切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2017, Vol. 11 ›› Issue (02) : 86 -91. doi: 10.3877/cma.j.issn.1674-3253.2017.02.004

所属专题: 文献

临床研究

经尿道激光与传统电切术治疗非肌层浸润性膀胱肿瘤安全性及疗效的meta分析
郑浩锋1, 梁观灿1, 陈延雄1, 李腾成1, 吴杰英1, 司徒杰1, 方友强1,()   
  1. 1. 510630 广州,中山大学附属第三医院泌尿外科
  • 收稿日期:2016-11-29 出版日期:2017-04-01
  • 通信作者: 方友强
  • 基金资助:
    广东省科技计划项目(2013B021800084); 高校基本业务费,青年教师培育项目(14ykpy25)

Laser versus transurethral resection of bladder tumor for non-muscle invasive bladder cancer: a systematic review and meta-analysis

Haofeng Zheng1, Guancan Liang1, Yanxiong Chen1, Tengcheng Li1, Jieying Wu1, Jie Situ1, Xin Gao1()   

  1. 1. Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
  • Received:2016-11-29 Published:2017-04-01
  • Corresponding author: Xin Gao
  • About author:
    Corresponding author: Fang Youqiang, Email:
引用本文:

郑浩锋, 梁观灿, 陈延雄, 李腾成, 吴杰英, 司徒杰, 方友强. 经尿道激光与传统电切术治疗非肌层浸润性膀胱肿瘤安全性及疗效的meta分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2017, 11(02): 86-91.

Haofeng Zheng, Guancan Liang, Yanxiong Chen, Tengcheng Li, Jieying Wu, Jie Situ, Xin Gao. Laser versus transurethral resection of bladder tumor for non-muscle invasive bladder cancer: a systematic review and meta-analysis[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(02): 86-91.

目的

系统性评价经尿道激光与传统电切术两种手术方式治疗非肌层浸润性膀胱肿瘤的安全性及疗效。

方法

选用并详细搜索PubMed、Scopus、Web of science和Cochrane library的所有比较经尿道激光与传统电切术治疗非肌层浸润性膀胱肿瘤的临床文章,包括随机对照实验、回顾性研究及前瞻性队列研究。

结果

共9篇文章,包括4篇随机对照实验、4篇回顾性研究及1篇前瞻性队列研究纳入该次分析中。总纳入病例数为1396例,包括694例经尿道激光病例及702例传统电切术病例。从分析中可以发现,虽然经尿道激光在手术时间上与传统电切术无明显差别(WMD=1.63,95%CI=-1.44~4.70,P=0.30),但其平均住院时间(WMD=-1.11,95%CI=-1.71~-0.50,P=0.0004)及术中、术后并发症情况均显著优于传统电切术,且术后1年(OR=0.87,95%CI=0.59~1.27,P=0.47)及2年复发率(OR=0.70,95% CI=0.46~1.09,P=0.11)无明显区别。

结论

经尿道激光治疗非肌层浸润性膀胱肿瘤术式较传统电切术安全,且效能不低于传统电切术,应作为微创治疗非肌层浸润性膀胱肿瘤的重要方案之一。

Objective

To provide a systematic review and meta-analysis of studies comparing laser versus transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC).

Methods

This study comprehensively searched PubMed, Scopus, Web of science, Cochrane library, and performed a systematic review and meta-analysis of all randomized controlled trials (RCTs), retrospective comparative studies and prospective studies assessing the two techniques.

Results

Nine studies including 4 RCTs, 4 retrospective studies and 1 prospective study fulfilled the predefined inclusion criteria and were included in the final analysis. These studies included data of 1396 cases (694 for lasers and 702 for TURBT). Although there was no significant difference between lasers and TURBT for operation time (WMD=1.63, 95%CI=-1.44~4.70, P=0.30), lasers provided shorter hospital stays (WMD=-1.11, 95%CI=-1.71~- 0.50, P=0.0004) as well as lower complication rates. What's more, the recurrence rates showed no significantly difference when we took a one-year follow-up (OR=0.87, 95% CI=0.59~1.27, P=0.47), or even two-year follow-up (OR=0.70, 95% CI=0.46~1.09, P=0.11).

Conclusions

Laser is not only safer, but also has the same efficacy as TURBT when dealing with NMIBC. And it should be recommended when minimally invasive therapy is necessary.

图1 文献筛选流程图
表1 非随机对照文献质量评价
表2 随机对照文献质量评价
表3 纳入文献基本特征的汇总
图2 手术时间森林图和meta分析(min)
图3 住院时间森林图和meta分析(d)
图4 术后置管时间森林图和meta分析(d)
图5 闭孔神经反射森林图和meta分析
图6 膀胱灌洗情况森林图和meta分析
图7 膀胱穿孔情况森林图和meta分析
图8 术后复发情况森林图和meta分析
图9 闭孔神经反射偏倚漏斗图SE为标准误,RR为风险系数
[1]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66(1):7-30.
[2]
Abdollah F, Gandaglia G, Thuret R, et al. Incidence, survival and mortality rates of stage-specific bladder cancer in United States: a trend analysis[J]. Cancer Epidemiol, 2013, 37(3):219-225.
[3]
Aldousari S, Kassouf W. Update on the management of non-muscle invasive bladder cancer[J]. Can Urol Assoc J, 2010,4(1):56-64.
[4]
Dołowy A, Krajewski W, Dembowski J, et al. The role of lasers in modern urology[J]. Cent European J Urol, 2015, 68(2):175-182.
[5]
张翼飞,梁朝朝,施浩强,等.整块剜除术治疗非肌层浸润性膀胱肿瘤[J/CD].中华腔镜泌尿外科杂志:电子版, 2016(6):379-382.
[6]
Saito S. Transurethral en bloc resection of bladder tumors[J]. J Urol, 2001, 166(6):2148-2150.
[7]
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group[J]. JAMA, 2000, 283(15):2008-2012.
[8]
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration[J]. PLoS Med, 2009, 6(7):e1000100.
[9]
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample[J]. BMC Med Res Methodol, 2005, 5(1):13.
[10]
侯祺,黄文涛,李茂胤,等.微通道经皮肾镜与输尿管软镜治疗肾结石有效性和安全性的meta分析[J/CD].中华腔镜泌尿外科杂志:电子版, 2015, 9(3):29-32.
[11]
Migliari R, Buffardi A, Ghabin H. Thulium laser endoscopic En bloc enucleation of Nonmuscle-Invasive bladder cancer[J]. J Endourol, 2015, 29(11):1258-1262.
[12]
Muraro GB, Grifoni R, Spazzafumo L. Endoscopic therapy of superficial bladder cancer in high-risk patients: Holmium laser versus transurethral resection[J]. Surg Technol Int, 2005, 14(14):222-226.
[13]
Tao W, Yang D, Shan Y, et al. Safety and efficacy of 120W high performance system greenlight laser vaporization for non-muscle-invasive bladder cancer[J]. J Xray Sci Technol, 2013, 21(2):309-316.
[14]
Yang D, Xue B, Zang Y, et al. Efficacy and safety of potassium-titanyl- phosphate laser vaporization for clinically non-muscle invasive bladder cancer[J]. Urol J, 2014, 11(1):1258-1263.
[15]
Zhu YF, Jiang XZ, Zhang JP, et al. Safety and efficacy of Holmium laser resection for primary nonmuscle-invasive bladder cancer versus transurethral electroresection: single-center experience[J]. Urology, 2008, 72(3):608-612.
[16]
Chen X, Liao J, Chen L, et al. En bloc transurethral resection with 2-micron continuous-wave laser for primary non-muscle-invasive bladder cancer: a randomized controlled trial[J]. World J Urol, 2015, 33(7):989-995.
[17]
Liu H, Wu J, Xue S, et al. Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer[J]. J Int Med Res, 2013, 41(4):984-992.
[18]
Xu Y, Guan W, Chen W, et al. Comparing the treatment outcomes of potassium-titanyl-phosphate laser vaporization and transurethral electroresection for primary nonmuscle-invasive bladder cancer: A prospective, randomized study[J]. Lasers Surg Med, 2015, 47(4):306-311.
[19]
Zhang XR, Feng C, Zhu WD, et al. Two micrometer continuous-wave thulium laser treating primary non-muscle- invasive bladder cancer: is it feasible? a randomized prospective study[J]. Photomed Laser Surg, 2015, 33(10):517-523.
[1] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2] 孙俊锋, 涂家金, 付丹, 蒋满香, 刘金晶, 崔乃硕. 手部烧伤瘢痕挛缩畸形整形术后综合康复联合点阵二氧化碳激光治疗的临床效果[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 411-415.
[3] 蒋敏, 刘馨竹, 李大伟, 冯柏塨, 申传安. 点阵CO2激光联合其他非手术方式治疗痤疮瘢痕有效性的网状荟萃分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 429-439.
[4] 王刘欣, 郭艳霞, 陈永进, 张旻, 李强. 激光治疗应用于撕脱性损伤牙再植根面处理的研究进展[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(05): 345-350.
[5] 薛庆, 施赛叶, 徐雅文, 盛夏, 张芹芹. 追踪方法学联合失效模式与效应分析在膀胱灌注化疗患者中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 553-559.
[6] 吴春风, 卢国汉, 姚汝贺, 李健辉, 陈文杰, 黄宇. 21 F膀胱镜鞘联合8.0/9.8 F输尿管镜与等离子电切镜在膀胱结石钬激光碎石术中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 579-584.
[7] 杜贵伟, 陆勇, 成博, 贺薏, 梁爽. 钬激光碎石术术后联合坦索罗辛治疗对输尿管结石患者的影响分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 491-496.
[8] 李想, 郭征, 田洪哲, 李杜, 熊梦瑶, 潘铁军. 1 470 nm半导体激光减容性切除治疗高危前列腺增生的临床研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 448-452.
[9] 苏博兴, 肖博, 李建兴. 2024年美国泌尿外科学会年会结石领域手术治疗相关热点研究及解读[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 303-308.
[10] 莫林键, 杨舒博, 农卫赟, 程继文. 人工智能虚拟数字医师在钬激光前列腺剜除日间手术患教管理中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 318-322.
[11] 李勇, 彭天明, 王倩倩, 陈育纯, 蒲小勇, 刘久敏. 基于失巢凋亡相关基因的膀胱癌预后模型构建及分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 331-339.
[12] 赵旭鹏, 王集琛, 田硕, 李宏召, 李修彬, 张旭. EP300 通过上调FKBP10 促进膀胱肿瘤细胞迁移和侵袭[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 264-274.
[13] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[14] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[15] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?