摘要
目的系统评价半导体激光前列腺剜除术(DiLEP)与等离子前列腺剜除术(PKEP)治疗良性前列腺增生的临床疗效及安全性。方法检索PubMed、Cochrane、Embase、Web of Science、Ovid、中国知网、万方、维普和SinoMed生物医学数据库,根据标准筛选采用这两种术式治疗良性前列腺增生的随机对照试验(RCT)和非随机对照试验(non-RCT),对文献进行偏倚分析后,按Cochrane系统评价方法提取资料,采用RevMan5.3软件进行统计分析。结果最终纳入5篇RCT和1篇non-RCT,共计638例患者。Meta分析结果显示:在安全性方面,与PKEP组相比,DiLEP组术后血红蛋白下降更少、膀胱冲洗时间更短、留置尿管时间更短和尿路刺激症发生率更低;但两组在手术时间、住院时间和并发症(包膜穿孔、输血、暂时性尿失禁、二次导尿、尿路感染和逆行射精)方面的差异无统计学意义。在有效性方面,两组术后12个月Qmax、IPSS、QoL和PVR的差异无统计学意义。结论当前证据显示,DiLEP和PKEP治疗BPH的短期疗效相同;但经DiLEP治疗血红蛋白下降更少、尿路刺激症状更轻、术后恢复更快、膀胱冲洗时间和留置尿管时间更短。受纳入研究数量和质量限制,需要更多高质量的研究来验证上述结论和评估两种手术方式的优劣。
Objective To systematically evaluate the efficacy and safety of the diode laser enucleation of the prostate(DiLEP)versus plasmakinetic enucleation of the prostate(PKEP)for treatment of benign prostatic hyperplasia(BPH).Methods PubMed,Cochrane library,Embase,Web of Science,Ovid,CNKI,Wanfang Data,Vipand SinoMed databases were electronically searched to collect randomized controlled trials(RCTs)and non-randomized controlled trials(non-RCTs)on the efficacy and safety of DiLEP and PKEP for treatment of BPH.After assessed the risk of bias of included studies,relevant data were selected according to the standard of Cochrane systematic review,and the meta-analyses were performed using RevMan 5.3 software.Results A total of 5 RCTs and 1 non-RCTs involving 638 patients were included.The results of meta-analyses showed that,in safety outcomes,DiLEP was superior to PKEP in postoperative hemoglobin,postoperative bladder irrigation time,catheterization time and incidence of urinary irritative symptoms.There were no significant differences when comparing operative time,hospital stay and other major complications(capsule perforation,blood transfusion,transient incontinence,re-catheterization,urinary tract infection and retrograde ejaculation)between the two groups.As for efficacy,at 12 months after operation,there was no significant difference in the Qmax,IPSS,QoL and PVR between DiLEP and PKEP.Conclusion Current evidence indicates that DiLEP and PKEP have the same short-term effects on BPH.However,the DiLEP has some advantages including less decrease in hemoglobin,lowerincidence of urinary irritative symptoms,early recovery,shorter bladder irrigation time and catheterization time.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify above conclusions and evaluate the pros and cons of both surgical approaches.
作者
谢铁军
任明华
郭鹏宇
XIE Tie-jun;REN Ming-hua;GUO Peng-yu(Department of Urology,The First Affiliated Hospital of Harbin Medical University;Department of Urology,The Fourth Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《哈尔滨医科大学学报》
CAS
2020年第4期450-455,共6页
Journal of Harbin Medical University
