中药熏洗治疗混合痔术后水肿疗效的Meta分析

A Meta-analysis of the curative effect of TCM medicine fumigation in the treatment of postoperative edema of mixed hemorrhoids

目的:系统评价临床上利用中药熏洗疗法治疗混合痔术后局部水肿的疗效。方法:实时检索中国知网数据库、维普中文期刊服务平台、万方数据库、PubMed等中外数据库,检索时间范围为数据库注册建库至2021年8月20日,检索主要内容为运用中药熏洗方法治疗混合痔术后肛缘水肿的所有临床随机对照试验,按纳入及排除标准,由研究者筛选文献、提取资料并评价纳入研究的偏倚风险后,使用RevMan 5.3软件进行Meta分析。结果:文献筛选结果显示,共纳入6项随机对照研究,包括470例患者,其中中药熏洗组(试验组)235例,高锰酸钾溶液熏洗组(对照组)235例。Meta分析结果显示,与高锰酸钾溶液熏洗相比较,中药熏洗可显著提高混合痔术后水肿治疗的临床有效率[相对危险度(Relative Risk,RR)=1.30,95%置信区间(Confidence Interval,CI)(1.19,1.41),P <0.000 01],明显缩短水肿消退时间[均数差(Mean Difference,MD)=2.56,95%CI(–3.02,–2.09),P <0.000 01],明显缩短疼痛缓解时间[MD=–2.50,95%CI(–2.96,–2.04),P <0.000 01],明显缩短出血停止时间[MD=–2.22,95%CI(–2.55,0.89),P <0.000 01]。结论:现有证据表明,中药熏洗疗法对于混合痔术后局部水肿有显著的疗效,可明显缩短患者术后疼痛缓解时间、出血停止时间,但由于本Meta分析有一些不足之处,今后需大量高质量、大样本、多中心的随机对照试验进一步验证。

Objective:To evaluate the clinical effect of TCM medicine fumigation in the treatment of postoperative local edema of mixed hemorrhoids systematically.Methods:Real-time search on China National Knowledge Infrastructure(CNKI),VIP Chinese Periodicals,Wanfang Data,PubMed and other Chinese and foreign databases was made,and the search time range was from the registration and establishment of the database to August 20,2021.All clinical randomized controlled studies on TCM medicine fumigation treatment of postoperative anal edge edema after mixed hemorrhoids were searched.According to inclusion and exclusion criteria,the researchers screened the literature,extracted the data,and evaluated the risk of bias in the included studies.Meta-analysis was performed using RevMan 5.3 software system.Results:Literature screening results showed that a total of 6 randomized controlled studies were included,including 470 patients,with 235 patients in the traditional Chinese medicine fumigation group(the experimental group)and 235 patients in the potassium permanganate solution fumigation group(the control group).Meta-analysis results showed that compared with potassium permanganate solution fumigation,traditional Chinese medicine fumigation can significantly improve the clinical effective rate of mixed hemorrhoid postoperative edema[RR=1.30,95%CI(1.19,1.41),P<0.00001],significantly reduce the regression time of edema[MD=2.56,95%CI(3.02,–2.09),P<0.00001],significantly shorten the pain relief time[MD=–2.50,95%CI(–2.96,–2.04),P<0.00001],and significantly shorten the bleeding stop time[MD=–2.22,95%CI(–2.55,0.89),P<0.00001].Conclusion:Existing evidence shows that TCM medicine fumigation therapy has a significant effect on local edema after mixed hemorrhoids surgery,and it significantly reduces the time of postoperative pain relief and bleeding stop for patients.However,due to some shortcomings in this Meta-analysis,a large number of high-quality,large sample and multi-center randomized controlled trials are needed for further verification.