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目的系统评价经尿道膀胱癌电切术(TURBT)的同期行经尿道前列腺电切术(TURP)与仅行TURBT或分期行TURBT和TURP比较治疗膀胱癌合并良性前列腺增生症的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CBM、WanFang Data和CNKI,搜集TURBT的同期行TURP与仅行TURBT或分期行TURBT和TURP比较治疗膀胱癌合并BPH的相关随机对照试验(RCT)和队列研究,检索时限截至2015年1月1日。由2名研究者独立进行文献筛选、资料提取,并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入13个研究,包括3个RCT(n=137)和10个回顾性队列研究(n=998)。Meta分析结果显示:同期组与对照组在术后肿瘤总体复发率[RCT:OR=0.55,95%CI(0.24,1.24),P=0.15;队列研究:OR=0.78,95%CI(0.60,1.01),P=0.06]、尿道及前列腺窝部肿瘤复发率[RCT:OR=1.40,95%CI(0.28,7.06),P=0.68;队列研究:OR=1.36,95%CI(0.49,3.74),P=0.55]、肿瘤进展率[队列研究:OR=0.93,95%CI(0.53,1.61),P=0.79]以及围手术期并发症发生率[RCT:OR=0.35,95%CI(0.08,1.55),P=0.17;队列研究:OR=1.75,95%CI(0.44,6.98),P=0.43]方面,差异均无统计学意义。结论与仅行TURBT或分期行TURBT和TURP相比,同期行TURBT和TURP治疗膀胱癌合并BPH不会增加膀胱癌术后复发、尿道及前列腺窝种植以及肿瘤进展的风险,也不会增加围手术期并发症发生的风险。但受纳入研究数量和质量所限,本研究结论尚需开展更多大样本、高质量的RCT进行验证。
Objective To evaluate the efficacy and safety of transurethral resection of the prostate (TURP) versus TURBT alone or in combination with TURBT and TURP in the treatment of bladder cancer complicated with benign prostatic hyperplasia (BPH) by transurethral resection of bladder cancer (TURBT). METHODS: Randomized controlled trials comparing Pubmed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang Data with CNKI, TURBT-collected concurrent TURP with TURBT alone or with TURBT and TURP for the treatment of bladder cancer with BPH RCT) and cohort studies, search deadlines as of January 1, 2015. Two researchers independently screened the literature, extracted data, and assessed the risk of bias included in the study. Meta-analysis was performed using RevMan 5.3 software. Results A total of 13 studies were included, including 3 RCTs (n = 137) and 10 retrospective cohort studies (n = 998). The results of Meta-analysis showed that the overall recurrence rate of tumor in the same period and control group was significantly higher than that of the control group (RCT: OR = 0.55, 95% CI 0.24,1.24, P = 0.15) 1.01), P = 0.06]. The recurrence rate of the tumor in the urethra and the prostate fossa was [RCT: OR = 1.40,95% CI 0.28,7.06, P = 0.68; ), P = 0.55], rate of tumor progression [cohort study: OR = 0.93,95% CI (0.53,1.61), P = .79] and incidence of perioperative complications [RCT: OR = 0.35,95% CI 0.08, 1.55), P = 0.17; there was no significant difference in cohort study: OR = 1.75,95% CI (0.44,6.98), P = 0.43]. Conclusions TURBT and TURP for bladder cancer with BPH during the same period do not increase the risk of postoperative recurrence, urethral and prosthetic fossa implantation and tumor progression compared with TURBT alone or staging TURBT and TURP, nor do they result in increased perioperative Risk of complications. However, due to the limited number and quality of studies involved, more large sample and high quality RCTs are needed to verify the conclusions of this study.