经尿道前列腺钬激光剜除术与双极等离子剜除术治疗良性前列腺增生的Meta分析

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

目的比较经尿道前列腺钬激光剜除术(HoLEP)与经尿道前列腺双极等离子剜除术(PKEP)治疗良性前列腺增生(BPH)的安全性和疗效性。方法计算机检索PubMed、EMbase、Cochrane of Library、Web of Science、Scopus、ScienceDirector、Wiley Online Library、CBM、CNKI、VIP、万方数据库,按照纳入和排除标准检索从各数据库建库开始至2020年10月25日为止的随机对照试验(RCT),使用RevMan 5.1和Stata 15.0软件进行Meta分析。结果纳入12篇文献,共1140例患者。与PKEP相比,HoLEP的术中出血量较少(WMD=-27.07,95%CI:-39.72~-14.42,P<0.001)、切除腺体量较多(WMD=-1.00,95%CI:-1.08~-0.91,P<0.001)、膀胱冲洗时间较短(SMD=-1.71,95%CI:-1.89~-1.52,P<0.001)、术后留置导尿管时间较短(SMD=-0.92,95%CI:-1.42~-0.42,P<0.001)、住院时间较短(SMD=-0.79,95%CI:-1.22~-0.36,P<0.001),两组手术时间、术后并发症、血红蛋白方面比较,差异均无统计学意义(均P>0.05);术后3、6个月HoLEP和PKEP的有效性比较,差异均无统计学意义(均P>0.05)。结论与PKEP术式相比,HoLEP切除腺体更干净彻底,手术时间较短,术中出血量少,安全性更高,但需根据临床具体情况选择手术方式。

Objective To compare Holmium laser enucleation of the prostate(HoLEP)with plasmakinetic enucleation of the prostate(PKEP)for benign prostatic hyperplasia(BPH)in terms of efficacy and safety.Methods PubMed,EMbase,Cochrane of Library,Web of Science,Scopus,ScienceDirector,Wiley Online Library,CBM,CNKI,VIP,WanFang databases from the beginning to October 25,2020 were searched to identify relevant randomized controlled trials(RCT)based on inclusion and exclusion criteria.Meta analysis was conducted with RevMan 5.1 and Stata 15.0 software.Results Twelve studies were included with a total of 1140 patients.HoLEP was less intraoperative blood loss(WMD=-27.07,95%CI:-39.72--14.42,P<0.001),more glandular resection(WMD=-1.00,95%CI:-1.08--0.91,P<0.001),Shorter bladder irrigation time(SMD=-1.54,95%CI:-2.45--0.63,P<0.001),shorter postoperative indwelling catheter time(SMD=-0.92,95%CI:-1.42--0.42,P<0.001),shorter postoperative hospital stay(SMD=-0.79,95%CI:-1.22--0.36,P<0.001)than in PKEP,there was no statistical significance in operation time,posteroperative complications,hemoglobin between two groups(all P>0.05).The 3 and 6 months postoperation efficacy indicators had no significant difference between HoLEP and PKEP(all P>0.05).Conclusions Compared with PKEP,HoLEP excision of glands is more clean and thorough,with shorter operation time,less intraoperative blood loss and higher safety.However,surgical methods should be selected according to clinical conditions.