经尿道前列腺等离子双极与单极电切术治疗良性前列腺增生的有效性与安全性的系统评价和Meta分析  

Efficacy and safety of transurethral plasmakinetic resection of prostate versus transurethral resection for benign prostatic hyperplasia:a systematic review and meta-analysis

作　　者：王永博 阎思宇 黄兴 郭幸沛[1] 邓雨晴 娄佳奡 顾佳敏 靳英辉 李晓东 曾宪涛[1,2] Yong-Bo WANG;Si-Yu YAN;Xing HUANG;Xing-Pei GUO;Yu-Qing DENG;Jia-Ao LOU;Jia-Min GU;Ying-Hui JIN;Xiao-Dong LI;Xian-Tao ZENG(Center for Evidence-Based and Translational Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Urology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Thyroid Breast Surgery,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China;College of Medicine,Wuhan University of Science and Technology,Wuhan 430081,China;Institute of Evidence-Based Medicine and Knowledge Translation,Henan University,Kaifeng 475000,Henan Province,China)

机构地区：[1]武汉大学中南医院循证与转化医学中心,武汉430071 [2]武汉大学中南医院泌尿外科,武汉430071 [3]华中科技大学同济医学院附属武汉中心医院甲乳外科,武汉430014 [4]武汉科技大学医学院,武汉430081 [5]河南大学循证医学与临床转化研究院,河南开封475000

出　　处：《医学新知》2021年第2期115-131,共17页New Medicine

基　　金：国家重点研发计划科技助力经济2020重点专项(国科生字[2020]18号);国家重点研发计划数字诊疗装备研发重点专项(2016YFC0106300)。

摘　　要：目的系统评价经尿道前列腺等离子双极电切术(transurethral plasmakinetic resection of prostate,TUPKP)与单极电切术(trans urethral resection prostate,TURP)治疗良性前列腺增生(benign prostatic hyperplasia,BPH)的有效性和安全性。方法计算机检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、维普、中国生物医学文献数据库及万方数据库,搜集所有关于TUPKP与TURP治疗BPH的随机对照试验(randomized controlled clinical trials,RCTs),检索日期至2020年9月15日。由2名评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行Meta分析。结果共纳入45项RCTs,6490例受试者。Meta分析结果显示:在普通体积(<80 mL)BPH患者中,有效性方面TUPKP术后3个月国际前列腺症状评分、60个月最大尿流率(maximum flow rate,Q_(max))分数、6个月国际勃起功能评分、60个月残余尿量均优于TURP,而在术后3~60个月生活质量评分、切除组织重量方面无统计学差异;安全性方面TUPKP在手术时间、住院时间、膀胱冲洗时间、术中失血量、术后导尿管留置时间、术后尿道狭窄方面均优于TURP,且差异有统计学意义。在大体积(≥80 mL)BPH患者中,有效性方面TUPKP术后3、12个月的Q_(max)和切除组织重量方面与TURP组无统计学差异;安全性方面TUPKP在手术时间、住院天数和术中出血量方面优于TURP,差异均有统计学意义。结论当前证据显示,无论是在普通体积还是大体积BPH患者中,TUPKP与TURP的有效性相当,安全性优于TURP。Objective To systematically evaluate the efficacy and safety of transurethral plasmakinetic prostatectomy(TUPKP)and trans urethral resection of prostate(TURP)in the treatment of benign prostatic hyperplasia(BPH).Methods We searched the databases of PubMed,Embase,Web of Science,the Cochrane Library,CNKI,Weipu,China Biomedical Literature Database and Wanfang Database,and collected relevant randomized controlled trials(RCTs)from their inception to September 15,2020.Data extraction and assessment of risk of bias were performed by two reviewers independently.Meta-analysis was performed using Stata 16.0 software.Results A total of 45 RCTs involving 6490 subjects were included.The results of Meta-analysis showed that,in patients with normal volume of prostate(<80 mL)BPH,in terms of effectiveness,results for TUPKP were superior to TURP for the postoperative 3 months international prostate symptom score,60 months maximum flow rate(maximum flow rate,Qmax)score,6 months international erectile function score and 60 months residual urine volume.However,there were no statistical difference in the quality of life score and the weight of the resected tissue in the third to sixty months after surgery;In terms of safety,TUPKP was superior to TURP in terms of the time of operation,hospitalization,bladder irrigation,postoperative catheterization,decreased the intraoperative blood loss,and the incidence of postoperative urethral stricture,and the difference were statistically significant.In the terms of effectiveness for patients with large volume(≥80 mL)BPH,Qmax and resection tissue weight at 3 and 12 months after TUPKP were not statistically different from those in the TURP group.In the terms of safety,TUPKP was superior than TURP in operating time,length of hospitalization and intraoperative blood loss,and the differences were statistically significant.Conclusion The current evidence shows that TUPKP is equivalent to TURP in treatment efficacy,but is superior to TURP in terms of safety for patients with normal or large BPH.

关 键 词：经尿道前列腺等离子双极电切术 经尿道前列腺电切术 良性前列腺增生 随机对照试验 

分 类 号：R699.8[医药卫生—泌尿科学]