经尿道电切除术和经尿道等离子双极电切术治疗良性前列腺增生的META分析

Meta analysis of TURP vs PKRP for the treatment of benign prostatic hyperplasia

目的客观评价普通的经尿道电切除术(TURP)与经尿道等离子双极电切术(PKRP)治疗良性前列腺增生症疗效及安全性。方法通过电子检索和手工检索全面收集关于经TURP与PKRP治疗良性前列腺增生症的随机对照试验、非随机对照试验和回顾性对照试验的英文及中文资料,并按Cochrane协作网推荐的方法进行Meta分析。使用统计软件RevMan 5.0完成Meta分析及敏感性分析。结果经筛选,最后纳入15篇文献,包括受试患者1828例进行Meta分析,文献具有可比性。通过对比分析两种术式相关效应指标及不良反应和并发症得出:PKRP术中出血量少于TURP,手术时间、术后的膀胱冲洗时间、置尿管时间和住院时间均短于TURP;且PKRP术后对残余尿的改善优于TURP。PKRP术后TURP综合征、继发性出血、包膜穿孔发生率均低于TURP,经比较差异具有统计学意义。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,其疗效相似;但PKRP术后并发症的发生少于TURP。腔镜治疗前列腺增生的效果及安全性尚需有待高质量大样本长期随访的随机对照试验进一步验证。

Objective To evaluate the efficacy and safety of TURP vs PKRP for treating benign prostatic hyperplasia （BPH）. Methods The randomized controlled trials （RCT） , non - randomized controlled trials （NRCT） and retrospective controlled trials of the treatment of BPH by TURP by PKRP in Chinese and English all over the world were identified by electronic - searching and hand - searching. Meta - analysis was conducted using the methods recommended by the Cochrane Collaboration. Meta - analysis and Sensibility - analysis was processed by RevMan 5.0. Results After being selected, 15 studies were utilized which include 1828 patients＇Meta analyses. Hence, the documents have their comparability. It can be indicated through the comparison of the index of interrelated effect and untoward effect between PKRP and TURP ： firstly, blood loss in PKRP was less than that in TURP. secondly, operation time, bladder washing - out time, catheter time and hospital stay which were cost in PKRP were shorter than those in TURP; besides, RU improvements through PKRP was better than TURP. furthermore, TUR syndrome, secondary hemorrhage and capsula perforation were lower than TURP. Those differences possess statistical significances. Conclusion Meta analysis indicates that both two orifice translumenal endoscopic surgeries are the effective methods to cure benign prostatic hyperplasia, and the therapeutic effectiveness are similar, while the postoperative complications of PKRP are less than TURP. The impacts and security of endoscopic treatment in benign prostatic hyperplasia should be further verified by the high quality, large sample and long- term follow- up＇s RCT.