中国循证医学杂志

中国循证医学杂志

经尿道等离子双极电切术与钬激光剜除术治疗良性前列腺增生症的系统评价

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目的 系统评价经尿道等离子双极电切术(TUPKP)与钬激光剜除术(HoLEP)治疗良性前列腺增生症(BPH)的有效性和安全性。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI、WanFang Data 和 VIP 数据库,搜集关于 TUPKP 与 HoLEP 治疗 BPH 的随机对照试验(RCT),检索时限均从建库至 2018 年 1 月。由 2 名评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 最终纳入 9 个 RCT,包括 784 例 BPH 患者。Meta 分析结果显示,与 HoLEP 相比,在有效性方面,TUPKP 术后 48 个月 Qmax 优于 HoLEP,但在术后 3 个月 PVR、术后 60 个月 Qmax、术后 72 个月 Qmax、术后 48 个月 IIEF-5 评分、术后 72 个月 IIEF-5 评分方面均差于 HoLEP。在术后 1~36 个月 Qmax、术后 1~72 个月 IPSS 评分、前列腺体积、术后 6 个月 PVR、术后 1~24 个月 IIEF-5 评分、术后 1~36 个月 QoL 评分、切除组织重量方面,两组差异均无统计学意义。在安全性方面,TUPKP 手术时间比 HoLEP 短;在术中失血量、住院天数、尿管留置时间、膀胱冲洗时间、术中冲洗量、术后大出血、血尿发生率方面 TUPKP 差于 HoLEP;在血清钠下降、血红蛋白下降、PSA、术后尿潴留、输血、膀胱痉挛、暂时性尿失禁、尿路感染、TURS、附睾炎、暂时性排尿困难、尿路刺激症状、二次手术、逆行射精、尿失禁、ED 和尿道狭窄方面,两组差异均无统计学意义。 结论 当前证据显示,TUPKP 与 HoLEP 治疗 BPH 的有效性和安全性方面均相当。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically evaluate the efficacy and safety of the transurethral bipolar plasmakinetic prostatectomy (TUPKP) versus holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH). Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of TUPKP and HoLEP for treatment of BPH from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, the meta-analyses were performed by using RevMan 5.3 software. Results A total of 9 RCTs involving 784 patients were included. The results of meta-analyses showed that, in efficacy outcomes, TUPKP was superior to HoLEP in Qmax at 48 months, and was inferior to HoLEP in PVR at 3 months, Qmax in 60 and 72 months, and IIEF-5 at 48 and 72 months. No significant association was found between two groups in Qmax from 1 to 36 months, IPSS from 1 to 72 months, prostate volume, PVR from 6 months, IIEF-5 from 1 to 24 months, QoL at 1 to 36 months, and resected prostate weight. As for safety, TUPKP was superior to HoLEP in operation time, while inferior to HoLEP in blood loss during procedure, hospital stay, catheterization period, bladder irrigation period, irrigation fluid, massive hemorrhage and hematuresis. No significant association was observed between two groups in serum sodium decrease, hemoglobin decrease, PSA, postoperative urine retention, blood transfusion, cystospasm, temporary incontinence, urinary tract infection, TURS, epididymitis, temporary difficulty in urination, urinary tract irritation syndrome, reoperation, retrograde ejaculation, urinary incontinence, ED and urethrostenosis. Conclusions Current evidence shows that the efficacy and safety of TUPKP and HoLEP for treatment of BPH are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

关键词: 经尿道等离子双极电切术; 钬激光剜除术; 良性前列腺增生症; 系统评价; Meta 分析; 随机对照试验

Key words: Transurethral bipolar plasmakinetic prostatectomy; Holmium laser enucleation of the prostate; Benign prostatic hyperplasia; Systematic review; Meta-analysis; Randomized controlled trial

引用本文: 翁鸿, 曾宪涛, 任选义, 吕栋, 王行环, 代表 BPSC研究团队. 经尿道等离子双极电切术与钬激光剜除术治疗良性前列腺增生症的系统评价. 中国循证医学杂志, 2018, 18(8): 840-849. doi: 10.7507/1672-2531.201803054 复制

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