经尿道等离子腔内剜除术与经尿道等离子双极电切术比较治疗良性前列腺增生的Meta分析  

Transurethral PlasmaKinetic Enucleation for Prostate versus Transurethral PlasmaKinetic Resection for Prostate in Treating Benign Prostate Hyperplasia: A Meta-analysis

作　　者：李胜[1,2] 曾宪涛[3] 郭毅[4,5] 方志辉[1,6] 潘正波[1,2] 杨永波[1,6] 

机构地区：[1]武汉大学第二临床学院,武汉430071 [2]武汉大学中南医院泌尿外科,武汉430071 [3]湖北医药学院附属太和医院口腔科,十堰442000 [4]武汉大学公共卫生学院流行病学教研室,武汉430071 [5]武汉大学病毒学国家重点实验室,武汉430071 [6]武汉大学中南医院骨科,武汉430071

出　　处：《中国循证医学杂志》2011年第10期1172-1183,共12页Chinese Journal of Evidence-based Medicine

摘　　要：目的比较经尿道前列腺等离子剜除术(PKEP)与经尿道前列腺等离子双极电切术(PKRP)两种术式治疗良性前列腺增生的安全性和有效性。方法计算机检索PubMed、CENTRAL、EMbase、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有比较PKEP和PKRP治疗良性前列腺增生症的随机对照试验(RCT),检索时限均为建库至2011年3月31日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行RCT的筛选、资料提取和质量评价后,采用RevMan 5.1软件进行Meta分析,并采用GRADE系统进行证据质量评价。结果共纳入8个研究,991例患者。Meta分析结果显示:①在安全性方面:与PKRP相比,PKEP手术时间较短[SMD=1.07,95%CI(0.19,1.94),P=0.02]、术中出血量较少[SMD=2.06,95%CI(1.42,2.69),P<0.01]、切除腺体量较多[SMD=–0.91,95%C(I–1.33,–0.48),P<0.0001]、外科包膜穿孔较少[RR=4.48,95%C(I1.43,14.02),P=0.01]、术后留置导尿时间较短[SMD=1.98,95%CI(0.39,3.57),P=0.01]、膀胱冲洗时间较短[SMD=3.49,95%CI(0.51,6.47),P=0.02]、住院天数较短[SMD=0.89,95%CI(0.64,1.13),P<0.01]、术后总并发症差异无统计学意义[RR=0.82,95%CI(0.54,1.24),P=0.35];②在有效性方面:术后3月PKEP的IPSS评分低于PKRP,QOL评分高于PKRP;术后6月RUV的改善PKEP优于PKRP;其它术后3月和6月组间指标差异均无统计学意义(P>0.05)。基于系统评价结果,采用GRADE系统推荐分级方法评价证据质量及推荐等级,结果显示,证据水平均为低级,推荐强度为弱推荐。结论 PKEP和PKRP两种术式相比,疗效相似,但PKEP术中切除增生腺体更干净彻底,相对手术时间却较短,出血较少,安全性更高;但因原始研究的质量均较低,建议临床上审慎选择使用;需要更多高质量、大样本的RCT进一步论证。Objective To objectively evaluate the efficacy and safety of plasmakinetic enucleation for prostate（PKEP） vs plasmakinetic resection for prostate（PKRP） in treating benign prostate hyperplasia（BPH）.Methods Such databases as PubMed,Cochrane Central Register of Controlled Trials（CENTRAL）,EMbase,the ISI Web of Knowledge databases,VIP,CNKI,CBM and Wanfang were searched from their establishment to March 2011 for collecting the randomized controlled trials（RCTs） about PKEP vs PKRP for the treatment of BPH,and the references of those RCTs were also searched by hand.After study selection,assessment and data extraction conducted by two reviewers independently,meta-analyses were performed by using the RevMan 5.1 software.The level of evidence was assessed by using the GRADE system.Results Eight studies involving 991 patients were included.The results of meta-analyses showed that： a） safety indicator： compared with the PKRP,PKEP had shorter operation time（SMD=1.07,95%CI 0.19 to 1.94,P=0.02）,less intraoperative bleeding（SMD=2.06,95%CI 1.42 to 2.69,P0.01）,much quantity of resectable prostate（SMD= –0.91,95%CI –1.33 to –0.48,P0.000 1）,less intraoperative perforation（RR=4.48,95%CI 1.43 to 14.02,P=0.01）,shorter catheterization time（SMD=1.98,95%CI 0.39 to 3.57,P=0.01）,shorter bladder irrigation time（SMD=3.49,95%CI 0.51 to 6.47,P=0.02） and shorter hospital stay（SMD=0.89,95%CI 0.64 to 1.13,P0.01）,but there was no significant difference in total postoperative complications（RR=0.82,95%CI 0.54 to 1.24,P=0.35）;and b） efficacy indicator： compared with the PKRP,the International Prostate Symptom Score（IPSS） was lower after 3 months,the Quality Of Life（QOL） was higher after 3 months,and the improvement of residual urine volume（RUV） was better after 6 months;but other efficacy indicators had no significant difference between the two groups（P0.05）.Based on GRADE system,all the evidence was at level C and weak recommendation（2C）.Conclusion The current evide

关 键 词：良性前列腺增生 经尿道前列腺等离子双极电切术 经尿道前列腺等离子腔内剜除术 META分析 系统评价 随机对照试验 

分 类 号：R699[医药卫生—泌尿科学]