中药保留灌肠法治疗内痔有效性及安全性的Meta分析

A Meta-analysis of efficacy and safety of traditional Chinese medicine retention enema on internal hemorrhoids

目的:系统评价中药保留灌肠治疗内痔及改善内痔术后症状的有效性及安全性。方法:检索2012年-2022年公开发表在国内外数据库中,以中药保留灌肠为主要治疗措施治疗内痔的随机对照试验,运用Revman 5.3软件进行Meta分析。结果:共纳入15项随机对照研究,患者1874例。Meta分析结果显示,相比于其他疗法,中药保留灌肠能取得更好的临床疗效[相对危险度(RR)=1.15,95%置信区间(CI)为(1.06,1.26),P=0.002],且不易发生术后不良反应[RR=0.26,95%CI为(0.13,0.51),P<0.0001],治疗后肛门坠胀发生率[RR=0.36,95%CI为(0.21,0.63),P=0.0004],便血发生率[RR=0.53,95%CI为(0.31,0.90),P=0.02]均低于其他治疗措施。结论:相比于其他传统中医外治疗法,中药坐浴、栓剂、口服药物及利多卡因灌肠等,中药保留灌肠方法简便,安全性良好,能够减轻患者痛苦,提高临床疗效,且不易发生不良反应,值得临床应用及推广。但由于受到纳入文献质量、数量及研究设计的限制,尚需更多高质量、多中心的随机对照试验对本研究结论加以支持。

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine retention enema in treating internal hemorrhoids and relieving postoperative symptoms of internal hemorrhoids.Methods:Randomized controlled trials on the treatment of internal hemorrhoids with traditional Chinese medicine retention enema as the main treatment measure published in domestic and foreign databases from 2012 to 2022 were searched,and Meta-analysis was performed using Revman 5.3 software.Results:A total of 15 randomized controlled trials with 1874 patients were included.Meta-analysis results showed that compared with other therapies,TCM retention enema could achieved better clinical efficacy[RR=1.15,95%CI(1.06,1.26),P=0.002],and was less likely to cause postoperative adverse reactions[RR=0.26,95%CI(0.13,0.51),P<0.0001].The incidence of anal distention[RR=0.36,95%CI(0.21,0.63),P=0.0004]and hematochezia[RR=0.53,95%CI(0.31,0.90),P=0.02]after treatment were lower than those of other treatments.Conclusion:Compared with other traditional Chinese medicine external therapy,traditional Chinese medicine sitz bath,suppository,oral medications and lidocaine enema,TCM retention enema is simple,safe,can reduce patients’pain,improve clinical efficacy,and is not prone to adverse reactions,and it is worthy of clinical application and promotion.However,due to the limitations of the quality,quantity and study design of included literatures,more high-quality,multicenter randomized controlled trials are needed to support the conclusion of this paper.