氨甲环酸在良性前列腺增生内镜手术中的疗效与安全性：一项以经尿道前列腺电切术（TURP）为主的系统评价与荟萃分析。
完整摘要 · 中文译文
背景：出血仍是良性前列腺增生（BPH）内镜手术中的一个重要问题。氨甲环酸（TXA）因其在经尿道前列腺手术中减轻出血相关问题的能力而受到越来越多的关注。我们进行了一项全面的荟萃分析，以评估TXA在接受良性前列腺增生内镜手术患者中的有效性和安全性，同时承认现有数据主要来源于经尿道前列腺电切术（TURP）。 方法：检索了PubMed、Web of Science、Cochrane Library、Embase、CNKI、万方、ClinicalTrials.gov和ICTRP，检索时间从各数据库建库至2026年4月。使用RevMan 5.4计算合并均数差（MD）和风险比（RR）及其95%置信区间（CI）。使用R版本4.4.2进行敏感性分析和发表偏倚评估。 结果：共纳入15项随机对照研究，涉及1，310例患者。与对照组相比，TXA显著缩短了手术时间（MD = -6.49分钟，95% CI：-10.79至-2.20）并减少了术中出血量（MD = -66.68 mL，95% CI：-123.84至-9.51）。TXA还导致24小时血红蛋白丢失显著减少（MD = -0.58 g/dL，95% CI：-0.88至-0.29）以及冲洗液体积减少（MD = -0.45 L，95% CI：-0.80至-0.10）。然而，两组在持续膀胱冲洗时间、导管留置时间、住院时间、切除腺瘤重量、输血需求方面均无显著差异。 深静脉血栓（DVT）发生率或内镜质量。 结论：在良性前列腺增生（BPH）内镜手术中，TXA（氨甲环酸）与较少术中出血、24小时后血红蛋白减少程度降低、冲洗液使用量减少以及手术时间缩短相关。这些结果应主要被视为来自经尿道前列腺电切术（TURP）的证据，且在单极和双极亚组中显示出一致效应。TURP之外的证据仅限于一项钬激光前列腺剜除术随机对照试验（RCT），该试验仅在统计学显著结局中贡献了手术时间数据。所报告的DVT罕见，现有证据不足以确定TXA的血栓栓塞安全性。需要更多RCT来阐明TXA在各种手术方法及出血风险增高患者中的作用。PROSPERO注册号：本研究已在https://www.crd.york.ac.uk/prospero/ 注册（注册号：CRD420251044211；注册链接：https://www.crd.york.ac.uk/PROSPERO/view/CRD420251044211）。
完整摘要 · 英文原文
BACKGROUND: Hemorrhaging continues to be a significant issue in endoscopic procedures for benign prostatic hyperplasia (BPH). Tranexamic acid (TXA) has garnered heightened scrutiny for its ability to mitigate bleeding-associated problems during transurethral prostate procedures. We performed a comprehensive meta-analysis to assess the effectiveness and safety of TXA in individuals having endoscopic procedures for BPH, acknowledging that the existing data primarily originated from transurethral resection of the prostate (TURP). METHODS: PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang, ClinicalTrials.gov, and ICTRP were examined from the beginning of their databases until April 2026. Pooled mean differences (MDs) and risk ratios (RRs) together with 95% confidence intervals (CIs) were computed utilizing RevMan 5.4. Sensitivity analyses and assessment of publication bias were performed using R version 4.4.2. RESULTS: Fifteen randomized controlled studies with 1,310 people were qualified. Compared to the control group, TXA significantly reduced operational time (MD = -6.49 minutes, 95% CI: -10.79 to -2.20) and intraoperative blood loss (MD = -66.68 mL, 95% CI: -123.84 to -9.51). TXA also led to significantly less hemoglobin loss at 24 hours (MD = -0.58 g/dL, 95% CI: -0.88 to -0.29) and decreased irrigation fluid volume (MD = -0.45 L, 95% CI: -0.80 to -0.10). However, there were no significant differences between groups in duration of continuous bladder irrigation, catheterization time, length of stay, weight of resected adenoma, blood transfusion requirements, incidence of deep vein thrombosis (DVT) or quality of endoscopic. CONCLUSIONS: TXA correlated with less intraoperative hemorrhage, decreased hemoglobin depletion after 24 hours, reduced irrigation fluid usage, and shortened surgical duration in endoscopic procedures for BPH. These results should be regarded primarily as evidence from TURP, demonstrating consistent effects across both monopolar and bipolar subgroups. Evidence outside TURP was limited to a single holmium laser enucleation of prostate RCT, which contributed data only to operative time among the statistically significant outcomes. Reported DVT were rare, and the available evidence remains underpowered to determine the thromboembolic safety profile of TXA. Additional RCTs are necessary to elucidate the function of TXA in various surgical methodologies and among patients with an elevated risk of hemorrhage. The PROSPERO Registration: The study was registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251044211; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251044211).