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目的:系统评价钬激光前列腺剜除术(HoLEP)与开放前列腺切除术(OP)在重度前列腺增生(>70g)外科治疗中的临床疗效和安全性。方法:检索国内外有关HoLEP与OP治疗重度前列腺增生的随机对照研究,对文献进行质量评价,按Cochrane系统评价方法提取资料,采用RevMan 5.3统计软件行统计分析。结果:共纳入3个随机对照研究共计260例患者,分析显示HoLEP组和OP组国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、生活质量评分(QOL)与剩余尿量(PVR)在术后短期(1个月与3个月)与长期(12个月与24个月)的差异均无统计学意义;切除腺体重量及术后并发症(二次导尿、尿失禁、膀胱颈挛缩/尿道狭窄、二次手术)差异无统计学意义。与OP组相比,HoLEP组血红蛋白下降值[MD=-0.95,95%CI(-1.35,-0.56),P<0.001]与输血[RR=0.16,95%CI(0.04,0.58),P=0.005]都更少,而手术时间[MD=32.21,95%CI(8.91,55.50),P=0.007]则更长。HoLEP所需留置导尿时间[MD=-3.83,95%CI(-7.17,-0.48),P=0.02]和住院时间[MD=-5.84,95%CI(-9.51,-2.17),P=0.002]均短于OP。结论:HoLEP和OP对重度前列腺增生的短期与长期疗效相同;HoLEP虽手术时间长,但出血量少,输血率低,术后恢复快,留置导尿时间及住院时间短;临床上应注重经尿道手术的推广及其卫生经济效益的优化。
Objective: To evaluate the clinical efficacy and safety of holmium laser surgery (HoLEP) and open prostatectomy (OP) in the surgical treatment of severe benign prostatic hyperplasia (> 70g). Methods: A randomized controlled study of HoLEP and OP in the treatment of severe prostatic hyperplasia was searched. The quality of the literature was evaluated. The data were extracted according to the Cochrane systematic evaluation method and statistically analyzed by RevMan 5.3 statistical software. RESULTS: A total of 260 randomized controlled trials were included in this study. The results showed that IPSS, Qmax, QOL and PVR in HoLEP group and OP group were significantly higher than those in control group There was no significant difference in the short-term postoperative (1 month and 3 months) and long-term (12 months and 24 months) resection of the gland weight and postoperative complications (secondary catheterization, urinary incontinence, Bladder neck contracture / urethral stricture, secondary surgery) was no significant difference. Compared with the OP group, the hemoglobin value of the HoLEP group [MD = -0.95,95% CI -1.35, -0.56, P <0.001] and the blood transfusions [RR = 0.16,95% CI 0.04,0.58, P = 0.005], but the operation time [MD = 32.21, 95% CI (8.91, 55.50), P = 0.007] was longer. The indwelling catheterization time required for HoLEP [MD = -3.83, 95% CI (-7.17, -0.48), P = 0.02] and length of stay [MD = -5.84,95% CI (-9.51, -2.17), P = 0.002] are shorter than OP. Conclusion: HoLEP and OP have the same short-term and long-term curative effect on severe benign prostatic hyperplasia. Although the operation time is long, HoLEP has less bleeding, low transfusion rate, faster recovery after operation, shorter indwelling catheterization time and shorter hospital stay. Promotion of Urethral Surgery and Optimization of Its Hygienic and Economic Benefits.