钬激光前列腺剜除术和经尿道前列腺电切术治疗良性前列腺增生疗效和安全性的Meta分析

陈佳炜; 海波; 董伟; 程子睿; 蒋国松; 庞自力

doi:10.13201/j.issn.1001-1420.2021.06.002

钬激光前列腺剜除术和经尿道前列腺电切术治疗良性前列腺增生疗效和安全性的Meta分析

- 华中科技大学同济医学院附属协和医院泌尿外科(武汉, 430022)

详细信息

通讯作者: 庞自力,E-mail:zilipang21@163.com

中图分类号: R697

收稿日期: 2020-12-14

Meta-analysis of efficacy and safety of holmium laser enucleation of the prostate and transurethral resection of the prostate in treatment of benign prostatic hyperplasia

- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technologyy, Wuhan, 430022, China

More Information

Corresponding author: PANG Zili, E-mail: zilipang21@163.com

Received Date: 14 December 2020

摘要

摘要: 目的:系统评价钬激光前列腺剜除术(HoLEP)和经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的疗效和安全性。方法:计算机检索PubMed、Embase、The Cochrane Library和Web of Science收集比较HoLEP和TURP治疗BPH的随机对照试验(RCT),检索时限均从建库至2020年6月。由两位评价员独立筛选文献、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:共纳入12项研究,包括1378例患者,其中HoLEP组691例,TURP组687例。Meta分析结果显示,HoLEP组留置导尿时间[MD=-0.80,95%CI(-1.02,-0.58),P<0.000 01]、住院时间[MD=-1.07,95%CI(-1.35,-0.80),P<0.000 01]、血红蛋白下降程度[MD=-0.39,95%CI(-0.60,-0.17),P=0.000 4]、输血率[RR=0.19,95%CI(0.08,0.44),P=0.000 1]及尿道狭窄发生率[RR=0.48,95%CI(0.26,0.90),P=0.02]低于TURP组;术后12个月及36个月的美国泌尿外科协会前列腺症状评分(AUA-SS)[MD=-0.99,95%CI(-1.59,-0.40),P=0.001;MD=-0.08,95%CI(-0.12,-0.04),P=0.000 2]、术后12个月及24个月的最大尿流率(Q_max)[MD=0.88,95%CI(0.27,1.49),P=0.005;MD=1.00,95%CI(0.38,1.61),P=0.002]、术后12个月的残余尿(PVR)[MD=-8.95,95%CI(-16.45,-1.45),P=0.02]优于TURP组,但手术时间[MD=16.48,95%CI(11.08,21.89),P<0.000 01]高于TURP组。结论:与TURP相比,HoLEP留置导尿时间及住院时间短,安全性高,术后短期及中期随访疗效更佳,输血率及尿道狭窄发生率更低,因此HoLEP治疗BPH具有更好的疗效及安全性。
- 钬激光前列腺剜除术 /
- 经尿道前列腺电切术 /
- 良性前列腺增生 /
- Meta分析
Abstract: Objective: To systematically review the efficacy and safety of holmium laser enucleation of the prostate(HoLEP) and transurethral resection of the prostate(TURP) for benign prostatic hyperplasia(BPH).Methods: We searched PubMed, Embase, The Cochrane Library and Web of Science from inception to June 2020 to collect the randomized controlled trials(RCTs). Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.3 software was used for Meta-analysis.Results: A total of 12 studies were included, involving 1378 patients, 691 patients in HoLEP group and 687 patients in TURP group. The Meta-analysis showed that the catheter indwelling time [MD=-0.80, 95%CI(-1.02,-0.58), P<0.000 01], hospital stay [MD=-1.07, 95%CI(-1.35,-0.80), P<0.000 01], hemoglobin loss [MD=-0.39, 95%CI(-0.60,-0.17), P=0.000 4], transfusion rate [RR=0.19, 95%CI(0.08, 0.44), P=0.000 1], and incidence of urethral stricture [RR=0.48, 95%CI(0.26, 0.90), P=0.02] in the HoLEP group were lower than those in the TURP group. And the AUA-SS at 12 months and 36 months postoperatively [MD=-0.99, 95%CI(-1.59,-0.40), P=0.001; MD=-0.08, 95%CI(-0.12,-0.04), P=0.000 2], the Q_max at 12 months and 24 months postoperatively [MD=0.88, 95%CI(0.27, 1.49), P=0.005; MD=1.00, 95%CI(0.38, 1.61), P=0.002]and the PVR at 12 months postoperatively [MD=-8.95, 95%CI(-16.45,-1.45), P=0.02] in the HoLEP group were superior to the TURP group. However, HoLEP group had longer operation time [MD=16.48, 95%CI(11.08, 21.89), P<0.000 01].Conclusion: Compared with TURP treatment, HoLEP has shorter catheter indwelling time and hospital stay, higher safety, better results in short-term and mid-term follow-up after surgery, and lower postoperative blood transfusion rate and incidence of urethral stricture. Therefore, HoLEP has better efficacy and safety in the treatment of BPH.
- holmium laser enucleation of the prostate /
- transurethral resection of the prostate /
- benign prostatic hyperplasia /
- Meta-analysis

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