经尿道等离子双极电切术治疗中国高危高龄良性前列腺增生症效果的系统评价与荟萃分析

Transurethral bipolar plasmakinetic prostatectomy for benign prostatic hyperplasia in high-risk and senior patients in China: a systematic review and meta-analysis

目的评价经尿道等离子双极电切术治疗中国高危高龄良性前列腺增生症患者的有效性和安全性。方法计算机检索PubMed、Cochrane Library、CNKI、CBM和万方数据库,搜集经尿道等离子双极电切术治疗中国高危高龄良性前列腺增生症的病例系列研究,检索时间为建库至2018年9月14日。由两名评价者独立提取数据与质量评价,采用Comprehensive Meta-Analysis V2软件进行荟萃分析。结果最终纳入18项研究,共1 899例患者。术后第1、3、6、12和24个月的Qmax改变量分别为12.28 ml/s(95%CI:8.42~16.14)、12.88 ml/s(95%CI:9.85~15.92)、14.32 ml/s(95%CI:10.47~18.18)、14.93 ml/s(95%CI:10.19~19.67)和20.00 ml/s(95%CI:19.08~20.92);IPSS评分改变量分别为-18.60(95%CI:-23.20^-14.00)、-17.62(95%CI:-20.21^-15.03)、-19.14(95%CI:-20.70^-17.59)、-19.06(95%CI:-21.53^-16.60)和-22.90(95%CI:-24.26^-21.54);QoL评分改变量分别为-2.38(95%CI:-4.26^-0.50)、-3.39(95%CI:-4.57^-2.21)、-3.75(95%CI:-4.14^-3.36)、-3.36(95%CI:-4.56^-2.16)和-4.58(95%CI:-4.75^-4.41);PVR改变量分别为-231.16 ml(95%CI:-288.30^-174.01)、-76.10 ml(95%CI:-116.71^-35.50)、-159.90 ml(95%CI:-207.21^-112.59)和-87.70 ml(95%CI:-91.91^-83.48),术后不良反应发生率均不高。结论经尿道等离子双极电切术治疗高危高龄良性前列腺增生症患者有较好的临床疗效和安全性。

Objective To evaluate the effectiveness and safety of transurethral bipolar plasmakinetic prostatectomy in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China. Methods The PubMed, Cochrane Library, CBM, CNKI and WanFang databases were searched with computer for collecting relevant interventional case series from establishment dates to September 14, 2018. After quality evaluation and data extraction independently conducted by two authors, the Meta-analysis was performed using the Comprehensive Meta-analysis V2 software. Results Eighteen studies involving 1 899 patients are included. Maximum flow rate increased to 12.28 ml/s (95%CI: 8.42-16.14), 12.88 ml/s (95%CI: 9.85-15.92),14.32 ml/s (95%CI: 10.47-18.18), 14.93 ml/s (95%CI: 10.19-19.67) and 20.00 ml/s (95%CI: 19.08-20.92) in 1, 3, 6, 12 and 24 months after surgery, respectively. International prostate symptom score decreased to -18.60 (95%CI:-23.20--14.00),-17.62 (95%CI:-20.21--15.03),-19.14 (95%CI:-20.70--17.59),-19.06 (95%CI:-21.53--16.60) and -22.90 (95%CI:-24.26--21.54), respectively. Quality of life decreased to -2.38 (95%CI:-4.26--0.50),-3.39 (95%CI:-4.57--2.21),-3.75 (95%CI:-4.14--3.36),-3.36(95%CI:-4.56--2.16), and -4.58(95%CI:-4.75--4.41). Post void residual decreased to -231.16 ml (95%CI:-288.30--174.01),-76.10 ml (95%CI:-116.71--35.50),-159.90 ml(95%CI:-207.21--112.59) and -87.70 ml (95%CI:-91.91--83.48). The event rate of postoperative adverse reactions all were not high. Conclusion Transurethral bipolar plasmakinetic prostatectomy has better clinical efficacy and no obvious side effects in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China.