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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 209 -214. doi: 10.3877/cma.j.issn.1674-3253.2021.03.007

临床研究

经尿道铥激光切除术治疗非肌层浸润性膀胱癌的荟萃分析
游成宇1, 彭磊1, 韦堂墙1, 王辉1, 王安果1,()   
  1. 1. 637000 四川,川北医学院附属南充市中心医院泌尿外科
  • 收稿日期:2021-01-20 出版日期:2021-06-01
  • 通信作者: 王安果
  • 基金资助:
    国家自然科学基金(81900617)

Safety and efficacy of transurethral resection with thulium laser for non-muscle-invasive bladder cancer: A meta-analysis

Chengyu You1, Lei Peng1, Tangqiang Wei1, Hui Wang1, Anguo Wang1,()   

  1. 1. Department of Urology, Second Affiliated Hospital of North Sichuan Medical College, Nanchong Central Hospital, Sichuan 637000, China
  • Received:2021-01-20 Published:2021-06-01
  • Corresponding author: Anguo Wang
引用本文:

游成宇, 彭磊, 韦堂墙, 王辉, 王安果. 经尿道铥激光切除术治疗非肌层浸润性膀胱癌的荟萃分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(03): 209-214.

Chengyu You, Lei Peng, Tangqiang Wei, Hui Wang, Anguo Wang. Safety and efficacy of transurethral resection with thulium laser for non-muscle-invasive bladder cancer: A meta-analysis[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 209-214.

目的

系统评价经尿道铥激光切除术治疗非肌层浸润膀胱癌的安全性及疗效。

方法

检索PubMed、EMBASE、Cochrane library、Web of Science、中国知网、万方、中国生物文献数据库、维普数据库,搜集国内外有关经尿道铥激光切除术治疗非肌层浸润性膀胱癌的随机对照试验(RCT),检索时限为建库至2019年11月,由两名研究者独立筛选文献、质量评价、提取数据后,采用RevMan 5.3软件进行Meta分析。

结果

共纳入12篇研究,共计1 273例患者。荟萃分析结果显示,与经尿道电切术治疗非肌层浸润性膀胱癌相比,经尿道铥激光切除术能明显减少手术时间(MD=-10.36,95%CI:-19.28~-1.44,P=0.02)、术中出血量(MD=-24.66,95%CI:-36.63~-12.68,P<0.001)、术后膀胱冲洗时间(MD=-30.51,95%CI:-45.06~-15.95,P<0.001)、尿管留置时间(MD=-2.42,95%CI:-3.57~-1.27,P<0.001)及住院时间(MD=-2.32,95%CI:-3.16~-1.47,P<0.001),有效降低手术并发症发生率(RR=0.09,95%CI:0.04~0.20,P<0.001)。但在1年复发率上两种手术方式差异无统计学意义(RR=0.84,95%CI:0.62~1.14,P=0.27)。

结论

目前证据表明,经尿道铥激光切除术治疗非肌层浸润性膀胱癌在安全性及疗效方面均优于经尿道电切术。但受纳入研究数量及质量限制,上述结论仍需大样本高质量研究进行验证。

Objective

To systematically review the safety and efficacy of transurethral resection with thulium laser for non-muscle-Invasive bladder cancer(NMIBC).

Methods

Randomized controlled trials(RCT) on transurethral resection with thulium laser for NMIBC were searched in PubMed, EMBASE, Cochrane library, Web of Science, CNKI, Wanfang and VIP databases from inception to Nov. 2019. Two reviewers independently screened literature, assessed quality, extracted data, and then Meta-analysis was performed using software Rev-Man 5.3.

Results

A total of 12 RCTs involving 1273 patients were included. The Meta-analysis showed that compared with electrocautery transurethral resection in treating NMIBC, transurethral resection with thulium laser could obviously shorten operation time (MD=-10.36, 95%CI: -19.28~-1.44, P=0.02), intraoperative hemorrhage (MD=-24.66, 95%CI: -36.63~-12.68, P<0.001), postoperative bladder irrigation time (MD=-30.51, 95%CI: -45.06~-15.95, P<0.001), postoperative catheterization (MD=-2.42, 95%CI: -3.57~-1.27, P<0.001), postoperative hospitalization (MD=-2.32, 95%CI: -3.16~-1.47, P<0.001) and decrease operative complications (RR=0.09, 95%CI: 0.04~0.20, P<0.001). But the one year recurrence rates between two kind sof operations were not statistically different (RR=0.84, 95%CI: 0.62~1.14, P=0.27).

Conclusions

Evidence shows that transurethral resection with thulium laser for NMIBC is better than electrocautery transurethral resection in safety and efficacy. However, more large-scale high-quality studies are warranted to assess these results because the limited quality and quantity of the included studies.

表1 纳入文献的基本信息
图1 两种手术方式手术时间比较的Meta分析结果
图2 纳入研究偏倚风险评估结果
表2 两种手术方式之间手术并发症比较的Meta分析结果
图3 闭孔神经反射发生率漏斗图
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