经尿道电汽化切除术与经尿道电切术治疗良性前列腺增生症疗效及安全性比较

Efficacy and Safety of TUEVP vs TURP for the Treatment of Benign Prostatic Hyperplasia.

目的评价经尿道前列腺汽化切割术(TUEVP)与经尿道前列腺电切术(TURP)治疗BPH的疗效以及安全性。方法搜集世界范围内运用TUEVP与TURP治疗BPH随机对照试验(RCT)、非随机对照试验(NRCT)和回顾性对照试验的英文及中文文献,并追查已纳入文献的参考文献。计算机检索:Pubmed,Ovid,ScineceDirect,NGC,EBSCO,EMBASE,CNKI,CBM;手工检索:《中华泌尿外科杂志》、《临床泌尿外科杂志》、《中国男科学杂志》、《中华男科学杂志》等4种相关杂志。由两位系统评价员做独立文献筛查、质量评价和资料提取,并交叉核对,不同意见时经过讨论或请第3者裁决。使用统计软件Rev Man5.0完成Meta分析,SAS8.0计算失安全系数(Nfs)。结果经筛选,最后纳入17篇文献,包括受试患者2413例,进行Meta分析,其基线情况具有可比性。通过比较分析两种术式相关效应指标及不良反应和并发症得出:TUEVP术后的膀胱冲洗时间、置尿管时间和住院时间均短于TURP;TUEVP术后勃起功能障碍(ED)发生率(20.6%)低于TURP(29.0%);TURP术后对最大尿流率(MFR)的改善优于TUEVP;TURP术后继发性出血发生率(7.9%)低于TUEVP(3.6%),差异均有统计学意义。结论Meta分析显示两种腔道手术均是治疗前列腺增生的有效方法,其疗效和安全性相似;虽然受某些因素如随访时间和文献方法学质量的限制,但TU-EVP和TURP均有各自的优势,建议进行大样本、长期随访的高质量临床试验,提供更佳循证证据。

Objective To evaluate the efficacy and safety of TUEVP vs TURP for treating benign prostatic hyperplasia （BPH）. Methods Liferaturcs on randomized controlled trials （RCT） , non - randomized controlled trials （NRCT） and retrospective controlled trials of both Chinese and English studies about TUEVP vs TURP for the treatment of BPH all over the world were searched by Pubmed, Ovid, ScineceDirect, NGC, EBSCO, EMBASE, CNKI, CBM,as well as manual search of four Chinese journals： Chinese of Journal of Androloy, National Journal of Androlgy, Chinese Journal of Urology, Journal of Clinical Urology. Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data from the eligible studies,with confirmation by cross - checking. Divergences of opinion were settled by discussion or consulted by the expert. Meta - analysis was processed by Rev Man 5.0 ,fail - safe number （ Nfx ） was performed by SAS8.0. Results Seventeen RCTs involving 2413 men were enrolled the inclusion criteria in Meta analysis. The baseline of patients＇ characteristics was comparable in all the studies. By evaluating the relevant indicators, side effects and complications between TUEVP and TURP, the statistically significant differences of pooled estimates suggested a benefit of TUEVP over TURP for bladder wash - out time, catheterization time, hospital stay, incidence of ED （20. 6% vs 29. 0% ）. In contrast, pooled estimates of the difference favoured TURP over TUEVP for MFR and incidence of postoperative secondary hemorrhage （7.9% vs 3.6% ）. Conclusion This formal meta -analysis suggests that both TUEVP and TURP in patients with BPH provide comparable improvements,whose efficacy and safety is similar. While comparative analysis is limited by the methodological shortcomings of the underlying studies and the short fol- low - up,both TURP and TUEVP may offer distinct advantages. More high quality trials with large sample and longer follow - up are proposed, which will provide more evidence about evidence based medicine.