钬激光前列腺剜除术和开放前列腺切除术治疗大体积良性前列腺增生的Meta分析

Holmium laser enucleation versus open prostatectomy for large volume benign prostatic hyperplasia: a meta-analysis of the therapeutic effect and safety

目的比较钬激光前列腺剜除术(HoLEP)和开放前列腺切除术(OP)治疗大体积良性前列腺增生(BPH)的疗效和安全性。方法检索Medline、Embase中HoLEP和OP治疗大体积BPH的随机对照试验文献。Revman5.0进行Meta分析。结果纳入文献3篇。术后HoLEP组和OP组患者国际前列腺症状评分(IPSS)、最大尿流率(Qmax)较术前明显改善,但两组间IPSS、Qmax比较无统计学差异(P>0.05)。两组手术时间、前列腺切除重量、术后停留尿管时间和住院时间、术中输血率比较,差异有统计学意义(P<0.05)。两组间尿道狭窄、尿失禁及二次手术发生率比较,差异无统计学意义(P>0.05)。结论 HoLEP和OP对大体积BPH有相同的近期疗效。HoLEP组手术时间长、切除前列腺组织少,但是术中出血量少,术后留置尿管时间、住院时间短。

Objective To compare holmium laser enucleation （HoLEP） versus open prostatectomy （OP） for large volume benign prostatic hyperplasia. Methods The randomized controlled trials （RCTs） pertaining to HoLEP and OP for management of large volume benign prostatic hyperplasia were retrieved from Medline and Embase. Meta-analysis was performed using Review Manager 5.0 software. Results Three RCTs were included in the analysis. No significant differences were found in IPSS or Qmax between HoLEP and OP （P〉0.05）. Compared with OP, HoLEP was associated with significantly less blood loss, a shorter catheterization time and a shorter hospital stay, but a longer operating time. HoLEP and OP were similar in terms of urethral stricture, stress incontinence, transfusion requirement and the rate of reintervention. Conclusion HoLEP and OP have similar therapeutic effects in the management of large volume benign prostatic hyperplasia. Although with a longer operating time and less resected tissue, HoLEP causes less blood loss and requires a shorter catheterization time and a shorter hospital stay. HoLEP has a comparable safety to OP in terms of the adverse events.