经尿道等离子双极电切术治疗中国高危高龄良性前列腺增生症效果的系统评价与荟萃分析  

Transurethral bipolar plasmakinetic prostatectomy for benign prostatic hyperplasia in high-risk and senior patients in China: a systematic review and meta-analysis

作　　者：张中元[1] 赵明娟 洪保安 马琳璐 靳英辉 曾宪涛 龚侃[1] Zhang Zhongyuan;Zhao Mingjuan;Hong Baoan;Ma Linlu;Jin Yinghui;Zeng Xiantao;Gong Kan(Department of Urology, the First Hospital of Peking University, Beijing 100034, China;Department of Cardiology, the Fist Affiliated Hospital of Henan University, Kaifeng 475004, China;Department of Cardiology, the Fist Affiliated Hospital of Henan Chinese Medicine University, Zhengzhou 450046, China;Department of Urology, Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071)

机构地区：[1]北京大学第一医院泌尿外科,北京100034 [2]河南大学第一附属医院心血管内科,开封475004 [3]河南中医药大学第一附属医院心血管内科,郑州450046 [4]武汉大学中南医院循证与转化医学中心,泌尿外科,武汉430071

出　　处：《中华医学杂志》2019年第10期778-782,共5页National Medical Journal of China

基　　金：国家重点研发计划专项基金(2016YFC0106300);湖北省科技厅技术创新专项重大项目(2016ACA152).

摘　　要：目的评价经尿道等离子双极电切术治疗中国高危高龄良性前列腺增生症患者的有效性和安全性。方法计算机检索PubMed、Cochrane Library、CNKI、CBM和万方数据库,搜集经尿道等离子双极电切术治疗中国高危高龄良性前列腺增生症的病例系列研究,检索时间为建库至2018年9月14日。由两名评价者独立提取数据与质量评价,采用Comprehensive Meta-Analysis V2软件进行荟萃分析。结果最终纳入18项研究,共1 899例患者。术后第1、3、6、12和24个月的Qmax改变量分别为12.28 ml/s(95%CI:8.42~16.14)、12.88 ml/s(95%CI:9.85~15.92)、14.32 ml/s(95%CI:10.47~18.18)、14.93 ml/s(95%CI:10.19~19.67)和20.00 ml/s(95%CI:19.08~20.92);IPSS评分改变量分别为-18.60(95%CI:-23.20^-14.00)、-17.62(95%CI:-20.21^-15.03)、-19.14(95%CI:-20.70^-17.59)、-19.06(95%CI:-21.53^-16.60)和-22.90(95%CI:-24.26^-21.54);QoL评分改变量分别为-2.38(95%CI:-4.26^-0.50)、-3.39(95%CI:-4.57^-2.21)、-3.75(95%CI:-4.14^-3.36)、-3.36(95%CI:-4.56^-2.16)和-4.58(95%CI:-4.75^-4.41);PVR改变量分别为-231.16 ml(95%CI:-288.30^-174.01)、-76.10 ml(95%CI:-116.71^-35.50)、-159.90 ml(95%CI:-207.21^-112.59)和-87.70 ml(95%CI:-91.91^-83.48),术后不良反应发生率均不高。结论经尿道等离子双极电切术治疗高危高龄良性前列腺增生症患者有较好的临床疗效和安全性。Objective To evaluate the effectiveness and safety of transurethral bipolar plasmakinetic prostatectomy in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China. Methods The PubMed, Cochrane Library, CBM, CNKI and WanFang databases were searched with computer for collecting relevant interventional case series from establishment dates to September 14, 2018. After quality evaluation and data extraction independently conducted by two authors, the Meta-analysis was performed using the Comprehensive Meta-analysis V2 software. Results Eighteen studies involving 1 899 patients are included. Maximum flow rate increased to 12.28 ml/s (95%CI: 8.42-16.14), 12.88 ml/s (95%CI: 9.85-15.92),14.32 ml/s (95%CI: 10.47-18.18), 14.93 ml/s (95%CI: 10.19-19.67) and 20.00 ml/s (95%CI: 19.08-20.92) in 1, 3, 6, 12 and 24 months after surgery, respectively. International prostate symptom score decreased to -18.60 (95%CI:-23.20--14.00),-17.62 (95%CI:-20.21--15.03),-19.14 (95%CI:-20.70--17.59),-19.06 (95%CI:-21.53--16.60) and -22.90 (95%CI:-24.26--21.54), respectively. Quality of life decreased to -2.38 (95%CI:-4.26--0.50),-3.39 (95%CI:-4.57--2.21),-3.75 (95%CI:-4.14--3.36),-3.36(95%CI:-4.56--2.16), and -4.58(95%CI:-4.75--4.41). Post void residual decreased to -231.16 ml (95%CI:-288.30--174.01),-76.10 ml (95%CI:-116.71--35.50),-159.90 ml(95%CI:-207.21--112.59) and -87.70 ml (95%CI:-91.91--83.48). The event rate of postoperative adverse reactions all were not high. Conclusion Transurethral bipolar plasmakinetic prostatectomy has better clinical efficacy and no obvious side effects in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China.

关 键 词：经尿道等离子双极电切术 良性前列性增生症 高龄高危患者 系统评价 META分析 

分 类 号：R699.8[医药卫生—泌尿科学]