摘要目的：采用荟萃分析方法比较经尿道钬激光前列腺剜除术(HoLEP)和经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)所致膀胱出口梗阻(BOO)的疗效和安全性。方法：通过计算机检索PubMed、Web of Science、Cochrane Library万方数据库和中国生物医学文献数据库(截至2018年12月)中相关文献,按纳入及排除标准,收集比较HoLEP和TURP治疗BPH的临床随机对照试验(RCT),进行文献筛查、质量评价和数据提取,并用RevMan5.3软件进行统计分析。结果：经筛选后共10篇文献纳入分析,其中HoLEP组521例,TURP组517例。与TURP相比,HoLEP的优势在于留置尿管时间短（MD=-22.94,95%CI：-25.22~-20.66）、住院时间短（MD=-20.95,95%CI：-22.45~-19.44）、血红蛋白丢失量少（MD=-0.26,95%CI：-0.41~-0.12）、输血率低（RR=0.16,0.05~0.50）、尿道狭窄发生率低（RR=0.48,0.25~0.91）,而且远期剩余尿量少（MD=-4.63,95%CI：6.82~-2.44）、国际前列腺症状评分低（MD=-1.22,95%CI：-1.85~-0.58）、最大尿流率高（MD=0.92,95%CI：0.64~1.20）;HoLEP的劣势在于手术时间长（MD=21.42,95%CI：19.70~23.15）;术后尿失禁方面差异无统计学意义。结论：在外科治疗BPH所致BOO方面,HoLEP较TURP住院时间短、远期效果好、安全性高,有望成为BPH微创治疗的金标准。
Abstract：Objective： To compare the efficacy and safety of transurethral holmium laser enucleation of the prostate (HoLEP) and transurethral resection of prostate (TURP) in treatment of benign prostatic hyperplasia (BPH) due to bladder outlet obstruction (BOO) using meta-analysis methods. Methods： We retrospectively analyzed the clinical data from PubMed, Web of Science, Cochrane Library and Chinese Biomedical Literature Database (as of December 2018), and collected randomized controlled trials (RCT) of HoLEP versus TURP for BPH. Literature screening, quality evaluation and data extraction were performed and statistical analysis was performed using RevMan5.3 software. Results： After screening, a total of 10 articles were included in the analysis, including 521 patients in the HoLEP group and 517 patients in the TURP group. Compared with TURP, HoLEP had the advantages of shorter catheter indwelling time (MD= -22.94, 95% CI -25.22,-20.66), shorter hospital stay (MD=-20.95, 95% CI -22.45,-19.44), less hemoglobin loss (MD= -0.26, 95% CI -0.41,-0.12), lower transfusion rate (RR=0.16, 0.05,0.50), lower incidence of urethral stricture (RR=0.48, 0.25,0.91), lower long-term residual urine output (PVR) (MD=-4.63, 95% CI -6.82,-2.44), lower international prostate symptom score (IPSS) (MD=-1.22, 95% CI -1.85,-0.58), and higher maximum urinary flow rate (Qmax) (MD=0.92, 95% CI 0.64,1.20). The disadvantage of HoLEP was the longer operation time (MD=21.42, 95% CI 19.70,23.15). There was no significant difference in postoperative urinary incontinence between two groups. Conclusions： In the surgical treatment of BOO caused by BPH, HoLEP has shorter hospital stay, better long-term effect and higher safety than TURP, and it is expected to replace TURP as the gold standard for BPH surgical treatment.
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