非那雄胺治疗经尿道前列腺切除术出血疗效的meta分析

Efficacy of finasteride for perioperative bleeding in patients undergoing transurethral resection of prostate:a meta-analysis

目的:系统评价非那雄胺治疗经尿道前列腺切除术(TURP)出血的疗效。方法:计算机检索Cochrane图书馆、Pub Med、Embase、CNKI数据库、维普数据库和万方数字化期刊全文数据库中关于非那雄胺治疗TURP术出血疗效的随机对照试验(RCT),按纳入和排除标准选择试验,提取资料后采用Rev Man 5.2统计学软件进行meta分析。结果:共纳入24项RCT,合计1 984例患者。Meta分析结果显示,试验组在减少术中失血量[MD=-76.85,95%CI(-95.78,-57.92),P<0.01]、减少术中冲洗液吸收量[MD=-4.20,95%CI(-6.02,-2.37),P<0.01]、减少切除每克组织的失血量[MD=-2.58,95%CI(-3.79,-1.38),P<0.01]、缩短手术时间[MD=-11.27,95%CI(-15.13,-7.40),P<0.01]以及减少腺体微血管密度[MD=-18.33,95%CI(-27.34,-9.32),P<0.01]等方面均优于对照组,两组比较差异有统计学意义(P<0.01)。结论:TURP术前常规使用非那雄胺治疗,可以减少术中失血量和术中冲洗液吸收量,降低术后并发症的发生。但由于多数研究样本量较小,文献质量不高,上述结论还需多中心、大样本、随机双盲对照的RCT加以证实。

Objective： To evaluate the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of prostate. Methods： The randomized controlled trials（RCTs） about the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of prostate were retrieved from Cochrane Library, Pub Med, Embase, CNKI, VIP and Wanfang database by computer. Trial selection was performed according to including and excluding criteria. Meta-analysis was conducted using Rev Man 5.2 software after data extraction. Results： 24 RCTs were included, involving 1 984 patients. Our Meta-analysis showed that the experimental group were better than the control group in the following ways： reducing blood loss [MD=-76.85, 95%CI（-95.78,-57.92）, P〈0.01], irrigation absorption [MD=-4.20, 95%CI（-6.02,-2.37）, P〈0.01], blood loss per gram tissue resected [MD=-2.58, 95%CI（-3.79,-1.38）, P〈0.01], operating time[MD=-11.27, 95%CI（-15.13,-7.40）, P〈0.01] and microvessel density[MD=-18.33, 95%CI（-27.34,-9.32）, P〈0.01], there was statistical difference between the two groups（P〈0.01）. Conclusion： Finasteride showed advantage in reducing blood loss and irrigation absorption in treating perioperative bleeding in patients undergoing transurethral resection of prostate, which could reduce the risk of postoperative complications. Nevertheless, the number and quality of included study were not satisfactory, the study result should be confirmed by multi-center and large-scale randomized double-blind controlled trials.