前列腺动脉栓塞术与经尿道前列腺电切术治疗良性前列腺增生有效性及安全性的Meta分析

Meta-analysis of the efficacy and safety of prostate artery embolization and transurethral resection of prostate for benign prostatic hyperplasia

目的比较前列腺动脉栓塞术(PAE)和经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的有效性与安全性。方法计算机检索Cochrane Library、PubMed、Embase、CNKI、万方数据库、维普数据库。检索的起始时间为各个数据库建立的时间,截止时间是2018年9月。筛选有关PAE和TURP治疗BPH的文献,并对文献进行质量评价和资料提取,最后用Revman5.3进行Meta分析。结果在纳入的文献中,有3篇是病例对照试验,另外3篇是随机对照试验,共6篇。Meta分析结果显示,术后3个月TURP组患者的IPSS评分、QoL评分、排泄后残余尿量(PVR)、最大尿流率(Qmax)与PAE组比较差异均有统计学意义(P<0.05),而两组的前列腺体积(PV)变化比较差异无统计学意义(P>0.05);术后12个月TURP组患者的PVR、Qmax、PV、QoL评分与PAE组比较差异均有统计学意义(P<0.05),而两组的IPSS评分比较差异无统计学意义(P>0.05);TURP组患者术后逆行射精(RE)发生率高于PAE组,差异有统计学意义(P<0.05),而两组患者术后勃起功能障碍(ED)发生率、急性尿潴留发生率、尿道狭窄发生率比较差异均无统计学意义(P>0.05)。结论在治疗BPH方面,TURP的短期、长期治疗效果均优于PAE,而且术后并发症发生率与PAE的术后并发症发生率差异无统计学意义。

Objective To compare the efficacy and safety of prostate artery embolization(PAE) and transurethral resection of the prostate(TURP) in the treatment of benign prostatic hyperplasia(BPH). Methods The electronic databases of Cochrane Library, PubMed, CNKI, WanFang and VIP were searched by computer. The start time of the search was the time established for each database, and the deadline was September 2018. The literature was screened on PAE and TURP treatment of BPH, then quality evaluation and data extraction were performed on these literatures. Finally,the meta-analysis was conducted using Review Manager 5.3 software. Results Of the included literatures, 3 were case-control trials and 3 were randomized controlled trials, totaling 6 articles. The results of meta-analysis showed that the IPSS score, Qo L score, residual urine volume(PVR), and maximum urinary flow rate(Qmax) of the TURP group were significantly different from those of the PAE group at 3 months after operation(P<0.05);while there was no significant difference in the change of prostate volume(PV) between the two groups(P>0.05). At 12 months after operation, the PVR, Qmax,PV, Qo L scores of the TURP group were significantly different from those of the PAE group(P<0.05);but the differences in IPSS scores between the two groups were not statistically significant(P>0.05). The incidence of postoperative retrograde ejaculation(RE) was higher in the TURP group than in the PAE group(P<0.05);while the incidences of postoperative erectile dysfunction(ED), acute urinary retention, and urethral stricture were not significantly different between the two groups(P>0.05). Conclusion In the treatment of BPH, the short-term and long-term treatment effects of TURP are better than both of PAE, and the incidence of postoperative complications of TURP is not different from that of PAE.