摘要:
Objective:To systematically assess the efficacy and safety of holmium laser(HOLRBt)versus conventional transurethral resection(TURBT)for non muscle invasive bladder cancer(NMIBC).Methods:Ran-domized controlled trials(RCTs)regarding the efficacy and safety of HOLRBt vs.TURBT for NMIBC were re-trieved in PubMed,Cochrane library,Sciverse,CNKI,VIP and Wanfang database from databases establishment to Dec.2016.According to the including and exclusion criterion,two reviewers independently screened the trials, and the Meta-analysis was done with RevMan 5.3 soft ware.Results:A total of 14 RCTs were eligible for the study,including 1 746 cases.The pooled results showed that HOLRBt group had a less blood loss[MD = -66.00,95% CI=(80.75, -51.24),P< 0.000 01],and lower obturator reflex rate[RR= 0.06,95% CI=(0.02,0.16),P< 0.000 01]and perforation rate[RR= 0.15,95% CI=(0.07,0.33),P< 0.000 01]than TURBT group.However,there was no significant difference in operation time[MD= -0.14,95% CI=(-3.55,3.26),P=0.93]between two groups.Meanwhile,the one-year recurrence rate in HOLRBt group was sig-nificantly lower than that in TURBT group[RR=0.65,95% CI=(0.46,0.91),P=0.01].There was no sig-nificant difference in the 2-year recurrence rate between two groups[RR=0.52,95% CI=(0.20,1.37),P=0.19].Conclusions:Compared with TURBT,HOLRBt had less blood loss and lower obturator reflex rate and perforation rate.Therefore,HOLRBt should be considered as a preferable option for NMIBC.%目的:系统评价经尿道钬激光膀胱肿瘤切除术(HOLRBt)与TURBT治疗非肌层浸润性膀胱肿瘤(NMIBC)的疗效.方法:计算机检索PubM ed、Cochrane library、Sciverse、中国知网、维普及万方数据库,均从建库至2016年12月,收集所有比较 HOLRBt和 TURBT 治疗NMIBC的随机对照试验(RCT).同时检索纳入研究的参考文献.2名研究者独立筛选文献,应用Revman 5.3进行荟萃分析.结果:共14个RCTs,包含1746例患者.荟萃分析结果显示:HOLRBt组术中出血量少于 TURBT组[MD=-66.00,95% CI=(80.75,-51.24),P<0.00001],HOLRBt组闭孔神经反射[RR=0.06,95% CI=(0.02,0.26),P< 0.00001]、膀胱穿孔[RR=0.15,95% CI=(0.07,0.33),P<0.00001]发生率低于TURBT 组;然而两者手术时间差异无统计学意义[MD= -0.14,95% CI=(-3.55,3.26),P=0.93].另外,HOLRBt组术后1年NMIBC复发率低于TURBT组[RR=0.65,95% CI=(0.46,0.91),P=0.01];但两组术后2年复发率差异无统计学意义[RR = 0.52,95% CI =(0.20,1.37),P = 0.19].结论:与TURBT比较,HOLRBt治疗NMIBC具有较低的术中出血量及膀胱穿孔、闭孔神经反射等并发症发生率,有条件的单位可作为优先选择.