RPH与PPH治疗混合痔的有效率和安全性的Meta分析

Effectiveness and Safety of RPH and PPH for Mixed Hemorrhoids:A Meta-analysis

为系统性比较RPH与PPH治疗混合痔的有效率和安全性,本研究通过计算机检索PubMed、Embase、Cochrane、中国学术期刊全文数据库(CNKI)、万方数据库和维普数据库中关于RPH与PPH治疗混合痔的临床随机对照研究,应用ReMan 5.3软件进行Meta分析,比较2种术式的临床疗效、住院时间及术后并发症等。结果显示,最终纳入文献13篇,病例共计2 519例。Meta分析显示,与PPH相比,RPH有效率更高[RR=1.02,95%CI (1.01,1.03),P=0.0002]、住院时间更短[MD=-0.89,95%CI (-1.48,-0.29),P=0.003]。在术后并发症方面,RPH术后尿潴留[RR=0.25,95%CI (0.16,0.38),P <0.00001]、出血[RR=0.19,95%CI(0.11,0.34),P <0.00001]、肛门直肠狭窄[RR=0.15,95%CI(0.06,0.37),P <0.0001]风险更低;在肛缘水肿、肛门失禁、疼痛方面,2种术式比较差异均无统计学意义(均P>0.05)。结果表明,与PPH相比,RPH治疗混合痔在提高有效率、缩短住院时间,以及减少术后尿潴留、出血、肛门直肠狭窄发生方面具有明显优势。但本研究尚有一定局限性,需今后更多高质量的临床试验提供更加可靠的循证医学证据。

To systematically compare the effectiveness and safety of RPH and PPH for mixed hemorrhoids, Electronic databases including PubMed,Embase,Cochrane,CNKI,Wan Fang Data,VIP were searched,in which the found randomized control trials about RPH and PPH treatment of mixed hemorrhoids were then appraised,and Meta analysis was conducted with RevMan 5.3software,then the clinical efficacy,hospital stay and postoperative complications between the two operations were compared.As results, a total of 13RCTs involving 2519patients were included.The results of meta-analysis showed that: compared with PPH group,RPH group had higher effective rate[RR =1.02,95%CI (1.01,1.03),P = 0.0002],shorter hospital stay[MD =-0.89,95%CI (-1.48,-0.29),P =0.003].RPH group experienced fewer complications,including urinary retention[RR =0.25,95%CI (0.16,0.38),P <0.00001], postoperative hemorrhage[RR =0.19,95%CI(0.11,0.34),P <0.00001],anorectal stenosis[RR =0.15, 95%CI (0.06,0.37),P <0.0001].In the anal margin of edema,anal incontinence and pain,there was no significant difference between PPH and RPH(all,P >0.05).Results show that RPH is superior to PPH in terms of effective rate,hospital stay,urinary retention,postoperative hemorrhage,anorectal stenosis.Due to the limitation of quality of the included studies,the above conclusions need to be conducted by more highquality research to provide more reliable basis of evidence-based medicine.