前列腺动脉栓塞术与经尿道前列腺电切术治疗前列腺增生的Meta分析

目的比较前列腺动脉栓塞术(PAE)与经尿道前列腺电切术(TURP)治疗良性前列腺增生的疗效与安全性,为前列腺增生症适宜治疗方案的选择提供理论依据。方法通过检索PubMed、EMBASE、Cochrane Library、CNKI、CBM、维普和万方等数据库,筛选出符合要求的PAE和TURP对比研究,并对所有纳入文献进行质量评价和资料提取,最后应用统计学软件Rev Man 5.3进行Meta分析,比较PAE与TURP治疗良性前列腺增生的优劣势。结果本研究最终共纳入9篇文献,共计675例患者。Meta分析结果显示:①临床疗效方面,术后3个月,TURP组优于PAE组,疗效指标IPSS、QOL、Qmax、PVR、PV的改善差异有统计学意义;术后12个月,TURP组改善情况优于PAE组,虽然指标IPSS、PVR的改善差异无统计学意义,但其余指标QOL、Qmax、PV的改善差异具有统计学意义;术后24个月,PAE组与TURP组治疗效果相近,指标IPSS、QOL、Qmax、PVR、PV的改善差异无统计学意义;PAE组失败率(4.4%)大于TURP组(0.5%);②安全性方面,PAE组比TURP组术中出血量少[MD=-98.25,95%CI:-105.51^-91.00,P<0.00001]、留置导尿时间短[MD=-1.61,95%CI:-2.31^-0.90,P<0.0006]、住院时间短[MD=-3.07,95%CI:-4.40^-1.74,P<0.00001];两组手术时间差异无统计学意义[MD=17.28,95%CI:-15.92~50.48,P=0.31];PAE组并发症(21.6%)少于TURP组(33.7%)。结论PAE治疗良性前列腺增生短期疗效(3个月)不及TURP;但中长期疗效(24个月)与TURP相近。总体来说,PAE较TUPR安全性高,具有术中出血量少,留置导尿时间短、住院时间短、并发症少的优点,对于不能耐受麻醉及TURP者可选择PAE治疗良性前列腺增生。但PAE手术失败率相对较高,其疗效的稳健性相对较差,目前尚没有足够的证据认定PAE优于TURP。未来随着更大样本、更多中心以及设计精良的随机对照试验出现,PAE用于治疗前列腺增生的疗效可以得到进一步的论证。

Prostate artery embolization versus transurethral resection of prostate for benign prostatic hyperplasia:a Meta analysis

Objective To compare the efficacy and safety between prostate artery embolization(PAE)and transurethral resection of prostate(TURP)for the treatment of benign prostatic hyperplasia(BPH),and to offer the theory basis for the selection of appropriate treatment options for benign prostatic hyperplasia.Methods Datebases such as PubMed,EMBASE,Cochrane Library,CNKI,CBM,VIP and WanFang Data were used to search the randomized controlled trials(RCTs)and non-RCTs about PAE vs.TURP research about benign prostatic hyperplasia treatment.After the study selection,assessment and data extraction were conducted by two researches independently,and meta analysis was conducted using the RevMan 5.3 software to compare the efficacy and safety between PAE and TURP for the treatment of BPH.Results Nine studies including 675 patients which met with the selection criteria were involved in our study.The meta analysis results showed:The clinical efficacy of PAE was equal to TURP after 3 months follow-up,and the curative effect of PAE group was better than that of TURP group.The optimization of IPSS,QOL,Qmax,PVR and PV of the PAE group was also significantly better than the TURP group.After 12 months follow-up,though there was no statistical difference in the improvement of IPSS and PVR,some of indicators of the PAE group was significantly well than that of the TURP group such as QOL,Qmax and PV.Thus,the improvement of TURP group was better than that of PAE group.At last,we found there was no statistically significant difference in the improvement of IPSS,QOL,Qmax,PVR and PV between the PAE group and TURP group after 24 months follow-up,while the failure rate was higher in the PAE group(4.4%)than that of the TURP group(0.5%).Safety indicator:The results indicated that PAE group had less blood loss(MD=-98.25,95%CI:-105.51-91.00,P<0.00001),shorter catheterization time(MD=-1.61,95%CI:-2.31-0.90,P<0.0006),and shorter hospital stay(MD=-3.07,95%CI=-4.40-1.74,P<0.00001)compared with TURP group,though there was no significant difference in operation time between the two groups(MD=17.28,95%CI;-15.92-50.48,P=0.31).The complications in the PAE group(21.6%)were significantly lower than that in the TURP group(33.7%).Conclusions The short-term efficacy(3 months)of the PAE in the treatment of BPH is less effect than the TURP.The medium and long-term efficacy(24 months)of the PAE is equal to the TURP group,PAE is superior to TURP in intraoperative blood loss,time of indwelling catheter,time of hospital stay and the proportion complications.PAE can be used for patients with BPH,who cannot tolerate anesthesia and TURP.But the failure rate of PAE is higher than TURP.There is no enough evidence to conclude that PAE is superior than TURP for the treatment of BPH.More investigations with large-scale persons and rational designed research are needed to explore a optional therapeutic method for the BPH treatment.