不同手术方式治疗小体积前列腺增生的网状meta分析

Comparison among different surgical methods in treatment of small sizedprostatic hyperplasia:a network meta-analysis

目的:采用网状meta分析评价不同手术方式对小体积前列腺增生术后尿流率的影响。方法:通过以下数据库检索小体积前列腺增生术后尿流率的随机对照研究和病例对照研究:Pubmed、Embase、Cochrane library、Web of science、中国知网、维普、万方、中国生物医学文献数据库等,检索时间为建库至2022年12月;由2名研究人员分别检索、筛选文献,单独评价纳入研究的文献质量并提取文献数据,符合纳入标准的文献通过R4.2.2统计软件进行网状meta分析。结果:共纳入19项研究,1 460例患者,涉及6种手术方式,包括经尿道前列腺电切术(transurethral resection of the prostate, TURP)、经尿道前列腺切开术(transurethral incision of the prostate, TUIP)、经尿道钬激光前列腺剜除术(holmium laser enucleation of the prostate, HoLEP)、经尿道钬激光前列腺切开术(holmium laser transurethral incision of the prostate, HoLIP)、经尿道前列腺电切术联合经尿道膀胱颈切开术(transurethral resection of the prostate combined with transurethral incision of the bladder neck, TURP+TUIBN)、经尿道铥激光汽化术联合经尿道膀胱颈切开术(thulium laser resection of the prostate combined with transurethral incision of the bladder neck, TmLRP+TUIBN)。网状meta分析结果显示:术后3个月最大尿流率(maximum flow rate, Qmax)排序为:HoLEP>TmLRP+TUIBN>TURP+TUIBN>TURP>HoLIP>TUIP,术后6个月Qmax排序为:HoLEP>TURP+TUIBN>TmLRP+TUIBN>TURP>HoLIP>TUIP,膀胱颈预防性切开及前列腺剜除可以改善术后尿流率。结论:6种手术方式治疗小体积前列腺增生各有优势,HoLEP、TmLRP+TUIBN、TURP+TUIBN在改善术后尿流率方面优于TURP,可以作为小体积前列腺增生优先选择的手术方式。

Objective:To compare the postoperative maximum flow rate among different transurethral surgical methods in treatment of small sized prostatic hyperplasia using network meta-analysis.Methods:Randomized controlled trials(RCTs)and case control study(CCS)were retrieved in Pubmed,Embase,Cochrane library,Web of Science,China Knowledge Network Database,VIP Database,Wanfang Database,China Biomedical Literature Database from databases establishment to December 2022.Two reviewers searched and evaluated the literature respectively.The software R4.2.2was used to perform network meta-analysis in this study.Results:Nineteen researches with a total of 1460patients were screened,including TURP,TUIP,HoLEP,HoLIP,TURP+TUIBN and TmLRP+TUIBN.Our analysis showed that the order of Qmax3months after operation were as follows:HoLEP>TmLRP+TUIBN>TURP+TUIBN>TURP>HoLIP>TUIP,and the order of Qmax6months after operation were:HoLEP>TURP+TUIBN>TmLRP+TUIBN>TURP>HoLIP>TUIP.Prophylactic bladder incision and enucleation of the prostate contribute to postoperative Qmax.Conclusion:The six surgical methods show their own advantages in the treatment of small sized prostatic hyperplasia.HoLEP,TmLRP+TUIBN and TURP+TUIBN can be used as superior surgical options for small sized prostatic hyperplasia.