经尿道钬激光治疗浅表性膀胱肿瘤效果的Meta分析  

Holmium Laser and Transurethral Electroresection for Superficial Bladder Cancer: A Meta-analysis

作　　者：吴刚[1] 谷宝军[1] 

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海200233

出　　处：《中国循证医学杂志》2011年第5期554-559,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的比较经尿道钬激光膀胱肿瘤切除术(holmium laser resection of bladder tumors,HOLBT)与经尿道膀胱肿瘤电切术(electrocautery transurethral resection for bladder tumors,TURBT)治疗浅表性膀胱肿瘤的疗效差别,为临床决策提供依据。方法计算机检索MEDLINE、EMbase、CBM、CNKI及Cochrane图书馆,并辅以手工及其它检索,查找所有比较钬激光与电切术治疗膀胱肿瘤的随机对照试验。按照纳入与排除标准选择文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入9个RCT,合计1323例患者。Meta分析结果显示:①与经尿道电切治疗浅表性膀胱肿瘤术相比,钬激光手术的术中出血少[WMD=–6.04,95%CI(–6.90,–5.19)]、术后膀胱冲洗时间短[WMD=–14.99,95%CI(–17.58,–12.40)]、导尿管留置时间短[WMD=–2.46,95%CI(–3.59,–1.34)]、术后并发症如闭孔神经反射少[OR=0.03,95%CI(0.01,0.09)]、膀胱穿孔少[OR=0.12,95%CI(0.05,0.31)],且术后短期复发率低[OR=0.70,95%CI(0.52,0.96)]。结论当前证据表明,钬激光治疗对膀胱组织损伤小,术中出血少,是一种疗效可靠、并发症少的治疗浅表性膀胱肿瘤的微创术式。Objective To assess the safety and efficacy of holmium laser resection for superficial bladder cancer（HoLRBT） compared with electrocautery transurethral resection of bladder tumor（TURBT）.Methods Such databases as MEDLINE,EMbase,CBM,and The Cochrane Library were searched by computer to include the randomized controlled trials（RCTs） about holmium laser and transurethral electroresection for treating superficial bladder cancer.Meta-analyses were performed by RevMan 5.0 software after the data were abstracted and the quality was evaluated.Results Nine RCTs involving 1 323 patients were included.The results of meta-analyses showed in comparison with the TURBT,there were significant differences in HoLRBT for less intraoprative bleeding volume（WMD= –6.04,95%CI –6.90 to –5.19）,shorter mean bladder irrigating time（WMD= –14.99,95%CI –17.58 to –12.40）,shorter time of indwelling urethral catheter（WMD= –2.46,95%CI –3.59 to –1.34）,fewer postoperative complications such as the obturator nerve reflex（OR=0.03,95%CI 0.01 to 0.09）,fewer events of bladder perforation（OR=0.12,95%CI 0.05 to 0.31） and lower postoperative recurrence rate（OR=0.70,95%CI 0.52 to 0.96）.ConclusionsThe current evidence shows that HoLRBT is a feasible,safe,and effective alternative for the management of superficial bladder cancer because of few damages to bladder tissues and less operation bleeding.

关 键 词：膀胱肿瘤 钬激光 电切 META分析 随机对照试验 

分 类 号：R737.14[医药卫生—肿瘤]