钬激光治疗前列腺增生症的系统评价

目的系统评价钬激光治疗前列腺增生症的有效性和安全性。方法电子检索MEDLINE(1966～2004年)、EMBASE(1984～2004年)、Cochrane图书馆(2004年第4期)和截至2004年底的中文学术期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库和中文生物医学期刊数据库,并手检相关杂志。纳入钬激光治疗与经尿道前列腺电切术(TURP)的随机对照试验,对纳入研究的质量进行评价,并进行Meta分析。结果有4个RCT符合纳入标准,共计治疗前列腺增生症480例患者。Meta分析结果显示,钬激光治疗组与TURP组相比,在随访12个月和48个月时,两组在生活质量评分改善分别为WMD=-0.19,95%CI(-0.81,0.44),Z=0.59,P=0.56和WMD=-0.30,95%CI(-0.90,0.30),Z=0.98,P=0.33]、最大尿流率的改善分别为WMD=1.63ml/s,95%CI(-0.32,3.59),Z=1.64,P=0.10和WMD=3.80ml/s,95%CI(-1.36,8.96),Z=1.44,P=0.15]、国际前列腺症状评分或美国泌尿外科协会前列腺症状评分分别为WMD=-0.06,95%CI(-1.01,0.89),Z=0.12,P=0.91和WMD=-1.40,95%CI(-3.91,1.11),Z=1.09,P=0.27]及两组尿道狭窄发生率RR=0.75,95%CI(0.35,1.60),Z=0.74,P=0.46]方面,其差异均无统计学意义,但钬激光治疗缩短了患者住院时间TotalWMD=-24.89,95%CI(-28.56,-21.21),Z=13.27,P<0.000

Efficacy and Safety of Holmium Laser Prostatectomy: A Systematic Review

Objective To access the efficacy and safety of Holmium laser prostatectomy technique compared to TURP. Methods We searched MEDLINE (19962004), EMBASE (19842004), The Cochrane Library (Issue 4, 2004), CNKI, VIP, CMCC and CBMdisc; and handsearched the relevant Chinese journals. Randomized controlled trials (RCT) were included. The quality of trials was evaluated and meta-analysis was performed. Non-randomized controlled trials were also included to evaluate the safety and efficacy. Results We found 4 randomized controlled trials. A total of 480 participants were in the trials ranging from 60 to 200. There was no statistical difference between the two techniques at 12 or 48 months follow-up in terms of quality of life (QOL) improvement(WMD=-0.19, 95%CI-0.81 to 0.44, Z=0.59,P=0.56; WMD=-0.30, 95%CI-0.90 to 0.30, Z=0.98, P=0.33); Q_~max improvement(WMD=1.63 ml/s, 95%CI-0.32 to 3.59, Z=1.64, P=0.10; WMD=3.80 ml/s, 95%CI-1.36 to 8.96,Z=1.44, P=0.15); I-PSS or AUA (WMD=-0.06, 95%CI-1.01 to 0.89, Z=0.12, P=0.91; WMD=-1.40, 95%CI-3.91 to 1.11, Z=1.09, P=0.27) and the urethral stricture complication rate (RR=0.75, 95%CI 0.35 to 1.60, Z=0.74, P=0.46). However hospital stay was significantly shorter in the Holmium laser prostatectomy groups (total WMD=-24.89, 95%CI-28.56 to-21.21, Z=13.27, P<0.000 01). We can not draw consistent conclusions in terms of blood loss according to the present data. One study indicated Holmium laser prostatectomy technique was more cost-effective than TURP. Conclusions In short period Holmium laser prostatectomy is as safe as TURP in terms of hospital stay, urethral stricture and blood loss complication. This new technique is as effiective as TURP in terms of I-PSS (AUA), Q_~max and QOL. More RCTs and more long term follow-up is necessary.