经尿道前列腺等离子双极电切术与剜除术治疗良性前列腺增生的有效性和安全性的系统评价和Meta分析

Efficacy and safety of transurethral plasmakinetic resection of prostate versus transurethral plasmakinetic enucleation of prostate in treating benign prostate hyperplasia:a systematic review and Meta-analysis

目的评估经尿道前列腺等离子双极电切术(TUPKP)与剜除术(TUPEP)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PubMed、Embase、Web of Science、The Cochrane Library、中国知网、维普、中国生物医学文献数据库及万方数据库中相关的随机对照试验,检索至2020年9月15日,同时手动检索参考文献。由两名研究者独立进行文献筛选、资料提取与质量评价。采用Stata 13.0软件进行Meta分析。结果共纳入30项研究,包括3218例BPH患者,其中1626例接受TUPKP,1592例接受TUPEP。Meta分析结果显示:有效性方面治疗普通体积(<80 mL)前列腺时,TUPKP组比TUPEP组切除组织量更少,但术后6、12个月的残余尿量(PVR)更多,术后3、6个月的国际勃起功能指数-5(IIEF-5)更低,差异有统计学意义(P<0.05);术后1、3、6、12个月的国际前列腺症状评分(IPSS)、最大尿流率(Q_(max))、生活质量(QoL)及术后1、3个月的PVR在两组间无统计学差异(P>0.05)。治疗大体积(≥80 mL)前列腺时,相较于TUPEP组,TUPKP组切除组织量更少,但术后6个月的IPSS更高,3个月的Q_(max)更小且PVR更多,差异有统计学意义(P<0.05);术后1、3个月的IPSS,术后1、6个月的Q_(max),术后1、3、6个月的QoL,术后6个月的PVR和IIEF-5在两组间无统计学差异(P>0.05)。安全性方面治疗普通体积前列腺时,相较于TUPEP组,TUPKP组手术时间、住院时间、术后导尿管留置时间、膀胱冲洗时间更长,术中出血量更多,发生包膜穿孔、膀胱痉挛的风险更高,差异有统计学意义(P<0.05);尿道狭窄、暂时性尿失禁、逆行射精、尿潴留、尿路感染的风险在两组间无统计学差异(P>0.05)。治疗大体积前列腺时,与TUPEP组相比,TUPKP组手术时间、住院时间、术后导尿管留置时间、膀胱冲洗时间更长,差异有统计学意义(P<0.05);术中出血量,以及发生包膜穿孔、尿道狭窄、暂时性尿失禁、逆行射精、膀胱痉挛、尿潴留、尿路感染的风险在两组间无统计学差异(P>0.05)。结论对于普通体积和大体积BPH患者,TUPKP和TUPEP的有效性整体相当,但TUPEP在安全性方面优于TUPKP。

Objective To evaluate the efficacy and safety of transurethral plasmakinetic prostatectomy(TUPKP)versus transurethral plasmakinetic enucleation of prostate(TUPEP)in treating benign prostate hyperplasia(BPH).Methods PubMed,EMBASE,the Cochrane Library,CNKI,VIP,CBM database and Wanfang database were searched for relevant randomized controlled trials from January 1 st,2018 until September 15,2021,and references were manually searched.Two researchers independently conducted literature screening,data extraction and quality evaluation.Stata13.0 software was used for Meta-analysis.Results A total of 30 studies were included,reporting on 3,218 BPH patients,of whom 1,626 received TUPKP and 1,592 received TUPEP.Meta-analysis of results show that:for effectiveness,when treating a normal volume(<80 mL)prostate,compared with the TUPEP group,the TUPKP group had less tissue removed,higher PVR at 6 and 12 months after surgery,but lower IIEF-5 at 3 and 6 months after surgery(P<0.05).When treating a large volume(≥80 mL)prostate,compared with the TUPEP group,the TUPKP group had less tissue removed,higher IPSS at 6 months after surgery,and smaller Qmax and higher PVR at 3 months after surgery(P<0.05).In terms of safety:when treating a normal volume prostate,compared with the TUPEP group,the TUPKP group had longer operation time,hospitalization time,catheterization time,bladder irrigation time,more bleeding during the operation,and higher risk of capsular perforation and bladder spasm(P<0.05).When treating a large volume prostate,compared with the TUPEP group,the TUPKP group had longer operation time,hospitalization time,catheterization time,and bladder irrigation time(P<0.05).Conclusion For both normal or large volume prostates,the overall efficacy of TUPKP and TUPEP in the treatment of BPH is similar,but TUPEP is superior to TUPKP in terms of safety.