不同手术方式治疗慢性肛裂疗效评价的网状Meta分析

Reticular Meta-analysis of the efficacy evaluation of different surgical methods in the treatment of chronic anal fissure

目的评价不同手术方式治疗慢性肛裂的效果。方法通过计算机检索传统肛裂切除术、纵切横缝法、改良纵切横缝术、肛裂切除术+外括约肌切开术、肛裂切除术+内括约肌切开术5种手术治疗慢性肛裂的国内外临床研究,采用Stata13及GeMTC软件对其治愈率和并发症发生率进行传统Meta分析和网状Meta分析。结果共纳入21项临床研究2 430例患者。网状Meta分析显示肛裂切除术+内括约肌切开术和肛裂切除术+外括约肌切开术的治愈率均高于传统肛裂切除术,OR值分别为2.27(95%CI=1.14～4.36)、3.26(95%CI=1.67～6.75)。在并发症的发生率方面,纵切横缝术、传统肛裂切除术排前两位,肛裂切除术+内括约肌切开术最低。结论在5种常见的慢性肛裂手术方式中,肛裂切除术+内括约肌切开术的疗效和并发症发生均优于传统肛裂切除术、纵切横缝法、改良纵切横缝术、肛裂切除术+外括约肌切开术。

Objective To evaluate the clinical effect of five surgical methods on chronic anal fissure. Methods Randomized controlled clinical trials of five surgical treatments for chronic anal fissure were performed by searching Chinese and foreign literature databases and related academic websites, including traditional anal fissure resection, longitudinal and transverse suture, modified longitudinal and transverse suture, and resection+internal/external sphincterotomy. The literature was screened according to the inclusion and exclusion criteria and data were extracted. The quality of the literature was assessed using the Jadad tool, Stata and GeMTC software. Results A total of twenty one randomized controlled clinical trials, 5 surgical procedures, and 2 430 participants were included. Reticular Meta-analysis showed that the cure rates of anal fissure resection+internal/external sphincterotomy were higher than those of traditional anal fissure resection. OR values were 2.27 (95%CI=1.14-4.36) and 3.26 (95%CI=1.67-6.75), respectively. The incidence of complications was the highest in longitudinal and transverse suture and traditional anal fissure resection, the lowest in resection+internal sphincterotomy. Conclusion In the evaluation of effectiveness and complication evaluation, the clinical effect of anal fissure resection + internal sphincterotomy is superior to the other 4 surgical methods.