2μm激光治疗非肌层浸润性膀胱肿瘤的Meta分析  

Meta analysis of 2-μm laser in the treatment of non-muscle-invasive bladder tumor

作　　者：余杰[1] 王玉杰[1] 刘玉[2] 马琪[3] 张立东[1] 

机构地区：[1]新疆医科大学第一附属医院泌尿中心,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆医科大学第一附属医院循证医学教研室,新疆维吾尔自治区乌鲁木齐市830054 [3]新疆医科大学机能中心,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国组织工程研究》2013年第53期9251-9260,共10页Chinese Journal of Tissue Engineering Research

摘　　要：背景:2μm激光作为一种新型腔内技术治疗非肌层浸润性膀胱肿瘤,其疗效及安全性是否较传统经尿道膀胱肿瘤切除优越,目前结论不一。目的:系统评价2μm激光与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤的效果差异,为临床应用提供循证依据。方法:计算机检索PubMed、Ovid、Medline、EMbase、Cochrane Library、CBM、CNKI、万方数据库、维普数据库、超星数据库,同时辅以手工及其他检索,检索时间从建库截止至2013-09-30,查找所有2μm激光与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤的随机对照试验研究。按照拟定的纳入排除标准进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.2软件进行Meta分析。结果与结论:共纳入4个研究,全部为随机对照试验,共310例患者,其中2μm激光组161例,经尿道膀胱肿瘤切除组149例。Meta分析结果显示:①与经尿道膀胱肿瘤切除组相比,2μm激光组治疗后留置尿管时间短(MD=-1.47,95%CI[-2.32,-0.62])、膀胱冲洗时间短(SMD=-3.61,95%CI[-4.41,-3.13]),治疗过程中、治疗后膀胱刺激发生率低(RR=0.30,95%CI[0.19,0.47])、闭孔神经反射发生率低(RR=0.07,95%CI[0.01,0.34])、膀胱穿孔发生率低(RR=0.09,95%CI[0.02,0.45])。②2种治疗方案在手术时间、治疗后住院时间、治疗后尿道狭窄发生率及治疗后短期膀胱肿复发率方面差异无显著性意义。提示2μm激光与经尿道膀胱肿瘤切除治疗非肌层浸润性膀胱肿瘤效果相当,但治疗后膀胱冲洗时间、留置尿管时间短,治疗过程中、治疗后膀胱刺激、闭孔神经反射、膀胱穿孔发生率低,因此是一项疗效确切,安全性相对较高的微创技术。受纳入研究质量和可能存在发表偏倚的影响,上述结论尚需更多高质量的随机对照试验加以验证。BACKGROUND： 2-μm laser is a novel intracavity technique for treating non-muscle-invasive bladder tumor, but the efficacy and safety in comparison with transurethral resection of bladder tumor are poorly understood. OBJECTIVE： To evaluate the difference of curative effect between 2-μm laser and transurethral resection of bladder tumor in treatment of non-muscle-invasive bladder tumor, and to provide medicine-based evidence for clinical application.METHODS： An online retrieval of PubMed, Ovid, Medline, Embase, Cochrane Library, CBM, CNKI, Wanfang database, Weipu database and Superstar database was performed. We also supplemented by manual and other retrieval. The retrieval time arranged from inception until September 30, 2013. Randomized controlled trials of 2-μm laser and transurethral resection of bladder tumor in treatment of non-muscle invasive bladder tumor were searched. Meta analysis was performed using RevMan5.2 software after the data were abstracted and the quality was evaluated. RESULTS AND CONCLUSION： Four randomized controlled trials involving 310 patients were included, 161 cases in 2-μm laser group and 149 cases in transurethral resection of bladder tumor group. The results of Meta analysis showed that compared with transurethral resection of bladder tumor group, postoperative bladder irrigation time （SMD=-3.61, 95%CI [-4.41, -3.13]） and period of catheterization （MD=-1.47, 95%CI [-2.32, -0.62]） were shorter in 2-μm laser group, with less incidence of obturator nerve reflex （RR=0.07, 95%CI[0.01, 0.34]）, bladder irritation （RR=0.30, 95%CI [0.19, 0.47]） and bladder perforation （RR=0.09, 95%CI [0.02, 0.45] ）. There were no significant differences in operation time, period of hospitalization, postoperative urethral stricture incidence and bladder tumor recurrence rate in short-term between the two groups. Experimental findings indicate that, 2-μm laser is similar to transurethral resection of bladder tumor in treatment of non-muscle invasive bladder tumor. But the inci

关 键 词：器官移植 器官移植循证医学 非肌层浸润性膀胱肿瘤 膀胱肿瘤 2 ΜM激光 经尿道膀胱肿瘤切除 META分析 系统评价 

分 类 号：R318[医药卫生—生物医学工程]