包皮环切缝合器与包皮环切吻合器治疗包皮过长和包茎的meta分析

Meta-analysisof disposable circumcision suture device and circumcision anastomosis devicefor phimosis and redundant prepuce

目的:比较包皮环切缝合器与包皮环切吻合器治疗包茎及包皮过长的疗效及并发症发生情况。方法:计算机检索辅以手工及其他方式,检索中外各大数据库及相关期刊建库(或建刊)至2017年3月有关包皮环切缝合器与包皮环切吻合器治疗包茎及包皮过长的随机对照性文献,两位评价员独立按Cochrane系统评价手册5.3进行质量评价标准后,对纳入的结果采用Rev Man 5.3进行Meta分析。结果:纳入随机对照文献20篇,累计病例4801例;Meta分析显示:与包皮环切吻合器相比,包皮环切缝合器术后疼痛评分(WMD=0.05,95%CI:0.00~0.11,P<0.00001)、术后外观满意度(OR=4.23,95%CI:3.01~5.95,P<0.00001)、愈合时间(WMD=-9.30,95%CI:-11.01^-7.59,P<0.00001)、术后迟发出血(OR=4.28,95%CI:1.66~11.02,P=0.003)、术后感染(OR=0.16,95%CI:0.08~0.34,P<0.00001)、术后水肿(OR=0.17,95%CI:0.10~0.29,P<0.00001)、术后伤口裂开(OR=0.15,95%CI:0.08~0.26,P<0.00001)等指标差异明显,有统计学意义;手术时间(WMD=-0.38,95%CI:-1.05~0.29,P=0.27)、术中出血量(WMD=0.05,95%CI:0.00~0.11,P=0.07)差异无统计学意义。结论:与包皮环切吻合器相比,应用包皮环切缝合器行包皮环切术愈合时间短,术后疼痛评分低,术后外观满意度高,术后水肿、感染、伤口裂开等并发症发生率较低;手术时间、术中出血量2项指标未见明显差异;术后迟发性出血发生率较高。但由于各种原因,纳入的文章存在异质性,本结论可信度有待进一步提高。

Objective： To compare the curative effect and complications between circumcision suture device and circumcision anastomosis device for phimosis and redundant prepuce. Methods： The randomized controlled trials of circumcision suture device and anastomosis device of circumcision for phimosis and redundant prepuce were searched from major Chinese and foreign databases from the founded year to December 2016. After necessary methodological quality evaluation of selected studies and assessment of publication bias,the statics analysis was conducted by the software Rev Man5. 3. Results： 20 studies involving 4801 patients were included. Compared to the circumcision anastomosis device,differences in the pain score（ WMD = 0. 05,95% CI： 0. 00 ~ 0. 11,P〈0. 00001）,appearance satisfactory rate（ OR = 4. 23,95% CI： 3. 01 ~ 5. 95,P〈0. 00001）,wound healing（ WMD =-9. 30,95% CI：-11. 01 ^-7. 59,P〈0. 00001）,postoperative delayed bleeding（ OR = 4. 28,95% CI： 1. 66 ~ 11. 02,P = 0. 003）,postoperative infection（ OR = 0. 16,95% CI： 0. 08 ~ 0. 34,P〈0. 00001）,postoperative hematoma（ OR = 0. 17,95. 0% CI： 0. 10 ~ 0. 29,P〈0. 00001） andpostoperative wound dehiscence（ OR = 0. 15,95% CI：0. 08 ~ 0. 26,P〈0. 00001） were significant but differences inoperation time（ WMD =-0. 38,95% CI：-1. 05 ~0. 29,P = 0. 27） and bleeding volume（ WMD = 0. 05,95. 0% CI： 0. 00 ~ 0. 11,P = 0. 07） were not significant.Conclusions： Compared with circumcision anastomosis device,circumcision suture devicehas many advantages includingshorter time for wound healing,lower postoperativepain score,higher satisfied rate of postoperative appearance,lower incidence of infection and hematoma and wound dehiscence. There are no significant differences in operation time and intraoperative blood loss but the incidence ofdelayed postoperative bleeding. But for a variety of reasons,the credibility of this conclusion needs to beimproved because of the articles chosenare of heterogeneity.