商环包皮环切术与传统包皮环切术治疗包皮过长或包茎的Meta分析

Shang Ring circumcision versus conventional circumcision for redundant prepuce or phimosis: A meta analysis

目的:应用Meta分析评价商环包皮环切术与传统包皮环切术临床疗效和安全性。方法:检索国内外有关比较商环和传统手术用于治疗包皮过长或包茎的随机对照试验,由2名评价员独立按Cochrane系统评价方法对文献进行质量评价和提取资料后,采用RevMan 5.0统计软件进行Meta分析。结果:共纳入8个随机对照试验,2 277例患者。结果显示,与传统手术相比,商环包皮环切手术具有手术时间短[SMD=-5.82,95%CI(-7.39,-4.24),P<0.000 01]、术中出血量少[SMD=-3.28,95%CI(-3.47,-3.09),P<0.000 01]、创口感染率低[OR=0.44,95%CI(0.26,0.72),P=0.001]、术后出血发生率低[OR=0.05,95%CI(0.02,0.12),P<0.000 01]、术后患者对包皮外观满意率高[OR=12.72,95%CI(1.30,124.56),P=0.03]的优点,同时可以减轻患者术中疼痛[SMD=-3.32,95%CI(-3.50,-3.14),P<0.000 01]及术后24 h疼痛[SMD=-2.73,95%CI(-3.02,-2.43),P<0.000 01];但延长了患者创口的愈合时间[SMD=1.46,95%CI(1.03,1.90),P<0.000 01]。结论:商环包皮环切术具有手术时间短、并发症少、疼痛轻、术后包皮外观满意率高等优点,由于纳入文献的较少,需要更多大样本的随机对照试验进一步证实。

Objective: To compare the effect and safety of Shang Ring circumcision with those of conventional circumcision in the treatment of redundant prepuce or phimosis. Methods: We retrieved the randomized controlled trials on Shang Ring circumcision and conventional circumcision for the treatment of redundant prepuce or phimosis published at home and abroad. Relevant data were selected according to the Cochrane Handbook for Systematic Reviews by two reviewers after quality evaluation of the included trials,and the statistical software RevMan 5. 0 was used for meta analysis. Results: Totally 8 randomized controlled trials with 2 277 cases were included in this study. Compared with conventional circumcision,Shang Ring circumcision showed a shorter operation time( SMD =5. 82,95% CI [7. 39,4. 24],P < 0. 000 01),less intraoperative blood loss( SMD =3. 28,95% CI [3. 47,3. 09], P < 0. 000 01),lower rate of infection( OR = 0. 44,95% CI [0. 26,0. 72],P = 0. 001),lower rate of postoperative bleeding( OR = 0. 05,95% CI [0. 02,0. 12],P < 0. 000 01),higher rate of satisfaction with the postoperative penile appearance( OR = 12. 72, 95% CI [1. 30,124. 56],P = 0. 03),lower intraoperative pain score( SMD =3. 32,95% CI [3. 50,3. 14],P < 0. 000 01),and lower 24-hour-postoperative pain score( SMD =3. 28,95% CI [3. 47,3. 00],P < 0. 000 01),but longer wound healing time ( OR =1. 46,95% CI[1. 03,1. 90],P <0. 000 01). Conclusion: In comparison with conventional circumcision,Shang Ring circumcision has the advantages of shorter operation time,fewer complications,mild pain,and higher rate of satisfaction with the postoperative penile appearance. However,more high-quality randomized controlled trials with large samples are required to lend further support to our findings.