经尿道激光与传统电切术治疗非肌层浸润性膀胱肿瘤安全性及疗效的meta分析

Laser versus transurethral resection of bladder tumor for non-muscle invasive bladder cancer: a systematic review and meta-analysis

目的系统性评价经尿道激光与传统电切术两种手术方式治疗非肌层浸润性膀胱肿瘤的安全性及疗效。方法选用并详细搜索PubMed、Scopus、Web of science和Cochrane library的所有比较经尿道激光与传统电切术治疗非肌层浸润性膀胱肿瘤的临床文章,包括随机对照实验、回顾性研究及前瞻性队列研究。结果共9篇文章,包括4篇随机对照实验、4篇回顾性研究及1篇前瞻性队列研究纳入该次分析中。总纳入病例数为1396例,包括694例经尿道激光病例及702例传统电切术病例。从分析中可以发现,虽然经尿道激光在手术时间上与传统电切术无明显差别(WMD=1.63,95%CI=-1.44~4.70,P=0.30),但其平均住院时间(WMD=-1.11,95%CI=-1.71^-0.50,P=0.0004)及术中、术后并发症情况均显著优于传统电切术,且术后1年(OR=0.87,95%CI=0.59~1.27,P=0.47)及2年复发率(OR=0.70,95%CI=0.46~1.09,P=0.11)无明显区别。结论经尿道激光治疗非肌层浸润性膀胱肿瘤术式较传统电切术安全,且效能不低于传统电切术,应作为微创治疗非肌层浸润性膀胱肿瘤的重要方案之一。

Obiective To provide a systematic review and met,a-analysis of studies comparing laser versus transurethral resection of bladder tumor （TURBT） for non-muscle invasive bladder cancer （NMIBC）. Methods This study comprehensively searched PubMed, Scopus, Web of science, Cochrane library, and performed a systematic review and meta-analysis of all randomized controlled trials （RCTs）, retrospective comparative studies and prospective studies assessing the two techniques. Results Nine studies including 4 RCTs, 4 retrospective studies and 1 prospective study fulfilled the predefined inclusion criteria and were included in the final analysis. These studies included data of 1396 cases （694 for lasers and 702 for TURBT）. Although there was no significant difference between lasers and TURBT for operation time （WMD=1.63, 95%CI=- 1.44-4.70, P=-0.30）, lasers provided shorter hospital stays （WMD=-1.11, 95%CI=- 1.71- -0.50, P=-0.0004） as well as lower complication rates. What＇s more, the recurrence rates showed no significantly difference when we took a one-year follow-up （OR=0.87, 95% CI=0.59-1.27, P-0.47）, or even two-year follow-up （OR=0.70, 95% CI=0.46-1.09, P=-0.11）. Conclusion Laser is not only safer, but also has the same efficacy as TURBT when dealing with NMIBC. And it should be recommended when minimally invasive therapy is necessary.