基于Meta分析的消痔灵注射液联合外剥内扎术治疗混合痔的临床评价研究

Meta-analysis of Xiaozhiling Injection Combining Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids

目的:系统评价消痔灵注射液联合外剥内扎术治疗混合痔的临床疗效。方法:计算机检索PubMed、Embase、the Cochrane Library、CNKI、WanFang Data、VIP、SinoMed数据库,搜集关于消痔灵注射液联合外剥内扎术治疗混合痔的随机对照试验(RCT),检索时限均为从建库至2020年4月。由两位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3、Stata 12.0软件进行分析。结果:共纳入20个RCT,累计3683例受试者。Meta分析结果显示,对比单纯使用外剥内扎术,加用消痔灵注射液可提高患者的治愈率[RR=1.11,95%CI(1.05,1.18),P=0.0002],缩短创面愈合时间[MD=-3.75,95%CI(-5.14,-2.36),P<0.00001],减少一年复发率[RR=0.16,95%CI(0.08,0.31),P<0.00001]和并发症的发生等。结论:临床治疗混合痔时,使用消痔灵注射液联合外剥内扎术在提高疗效,减少复发方面有一定的辅助治疗作用,但本研究结论尚需更多设计合理、严格执行的大样本随机双盲对照试验加以证实。

Objective:To systematically evaluate the clinical efficacy of Xiaozhiling injection combined with Milligan-Morgan hemorrhoidectomy(MMH)in the treatment of mixed hemorrhoids.Methods:PubMed,Embase,the Cochrane Library,CNKI,WanFang Data,VIP and SinoMed were electronically searched to collect randomized controlled trials of Xiaozhiling injection combined with MMH in the treatment of mixed hemorrhoids from inception to April 2020.Two authors independently screened the literature,extracted data and evaluated the risk of bias,then used RevMan 5.3 and Stata 12.0 softwares to analysis.Results:A total of 20 RCTs with 3683 patients were included.The results of Meta-analysis showed that:compared with MMH,the combining use of Xiaozhiling injection and MMH could improve the cure rate of patients(RR=1.11,95%CI 1.05 to 1.18,P=0.0002),shorten the wound healing time(MD=-3.75,95%CI-5.14 to-2.36,P<0.00001),and reduce the occurrence of recurrence(RR=0.16,95%CI 0.08 to 0.31,P<0.00001)and complications.Conclusion:Using Xiaozhiling injection combined with MMH to treat mixed hemorrhoids has a certain adjuvant treatment effect in improving the efficacy and reduce recurrence,but the conclusions of this study still need more large sample double blind RCTs with reasonable design and strict implementation.