吻合器痔上黏膜环切术的近远期疗效及安全性的Meta分析

A meta-analysis on short and long term efficacy and safety of procedure for prolapse andhemorrhoids

目的对吻合器痔上黏膜环切术（PPH）的近、远期疗效及安全性进行系统回顾和Meta分析。方法计算机检索CochraneLibrary、PubMed、OVID、SpringerLinker、ScinceDirect、EBSCO、中国知网、维普中文科技期刊数据库、万方数据、中国生物医学文摘等中外生物医学数据库，搜集有关比较PPH与外剥内扎术（MMH）的随机对照研究，检索时限均从2000年1月至2013年1月。按Cochrane系统评价方法，评价所纳入研究的文献质量，并提取有效数据后采用RevMan5．1软件进行Meta分析。结果纳入符合条件的13项RCT研究，共1343例患者。Meta分析结果显示，近期疗效及安全性方面，与MMH相比，PPH手术时间（OR=-11．05，95％CI：-15．15～-6．95，P〈0．01）、住院时间（OR=-3．07．95％CI：-4．46～-1．69，P〈0．01）及恢复正常活动时间短（OR=-7．17，95％CI：-9．13～-5．20，P〈0．01）、术后疼痛轻（OR=-3．13，95％CI：-4．38～-1．88，P〈0．01），但治疗费用高（OR=2534．2，95％CI：509．0～4559．4，P=0．01）。远期疗效方面，PPH患者满意度高（OR=2．21，95％C／：1．03～4．75，P=0．04），但复发脱垂率（OR=3．75，95％CI：1．75～8．06，P〈0．01）及再次手术率高（OR=7．90，95％C／：1．78～35．03，P〈0．01）；术后肛门狭窄、肛门失禁和皮赘发生率在2种术式的差异无统计学意义（P〉0．05）。结论PPH可以作为MMH治疗Ⅲ°～Ⅳ°脱垂内痔的替代疗法，但应告知患者PPH远期有复发脱垂及再次手术的风险。

Objective To Systematic review and meta-analysis of short and long term efficacy and safety of procedure for prolapse and hemorrhoids. Methods Electronic databases including Cochrane Library, PubMed, OVID, SpringerLinker, ScinceDirect, EBSCO, CNKI, VIP, WanFang Data and CBM were searched. The date of search was between January 2000 and January 2013. Randomized controlled trials （RCTs） were indentified studying association of Compare PPH and Milligan-Mogan （MMH） treatment. Study selection and meta-analysis were conducted according to the Cochrane Handbook for RevMan 5.1 software. Results The trials involving 1343 patients were included. The results of meta- analysis indicated： compared with MMH, PPH operative time （ OR = - 11.05, 95% CI： - 15.15- - 6. 95, P 〈 0. 01 ）, duration of hospitalization （ OR = - 3.07, 95% CI： - 4.46- - 1.69, P 〈 0. 01 ） and return to normal activity time （ OR = - 7.17, 95% CI： - 9. 13- - 5.20, P 〈 0. 01 ） was short, postoperative pain light （ OR = -3.13, 95% CI： -4. 38- - 1.88, P 〈0. O1 ）, but the high cost of treatment （ OR =2534. 2, 95% CI： 509.0-4559.4, P = 0. 01 ）. Long-term efficacy, PPH was higher patient satisfaction （ OR = 2. 21, 95% CI： 1.03-4. 75, P = 0. 04）, but the recurrence rate of prolapse （ OR = 3.75, 95% CI： 1.75-8.06, P 〈0. 01 ） and reoperation rate （ OR = 7.90, 95% CI： 1.78-35.03, P 〈 0. 01 ） higher. The incidence of anal stenosis and anal incontinence postoperative were higher than MMH （ P 〉 0. 05 ）. The difference of post operative anal stenosis and anal incontinence and residual skin tag rate were not statistically significant （ all P 〉 0. 05 ）. Conclusions PPH surgery can be used as replacement therapy of MMH for m o-fro prolapsed hemorrhoids. But we should inform patients of prolapse recurrence and reoperation risk of PPH in the longterm.