摘要
目的:系统评价钬激光前列腺剜除术(HoLEP)与开放前列腺切除术(OP)在重度前列腺增生(>70g)外科治疗中的临床疗效和安全性。方法:检索国内外有关HoLEP与OP治疗重度前列腺增生的随机对照研究,对文献进行质量评价,按Cochrane系统评价方法提取资料,采用RevMan 5.3统计软件行统计分析。结果:共纳入3个随机对照研究共计260例患者,分析显示HoLEP组和OP组国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、生活质量评分(QOL)与剩余尿量(PVR)在术后短期(1个月与3个月)与长期(12个月与24个月)的差异均无统计学意义;切除腺体重量及术后并发症(二次导尿、尿失禁、膀胱颈挛缩/尿道狭窄、二次手术)差异无统计学意义。与OP组相比,HoLEP组血红蛋白下降值[MD=-0.95,95%CI(-1.35,-0.56),P<0.001]与输血[RR=0.16,95%CI(0.04,0.58),P=0.005]都更少,而手术时间[MD=32.21,95%CI(8.91,55.50),P=0.007]则更长。HoLEP所需留置导尿时间[MD=-3.83,95%CI(-7.17,-0.48),P=0.02]和住院时间[MD=-5.84,95%CI(-9.51,-2.17),P=0.002]均短于OP。结论:HoLEP和OP对重度前列腺增生的短期与长期疗效相同;HoLEP虽手术时间长,但出血量少,输血率低,术后恢复快,留置导尿时间及住院时间短;临床上应注重经尿道手术的推广及其卫生经济效益的优化。
Objective:To compare the efficacy and safety between holmium laser enucleation of the prostate(HoLEP)and open prostatectomy(OP)for benign prostatic hyperplasia(BPH)with prostates〉70g.Method:All randomized controlled trials(RCTs)of HoLEP and OP for the treatment of BPH were collected.The quality of included RCTs was assessed.Relevant data were selected according to the standard of Cochrane systematic review.RevMan 5.3software was used to perform data analysis.Result:Three RCTs involving 260 patients were enrolled finally.At the 1-,3-,12-and 24-month follow-up,there was no significant difference in the International Prostate Symptom Score(IPSS),peak flow rate(Qmax),quality of life score(QOL)and postvoid residual urine(PVR)between HoLEP and OP.Also,there was no significant difference between HoLEP and OP when comparing resected tissue weight and postoperative complications.The decrease in hemoglobin[MD=-0.95,95%CI(-1.35,-0.56),P〈0.001]was less in patients undergoing HoLEP,and HoLEP was associated with fewer blood transfusion[RR=0.16,95%CI(0.04,0.58),P=0.005].Compared with OP,HoLEP had longer procedure time[MD=32.21,95%CI(8.91,55.50),P=0.007],shorter catheterization time[MD=-3.83,95%CI(-7.17,-0.48),P=0.02]and shorter hospital stay[MD=-5.84,95%CI(-9.51,-2.17),P=0.002].Conclusion:HoLEP is as effective as OP for large BPH for the short and the long time.Although longer operating time is found in HoLEP,it has some advantages including less blood loss,low blood transfusion rate,early recovery,short catheterization time and short hospital stay.Urologists should pay attention to the promotion of transurethral surgery with health economic benefit optimization.
作者
杨俊
高彦俊
李冲
王志平
YANG Jun;GAO Yanjun;LI Chong;WANG Zhiping(Department of Urology,Institute of Urology,Lanzhou University Second Hospital,Institute of Gansu Nephro-Urological Clinical Center,Key Laboratory of Urological Disease of Gansu Province,Lanzhou,730000,China)
出处
《临床泌尿外科杂志》
2016年第9期797-802,共6页
Journal of Clinical Urology
关键词
前列腺增生
钬激光前列腺剜除术
开放前列腺切除术
META分析
benign prostatic hyperplasia
holmium laser enucleation of the prostate
open prostatectomy
me ta-analysis
