钬激光与等离子在非肌层浸润性膀胱癌手术中的应用效果及安全性比较的Meta分析  

Efficacy and Safety of HoLRBt Versus TURis for Non-Muscle Invasive Bladder Cancer:A Review and Meta-Analysis

作　　者：曹利瑞 张皓[2] 李树相 王尧 金玄[1] 王久威 谢泳 张青[1] CAO Li-rui;ZHANG Hao;LI Shu-xiang;WANG Yao;JIN Xuan;WANG Jiu-wei;XIE Yong;ZHANG Qing(Department of Urology,Tianjin Xiqing Hospital,Tianjin 300380;Department of Thoracic Surgery,Tianjin Xiqing Hospital,Tianjin 300380;Emergency Center,Tianjin Xiqing Hospital,Tianjin 300380)

机构地区：[1]天津市西青医院泌尿外科,天津300380 [2]天津市西青医院胸外科,天津300380 [3]天津市西青医院急创中心,天津300380

出　　处：《中国医疗器械信息》2022年第12期5-10,35,共7页China Medical Device Information

摘　　要：目的:系统评价钬激光与等离子在NMIBC治疗中的疗效及安全性。方法:从Pubmed、Embase、Medline、Cochrane图书馆、中国知网、中国生物医学文献数据库、万方数据库、维普医学数据库中检索使用经尿道钬激光切除与经尿道等离子切除治疗NMIBC的随机对照试验(RCT)。应用Revman5.4软件进行荟萃分析。结果:共有9篇文献,包括1110例患者,分析结果显示:HoLRBT组与TURis组在闭孔神经反射发生率[RR=0.03,95%CI:0.01~0.07,P<0.00001]、膀胱穿孔发生率[RR=0.1,95%CI:0.03~0.29,P<0.0001]、术中出血量[MD=-7.89,95%CI:-9.58~-6.19,P<0.00001]、术后住院时间[MD=-0.40,95%CI:-0.72~-0.08,P=0.01]、术后留置尿管时间[MD=-1.35,95%CI:-2.03~-0.67,P=0.0001]、术后1年肿瘤复发率[RR=0.59,95%CI:0.36~0.95,P=0.03]及术后2年肿瘤复发率[RR=0.57,95%CI:0.39~0.83,P=0.003]方面差异有统计学意义。两组在手术时间[MD=-3.48,95%CI:-8.09~1.13,P=0.14]、术后低钠血症[RR=0.25,95%CI:0.06~1.16,P=0.08]及住院费用[SMD=-4.58,95%CI:-12.72~-3.57,P=0.27]方面差异无统计学意义。结论:与TURis相比,HoLRBT可以降低术中并发症,缩短术后留置尿管时间、术后住院时间,术后1年及术后2年肿瘤复发率低,是治疗非肌层浸润性膀胱癌安全可靠、有效的一种手术方式。Objective:To systematically evaluate the efficacy and safety of holmium laser resection of the bladder tumor(HoLRBt)versus Bipolar transurethral resection in saline(TURis)for non-muscle invasive bladder cancer(NMIBC).Methods:A systemic search of Pubmed,Embase,Medline,Cochrane library,CNKI,SinoMed,Wanfang database and VIP as well as manual bibliography searches were performed to identify the randomized controlled trials(RCT)regarding the efficacy and safety of HoLRBT versus TURis for NMIBC.The meta-analysis was done with Revman 5.4 software.Results:The analysis results showed that the significant difference in obturator reflex rate[RR=0.03,95%CI:0.01~0.07,P<0.00001],perforation rate[RR=0.1,95%CI:0.03~0.29,P<0.0001],intraoperative blood loss[MD=-7.89,95%CI:-9.58~-6.19,P<0.00001],postoperative hospital stay[MD=-0.40,95%CI:-0.72~-0.08,P=0.01],postoperative catheterization time[MD=-1.35,95%CI:-2.03~-0.67,P=0.0001],the one-year recurrence rate[RR=0.59,95%CI:0.36~0.95,P=0.03]and two-year recurrence rate[RR=0.57,95%CI:0.39~0.83,P=0.003]between two techniques.However,there was no significant difference in operation time[MD=-3.48,95%CI:-8.09~1.13,P=0.14],hyponatremia rate[RR=0.25,95%CI:0.06~1.16,P=0.08]and hospitalization expense[SMD=-4.58,95%CI:-12.72~-3.57,P=0.27]between two groups.Conclusions:Compared with TURis,HoLRBT can reduce intraoperative complications,shorten postoperative catheterization time,postoperative hospital stay,and reduce 1 year,2 years recurrence rate.Therefore,HoLRBt can be used as an alternative procedure for NMIBC.It is a safe and reliable methods for bladder tumor.

关 键 词：非肌层浸润性膀胱癌 钬激光切除 等离子电切 随机对照研究 META分析 

分 类 号：R699.5[医药卫生—泌尿科学]