钬激光剜除术和经尿道前列腺切除术治疗症状性前列腺梗阻的meta分析

目的比较钬激光前列腺剜除术（HoLEP）与经尿道前列腺电切术（TURP）两种术式的优缺点。方法检索Medline，Embase及Cochrane图书馆报道的HoLEP和TURP治疗症状性前列腺尿路梗阻的随机对照研究（RCTs）。主要观察指标包括最大尿流率（Qmax）、残余尿量、症状评分及生活质量评分，次要观察指标包括手术时间、住院时间、失血量、留置导尿管时间及并发症。结果6—12个月的术后随访中，Qmax在HoLEP和TURP治疗两组间没有统计学差异。但HoLEP术中失血量更少，留置导尿管时间及住院时间更短；而TURP手术时间小于HoLEP。两者在术后尿道狭窄、尿失禁、输血率及再次手术的发生率无统计学差异。结论HoLEP和TURP改善患者Qmax疗效相当。HoLEP手术时间比TURP长，但HoLEP失血量少，留置导尿管时间及住院时间较TURP短。术后各种并发症的发生率两者没有差别。

Meta analysis of holmium laser enucleation and transurethral resection of the prostate in the treatment of symptomatic prostatic obstruction

Objective To compare the transurethral holmium laser enucleation of the prostate （HoLEP） and transurethral resection of the prostate （TURP）. Methods Randomized controlled trials of HoLEP and TURP in the treatment of symptomatic prostatic obstruction were reviewed and amalyzed comprehensively on Medline, Embase and Cochrane. The primary measures were maximum flow rate （Qmax）, postvoid residual volume （RPV）, international prostate symptom score （IPSS） and quality of life, the secondary measures were operation time, length of stay, loss of blood, time of detaining urethral catheter and complications. Results In the coming follow up postoperative during 6 to 12 month, both of the two therapy was not statistic different in Qmax, but HoLEP has less blood loss during the operation, time of detaining urethral catheter and length of stay in the hospital, and the operation time of TURP was short than that of HoLEP. No statistic different were found in both of them upon postoperative urethral stricture, incontinence, necessary of blood transfusion and the risk of reoperation. Conclusions HoLEP and TURP have similar effect in raising Qmax and have no statistic different, in spite of the operation time of HoLEP was longer than that of TURP, and HoLEP has lots of advantages with regard to TURP. Both of them have no difference in the risk of postoperative complications.