. Department of General Surgery; 2. Department of Transplantation Surgery, ird Xiangya Hospital, Central South University, Changsha 410013, China) ABSTRACT Objective: To compare the surgical outcome and the clinical value between endoscopic axillary lymph node dissection and conventional open excision in the treatment of breast cancer. Methods: A computer-based online search of Medline, PubMed, Embase, Ovid, Cochrane Library, Vip, Wanfang, CNKI and Chinese Biological Medicine Database was performed, and conference literatures were manually searched. Using the Cochrane Collaboration guidelines, all randomized controlled trials comparing endoscopic axillary lymph node dissection and conventional open excision were systematically reviewed. The Cochrane Collaboration’s RevMan 5.0 software was used for data analysis. 收稿日期(Date of reception):2014-08-05 第一作者(First author):丁波泥,Email: [email protected]通信作者(Corresponding author):赵于军,Email: [email protected]基金项目(Foundation item):湖南省科技计划项目(2014SK3111)。is work was supported by the Science and Technology Project of Hunan Province, P. R. China (2014SK3111). DOI:10.11817/j.issn.1672-7347.2015.07.013 www.csumed.org/xbwk/fileup/PDF/201507782.pdf
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中南大学学报(医学版)J Cent South Univ (Med Sci) 2015, 40(7) htt p://www.csumed.org
(1. Department of General Surgery; 2. Department of Transplantation Surgery, Th ird Xiangya Hospital, Central South University, Changsha 410013, China)
ABSTRACT Objective: To compare the surgical outcome and the clinical value between endoscopic axillary lymph node dissection and conventional open excision in the treatment of breast cancer.
Methods: A computer-based online search of Medline, PubMed, Embase, Ovid, Cochrane Library, Vip, Wanfang, CNKI and Chinese Biological Medicine Database was performed, and conference literatures were manually searched. Using the Cochrane Collaboration guidelines, all randomized controlled trials comparing endoscopic axillary lymph node dissection and conventional open excision were systematically reviewed. The Cochrane Collaboration’s RevMan 5.0 software was used for data analysis.
基金项目(Foundation item):湖南省科技计划项目(2014SK3111)。Th is work was supported by the Science and Technology Project of Hunan Province,
P. R. China (2014SK3111).
DOI:10.11817/j.issn.1672-7347.2015.07.013
www.csumed.org/xbwk/fi leup/PDF/201507782.pdf
腔镜腋窝淋巴结清扫术与传统开放手术治疗乳腺癌的 Meta 分析 丁波泥,等 783
Results: A total of 25 studies involving 3 028 patients were included. The results of Meta-analyses showed that there were no significant difference in the number of lymph nodes harvested and recurrence between endoscopic axillary lymph node dissection and conventional open excision (P>0.05). The operative time of endoscopic axillary lymph node dissection was longer than that of conventional open excision. However, it was superior to open excision in the rate of complication and intra-operative blood loss (P<0.05).
Conclusion: As a minimally invasive surgery technique to treat breast cancer, endoscopic axillary lymph node dissection might be a promising replacement for conventional axillary lymph node dissection.
KEY WORDS breast cancer; endoscopy; axillary lymph node dissection; Meta-analysis
目前,乳腺癌的治疗理念已由“最大的可耐
受治疗”转变为“最小的有效性治疗”,在提高
生存率的同时,更强调改善患者的生活质量。传
统乳腺癌手术的创伤及并发症,对患者的心理及
生理均造成明显的损害,严重影响了患者的生活
质量。乳腔镜技术是20世纪90年代兴起的一种乳
腺微创技术,其手术方式几乎涵盖乳腺外科的各
个方面,而其中腔镜腋窝淋巴结清扫术 (a x i l l a r y lymph node dissection,ALND)则是目前应用较为
广泛的一种乳腺微创手术。有关ALND的文献为数
众多,但在当今循证医学的时代,关注ALND与常
规腋窝淋巴结清扫术的Meta分析却为数不多。本
研究拟对严格筛选的25篇文献的3 028例病例进行
Meta分析,比较腔镜ALND和传统开放手术治疗乳
腺癌的疗效及临床价值。
1 资料与方法
1.1 资料
1.1.1 研究类型
国 内 外 发 表 与 未 发 表 ( 包 括 学 术 会 议 论 文 汇
编)的采用腔镜和开放手术行ALND治疗乳腺癌的
所有随机对照试验(RCT)或临床对照试验(CCT),
后者包括随机方法不完全或随机不正确的临床对
照试验,无论是否采用分配隐藏或盲法,不受样
本量大小或随访时间的限制。
1.1.2 纳入与排除标准
纳入标准:1 )病理确诊为乳腺癌;2 )采用全
腔镜技术完成ALND。确定所有入选文献后,仔细
阅读全文并提取数据,缺失的部分与文献通信作
者联系补全。
排除标准:1)信息少、数据不全或无法利用的
文献;2)重复发表的文献;3)综述性文献、个案报
道、会议报告等;4)不是使用全腔镜技术而是其它
腔镜辅助方式完成ALND;5)腔镜内乳淋巴结清扫
术的文献;6)原始文献无传统开放手术对照组。
1.1.3 干预措施
治疗组采用全腔镜技术行ALND;对照组采用
传统开放手术行ALND。
1.1.4 观察指标
观察指标包括手术时间、术中出血量、清扫
淋巴结数、术后并发症的发生率和肿瘤复发率。
1.2 文献检索 1.2.1 检索方式
计 算 机 检 索 P u b M e d , E m b a s e , M e d l i n e ,
Co c h r a n e L i b r a r y, S p r i n g e r,OV I D数据库,维
普、万方、中国期刊全文数据库,中国生物医学
文 献 数 据 库 和 人 工 查 阅 文 献 等 , 不 限 定 文 章 语
种,搜索全部已公开发表和未发表的文献,包括
会议论文、学位论文等。
1.2.2 检索策略
参考Cochrane协作网制定的检索策略进行计
算机检索。英文检索以“breast cancer”“axil lar y lymph node dissection”“mastoscopy/laparoscopy/endoscopy”为检索词,中文检索以腔镜、腋窝淋