摘要
目的系统评价1 470 nm激光汽化术与经尿道前列腺电切术(TURP)比较治疗良性前列腺增生(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,搜集有关1 470 nm激光汽化术与TURP比较治疗BPH有效性和安全性的随机对照试验(RCT)和非随机对照试验(non-RCT),检索时限均为建库至2018年10月22日。由2名研究者独立筛选文献、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。结果共纳入6个RCT和4个non-RCT。Meta分析结果显示:相比TURP,1 470 nm激光汽化术术中出血更少[MD=-103.87,95%CI(-148.08,-59.65),P<0.000 01]、住院时间更短[MD=-3.82,95%CI(-4.35,-3.28),P<0.000 01]、留置尿管时间更短[MD=-2.24,95%CI(-3.45,-1.02),P=0.000 3]、术后血红蛋白下降更少[MD=-1.63,95%CI(-3.14,-0.12),P=0.03]、继发性出血发生率更低[OR=0.13,95%CI(0.03,0.48),P=0.002]。但两组在手术时间、术后膀胱冲洗时间、短暂性尿失禁及尿道狭窄、术后3个月国际前列腺症状评分(IPSS)和最大尿流率(Qmax)变化方面的差异无统计学意义(P>0.05)。结论当前证据显示,1 470 nm激光汽化术在减少术中出血及继发性出血方面优于TURP,可能更适用于抗凝状态或有凝血功能障碍患者的前列腺手术。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 1470nm laser vaporization vs.transurethral resection of prostate(TURP) for 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) and non-randomized controlled trials(non-RCTs) about the efficacy and safety of 1470nm laser vaporization vs. TURP for BPH from inception to October 22^nd, 2018. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 6 RCTs and 4 non-RCTs were included. The results of meta-analysis showed that: 1470nm laser vaporization was superior to TURP in reducing intraoperative bleeding(MD=-103.87, 95%CI-148.08 to-59.65,P<0.000 01), hospital stay(MD=-3.82, 95%CI-4.35 to-3.28, P<0.000 01), postoperative indwelling catheter time(MD=-2.24, 95%CI-3.45 to-1.02, P=0.000 3), postoperative hemoglobin(MD=-1.63, 95%CI-3.14 to-0.12, P=0.03) and rate of secondary hemorrhage(OR=0.13, 95%CI 0.03 to 0.48, P=0.002). There were no significant differences in operative time, bladder irrigation time, transient urinary incontinence and urethral stricture, IPSS Score and Qmax at 3 months after operation between the two groups(P>0.05). Conclusion Current evidence shows that 1470nm laser vaporization is superior to TURP in reducing intraoperative bleeding and secondary hemorrhage. It may be more suitable for prostate surgery in anticoagulant or coagulative dysfunction patients. Due to limited quality and quantity of the included studies,more high quality studies are required to verify above conclusions.
作者
车鹏
魏鑫
曾雄峰
郜小帅
王坤杰
李虹
CHE Peng;WEI Xin;ZENG Xiongfeng;GAO Xiaoshuai;WANG Kunjie;LI Hong(Department of Urology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;The Third Hospital of Mianyang,Sichuan Mental Health Center,Mianyang,621000,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2019年第5期565-570,共6页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金项目(编号:81100494)
四川省科技支撑计划项目(编号:2016FZ0099)
