经尿道激光和传统电切手术治疗非肌层浸润型膀胱肿瘤的Meta分析

Novel transurethral laser surgery versus conventional TURBT for treating non-muscle invasive bladder cancer:a systematic review and meta-analysis

目的分析和对比经尿道激光和传统电切手术治疗非肌层浸润型膀胱肿瘤的有效性和安全性,为临床决策提供依据。方法计算机检索Google、Embase、Pubmed、Web of Science和Cochrane Library等国外数据库相关英文文献,纳入相关随机对照试验和临床观察性研究文献。采用Revman5.3软件进行Meta分析,分别评价手术时间、尿管留置时间、住院时间、膀胱穿孔、闭孔神经反射、尿道狭窄和肿瘤复发等指标。结果纳入相关文献10篇(经尿道激光手术610例,经尿道膀胱肿瘤电切术667例)。Meta分析结果显示,两者在手术时间、术后尿道狭窄及肿瘤复发率上无差异,但激光手术组术后留置尿管(P=0.0001,95%CI:-1.58^-0.51)和住院时间(P=0.000 1,95%CI:-1.58^-0.51)显著缩短,术中膀胱穿孔(P=0.000 5,OR=0.14,95%CI:0.04~0.42)、闭孔神经反射(P<0.000 01,OR=0.04,95%CI:0.01~0.12)和术后膀胱刺激征(P<0.000 01,OR=0.14,95%CI:0.08~0.24)显著减少。结论经尿道激光手术治疗非肌层浸润型膀胱肿瘤在围手术期安全性及术后恢复速度方面均优于传统电切,但两者在肿瘤预后和手术时间方面相似。然而,这一结论尚需大规模、多中心的临床随机对照试验来进一步验证。

Objective To explore the overall efficacy and safety of laser surgery versus conventional transurethral resection of bladder tumor（TURBT）in the treatment of non-muscle invasive bladder cancer（NMIBC）.Methods Studies on the treatment of NMIBC with laser surgery or TURBT were searched in databases including Google,Embase,Pubmed,Web of Science and Cochrane Library.The pooled data on operation duration,catheterization time,hospital stay,bladder perforation,obturator nerve reflex,bladder irritation,urethral stricture and tumor recurrence were compared.Results A total of10 studies involving 610 NMIBC cases treated with laser surgery and 667 cases treated with TURBT were included.During the12-and 24-month follow-up,there was no significant difference in tumor recurrence rate between the laser surgery group and TURBT group.Laser surgery was associated with shorter catheterization time（P=0.000 1,95%CI：-1.58--0.51）and hospital stay（P〈0.000 01,95%CI：-1.58--0.72）,less bladder perforation（P=0.000 5,OR=0.14,95%CI：0.04-0.42）,obturator nerve reflex（P〈0.000 01,OR=0.04,95%CI：0.01-0.12）and bladder irritation（P〈0.000 01,OR=0.14,95%CI：0.08-0.24）,but there was no significant difference in other variables between the two groups.ConclusionThe efficacy of laser surgery is similar to that of TURBT in relation to oncological outcome and operation time,but it offers several advantages in faster postoperative recovery and fewer perioperative complications over TURBT.Moreover,much more large-scale and multi-center randomized controlled trials are desired to support our conclusion.