经尿道钬激光剜除术与经尿道等离子体剜除术治疗良性前列腺增生的Meta分析

Meta-analysis of holmium laser enucleation of the prostate and transurethral plasma kinetic enucleation of the prostate for benign prostatic hyperplasia

目的:系统评价经尿道钬激光剜除术(HoLEP)与经尿道等离子体剜除术(TUPKEP)治疗良性前列腺增生的有效性和安全性。方法:检索PubMed、EMBase、Web of Science、万方数据资源系统、中国知网(CNKI)数据库及维普中文期刊数据库,截止时间2019年7月2日,获取HoLEP与TUPKEP治疗良性前列腺增生的比较研究文献,观察指标包括国际前列腺评分(IPSS)、生活质量评分(QoL)、最大尿流率(Qmax)、围术期结局指标以及并发症发生率,采用ReviewManager 5.3软件进行Meta分析。结果:共纳入11篇文献,其中1篇文献为非随机对照、10篇文献为随机对照。共纳入患者980例,HoLEP 491例,TUPKEP 489例。Meta分析结果显示,HoLEP与TUPKEP治疗良性前列腺增生在IPSS评分[MD=0.13,95%CI(-0.08~0.34),P=0.21]、QoL评分[MD=-0.07,95%CI(-0.11~0.02),P=0.003]、Qmax[MD=-0.04,95%CI(-0.30~0.23),P=0.79]方面差异均无统计学意义;安全性方面,TUPKEP手术时间短于HoLEP,但术中出血量、住院时间、膀胱冲洗时间均多于或长于HoLEP;在并发症发生率[OR=0.75,95%CI(0.41~1.37),P=0.35]方面,两者差异无统计学意义。结论:HoLEP与TUPKEP治疗良性前列腺增生具有相似的IPSS分、QoL及Qmax,并且在并发症发生率方面两者也无明显差异。在临床中需要结合患者实际情况选择最佳的手术方式。

Objective:To systematically evaluate the effect and safety of holmium laser enucleation of the prostate(HoLEP)and transurethral plasma kinetic enucleation of the prostate(TUPKEP)in the treatment of benign prostatic hyperplasia.Methods:PubMed,EMBASE,Web of Science,Wanfang Data Resource System,China Knowledge Network(CNKI)database and Weipu Chinese Journal Database were searched and the deadline was July 2,2019.Comparative literatures of HoLEP and TUPKEP in the treatment of benign prostatic hyperplasia were obtained.The observation indicators included international prostate score(IPSS),quality of life score(QoL),international erectile function index(Qmax),perioperative outcome index and complication rate.Meta-analysis was performed by using ReviewManager 5.3 software.Results:A total of 11 articles were included,of which 1 was non-randomized controls and 10 were randomized controls.A total of 980 patients were enrolled,491 in HoLEP and 489 in TUPKEP.Meta-analysis showed that the IPSS score[MD=0.13,95%CI(-0.080.34),P=0.21],Qo L score[MD=-0.07,95%CI(-0.11-0.02),P=0.003],Qmax[MD=-0.04,95%CI(-0.30-0.23),P=0.79]were not significantly different between HoLEP and TUPKEP.In terms of safety,operation time of TUPKEP was shorter than that of HoLEP.Intraoperative blood loss was more,and hospitalization and bladder irrigation time of TUPKEP was longer than those of HoLEP,but there was no significant difference in the incidence of complications[OR=0.75,95%CI(0.41-1.37),P=0.35].Conclusion:HoLEP and TUPKEP for benign prostatic hyperplasia have similar IPSS,QoL,and Qmax,and there are no significant differences in complications between the two approaches.In clinical practice,the best approach should be selected according to the actual conditions of the patients.