良性前列腺增生合并逼尿肌活动力低下的LUTS患者行TURP术后疗效及获益的META分析

发布时间：2019-01-27 20:46

【摘要】：研究背景：虽然目前经尿道前列腺电切术(transurethral resection of prostate, TURP)仍是良性前列腺增生所致LUTS手术治疗的“金标准”,但对于良性前列腺增生合并逼尿肌活动力低下的LUTS患者,能否从经尿道前列腺电切术(TURP)中获益目前仍充满争议。本研究整合现己发表的临床资料,通过系统Meta分析,进而评估良性前列腺增生并逼尿肌活动力低下患者行TURP术后的疗效及获益情况。研究方法：我们对Medline(建库-2015.04.10)和Embase(974-2015.4.10)数据库中有关良性列腺增生并逼尿肌活动力低下的LUTS患者行TURP术的相关文献进行了系统的文献检索,并检索了所有纳入文献的参考文献以排除可能的遗漏,所有文献均有两位检索人独立检索,如果出现分歧,则由第三位检索人与其共同协商解决。Meta分析最终结果根据纳入数据的异质性大小采用固定效应模型或随机效应模型进行统计分析。对于文献质量采用非临床随机对照研究的质量评价Newcastle-Ottawa Scale标准评分量表进行评估。研究结果：发表于1998.1-2014.1间的共9个研究符合我们的纳入标准,共纳入病例404例。在这些研究中,随访时间从3个月到144个月不等。对纳入数据的Meta分析显示良性前列腺增生并逼尿肌活动力低下相关的LUTS人群在TURP术后可获得明显的QoL, IPSS, PVR和Qmax改善:QoL在术后3个月时, MD=-2.27,95%CI=-2.50～-2.04, P0.00001。QoL在术后12个月时,MD=-2.23,95%CI=-2.50--1.95, P0.00001; IPSS在术后3个月时,MD=-9.38,95%CI--10.02-8.73, P＜0.00001。IPSS在术后12个月时,MD=-10.23,95%CI=-14.72-5.74, P0.00001;Qmax在术后3个月时,MD=6.19,95%CI=4.81-7.56, P＜0.00001。Qmax在术后12个月时,MD=5.66,95%CI=1.92-9.4, P=0.003; PVR在术后3个月时,MD=-27.50,95%CI-32.92--22.09, P0.00001。 PVR在术后12个月时,MD=-142.25,95%CI=-246.67--37.82,P=0.008。研究结论：良性前列腺增生并逼尿肌活动力低下并非经尿道前列腺电切术的手术禁忌症。良性前列腺增生并逼尿肌活动力低下相关的LUTS患者从TURP中可以获得至少一年的QoL, IPSS, Qmax和PVR的改善。但是基于原始研究设计中存在的异质性等因素存在,该结果应该谨慎解释而应避免过分解读。随着未来更大样本、设计良好的随机对照试验出现,该结论可能需要进行更新或重新进行解释。
[Abstract]:Background: although transurethral resection of the prostate (transurethral resection of prostate, TURP) is still the "golden standard" for the treatment of benign prostatic hyperplasia (BPH) with LUTS, LUTS patients with BPH complicated with detrusor dysfunction are involved. Whether to benefit from transurethral resection of the prostate (TURP) is still controversial. This study was conducted to evaluate the efficacy and benefits of TURP in patients with benign prostatic hyperplasia and detrusor dysfunction through systematic Meta analysis. Methods: we conducted a systematic literature search on TURP in LUTS patients with benign hyperplasia of glands and detrusor dysfunction in the databases of Medline (Jianku-2015.04.10) and Embase (974-April 10). All references included in the literature were retrieved to eliminate possible omissions. Two searchers searched independently of all the documents, and if differences arose, The final results of Meta analysis were analyzed by the fixed effect model or random effect model according to the heterogeneity of the data included. The quality of literature was evaluated by the Newcastle-Ottawa Scale standard rating scale of non-clinical randomized controlled study. Results: a total of 9 studies published in 1998.1-2014.1 met our inclusion criteria, covering 404 cases. In these studies, follow-up ranged from 3 months to 144 months. Meta analysis of the data included showed that significant QoL, IPSS, PVR and Qmax improvements were observed in LUTS patients with benign prostatic hyperplasia associated with detrusor dysfunction after TURP: QoL at 3 months after TURP, At 12 months after MD=-2.27,95%CI=-2.50~-2.04, P0.00001.QoL, MD=-2.23,95%CI=-2.50--1.95, P 0.00001; At 3 months after IPSS, MD=-9.38,95%CI--10.02-8.73, P < 0.00001.IPSS at 12 months after operation, MD=-10.23,95%CI=-14.72-5.74, P 0.00001; At 3 months after Qmax, MD=6.19,95%CI=4.81-7.56, P < 0.00001.Qmax and MD=5.66,95%CI=1.92-9.4, P0. 003 at 12 months after operation; At 3 months after PVR, MD=-27.50,95%CI-32.92--22.09, P 0.00001. At 12 months after PVR, MD=-142.25,95%CI=-246.67--37.82,P=0.008. Conclusion: benign prostatic hyperplasia with detrusor dysfunction is not a contraindication for transurethral resection of prostate. LUTS patients with benign prostatic hyperplasia associated with detrusor dysfunction can receive at least one year of improvement in QoL, IPSS, Qmax and PVR from TURP. However, due to the heterogeneity in the original design, the results should be interpreted carefully and not interpreted excessively. With larger future samples and well-designed randomized controlled trials, this conclusion may need to be updated or reinterpreted.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R699.8

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