摘要
目的评价经尿道钬激光前列腺剜除术(holmium laser enucleation of the prostate,HoLEP)与经尿道等离子前列腺剜除术(plasma kinetic enucleation of the prostate,PKEP)治疗良性前列腺增生(benign prostate hyperplasia,BPH)的安全性与临床疗效。方法系统检索PubMed、Embase、Cochrane Library、中国知网、维普、万方等数据库中有关HoLEP与PKEP治疗BPH的随机对照试验,检索时限为2000年1月—2021年3月。评价指标包括手术时间、术中估计失血量、平均留置导管时间、平均膀胱冲洗时间、平均住院时间和术后并发症等安全性指标,以及术后国际前列腺症状评分(International Prostatic Symptomatic Score,IPSS)、术后最大尿流率(maximum urinary flow rate,Qmax)、术后生活质量评分(quality of life,QoL)和术后残余尿(postvoid residual,PVR)等有效性指标。结果共纳入14篇随机对照试验,累计1478例患者,其中HoLEP组744例,PKEP组734例。Meta分析结果显示,HoLEP组术中出血量[加权均数差(weighted mean difference,WMD)=-25.95 mL,95%置信区间(confidence interval,CI)(-31.65,20.25)m L,P=0.025]少于PKEP组,平均留置导管时间[WMD=-10.35 h,95%CI(-18.25,-2.45)h,P=0.042]、平均膀胱冲洗时间[WMD=-10.28 h,95%CI(-17.52,-3.04)h,P=0.038]、平均住院时间[WMD=-1.24 d,95%CI(-1.85,-0.62)d,P=0.033]短于PKEP组,术后并发症发生率[风险比=0.70,95%CI(0.56,0.87),P=0.047]、术后6个月Qmax[WMD=-0.89 m/s,95%CI(-1.74,-0.05)m/s,P=0.037]低于PKEP组;两组的手术时间,术后3个月IPSS、Qmax、QoL、PVR,以及术后6个月IPSS、QoL、PVR差异无统计学意义(P>0.05)。结论HoLEP和PKEP治疗BPH的有效性无明显差异,但是HoLEP更加安全。此结论需要在设计更精密、样本量更大、多中心合作的随机对照试验中去验证。
Objective To evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate(HoLEP)versus transurethral plasma kinetic enucleation of the prostate(PKEP)in the treatment of benign prostate hyperplasia(BPH).Methods Randomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,Chongqing VIP database,and Wanfang database.Operative duration,estimated intraoperative blood loss,average duration of urinary catheterization,average duration of bladder irrigation,average length of hospital stay,and postoperative complications were used as safety evaluation indicators.Postoperative International Prostatic Symptomatic Score(IPSS),postoperative maximum urinary flow rate(Qmax),postoperative quality of life(QoL),and postvoid residual(PVR)were used as effective evaluation indicators.Results A total of 14 randomized controlled trials were included in this study,with a total of 1478 patients(744 in the HoLEP group and 734 in the PKEP group).The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group[weighted mean difference(WMD)=-25.95 mL,95%confidence interval(CI)(-31.65,20.25)mL,P=0.025],the average duration of urinary catheterization[WMD=-10.35 h,95%CI(-18.25,-2.45)h,P=0.042],average duration of bladder irrigation[WMD=-10.28 h,95%CI(-17.52,-3.04)h,P=0.038],and average length of hospital stay[WMD=-1.24 d,95%CI(-1.85,-0.62)d,P=0.033]in the HoLEP group were shorter than those in the PKEP group,and the incidence of postoperative complications[risk ratio=0.70,95%CI(0.56,0.87),P=0.047]and 6-month postoperative Qmax[WMD=-0.89 m/s,95%CI(-1.74,-0.05)m/s,P=0.037]in the HoLEP group were lower than those in the PKEP group.However,there was no significant difference in the operative duration,3-month postoperative IPSS,3-month postoperative Qmax,3-month postoperative QoL,3-month postoperative PVR,6-month postoperative IPSS,6-month postoperative QoL,or 6-month postoperative PVR between the two groups(P>0.05).Conclusions In the treatment of BPH,the effectiveness of HoLEP does not differ from that of PKEP,but HoLEP is safer.The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.
作者
彭磊
李金泽
游成宇
李贤辉
程波
李云祥
PENG Lei;LI Jinze;YOU Chengyu;LI Xianhui;CHENG Bo;LI Yunxiang(Department of Urology,Nanchong Central Hospital,the Second Affiliated Medical College,North Sichuan Medical College(University),Nanchong,Sichuan 637000,P.R.China;Department of Urology/Institute of Urology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Neurology,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,P.R.China)
出处
《华西医学》
CAS
2021年第7期919-929,共11页
West China Medical Journal
基金
四川省科技计划项目(2020YFS0320)
四川省卫生健康委员会科研课题(20PJ305)。
关键词
钬激光前列腺剜除术
等离子前列腺剜除术
良性前列腺增生
随机对照试验
META分析
Holmium laser enucleation of the prostate
Plasmakinetic enucleation of the prostate
Benign prostate hyperplasia
Randomized controlled trials
Meta-analysis
作者简介
共同第一作者:李金泽;通信作者:李云祥,Email:liyunxiang369@126.com。
