吻合器痔上黏膜环切钉合术与Milligan-Morgan术随机对照试验的系统评价及meta-分析

发布时间：2018-11-24 19:25

【摘要】：目的通过系统评价与meta-分析的方法,以手术时间、住院时间、恢复正常工作或活动时间、术后出血、术后疼痛、术后尿潴留、术后肛门失禁、肛门狭窄、残余皮赘、复发脱垂及患者满意度等方面,综合评价吻合器痔上黏膜环切钉合术(PPH)与Milligan-Morgan术(MMH)对痔的治疗的安全性及有效性。方法按照预先制定的搜索策略,采用电子检索及手工检索。电子检索数据库有PubMed、EMBASE、Cochrane图书馆、中国生物医学数据库(CBM)、相关期刊论文(CNKI)、万方数据、维普维普中文科技期刊数据库(VIP)等,检索所有有关吻合器痔上黏膜环切钉合术与Milligan-Morgan术比较的随机对照试验(RCT),检索年限为1998年1月至2015年1月。同时手工检索《中国肛肠病杂志》、《结直肠肛门外科》、《中华胃肠外科杂志》3种专业相关杂志。此外,对相关综述与系统评价及其参考文献也进行检索。由两名人员分别独立完成文献查找、筛选及方法学质量评价。用Cochrane协作网推荐使用的meta-分析软件—RevMan5.3对结局指标进行合并分析,应用敏感性分析对研究文献的发表偏倚及结果可靠性进行评价,最后对分析结果进行整理报道。结果本文共纳入16个随机对照试验(RCT)的研究文献,包括1411例患者,其中行PPH共702例,行MMH共709例。Meta-分析结果显示,与MMH相比,PPH手术时间(WMD=-1234.95%CI:-17.87～-6.80,P0.0001)、件院时间(WMD=-1.48,95%Cl:-1.81～-1.14,P0.00001)恢复正常活动时间短(WMD＝-14.11,95%CI:-24.51～-3.70,P=0.008),在疼痛方面,PPH在术后短期内表现出明显优势。除了在肛门失禁及肛门狭窄方面,MMH有着更高的发生率,统计值分别为(RR=0.62,95%Cl:0.38～1.01,P=0.05)及(RR=0.62,95%Cl:0.15～ 0.99,P=0.05),两者在术后其他主要并发症方面无明显差异。远期随访方面,PPH患者满意度高(OR=2.36,95%CI:1.36～4.07,P=0.04),术后复发脱垂概率较MMH高。结论PPH在术后短期治疗方面更具优势,两者在术后主要并发症未见明显差异,变现出相似的安全性。复发脱垂率方面PPH更高。
[Abstract]:Objective to evaluate the operative time, hospitalization time, normal work or activity time, postoperative bleeding, postoperative pain, postoperative urinary retention, anal incontinence, anal stricture, residual dermatophyte by means of systematic evaluation and meta- analysis. In the aspects of recurrent prolapse and patient satisfaction, the safety and efficacy of stapler and hemorrhoid mucosal circumcision combined with (PPH) and Milligan-Morgan (MMH) in the treatment of hemorrhoids were comprehensively evaluated. Methods according to the search strategy, electronic retrieval and manual retrieval were used. The electronic retrieval databases include PubMed,EMBASE,Cochrane library, Chinese biomedical database (CBM), Chinese periodical full-text database (CNKI), Wanfang data, Weipu Chinese sci-tech journal database (VIP), etc. A randomized controlled trial (RCT),) was used to search for all cases of prolapse and hemorrhoid mucosal circumcision and nailing compared with Milligan-Morgan procedure. The length of (RCT), search was from January 1998 to January 2015. The Chinese Journal of anorectal Diseases, the Chinese Journal of Colorectal and anal surgery, and the Chinese Journal of Gastrointestinal surgery were also manually searched. In addition, the related review and systematic evaluation and its references are also searched. The two personnel independently completed the literature search, screening and methodological quality evaluation. The meta- analysis software RevMan5.3, recommended by Cochrane Cooperative Network, was used to analyze the outcome index. Sensitivity analysis was used to evaluate the publication bias and the reliability of the results. Finally, the analysis results were reported. Results A total of 16 randomized controlled trial (RCT) studies were included in this study, including 1411 patients, including 702 patients with PPH and 709 patients with MMH. The results of Meta- analysis showed that compared with MMH, the results of Meta- analysis showed that PPH operation time (WMD=-1234.95%CI:-17.87~-6.80,P0.0001), piece hospital time (WMD=-1.48,95%Cl:-1.81~-1.14,) P0.00001) the time to return to normal activity (WMD=-14.11,95%CI:-24.51~-3.70,P=0.008) was short, and PPH showed obvious advantages in the short term after operation. In addition to anal incontinence and anal stricture, MMH had a higher incidence of (RR=0.62,95%Cl:0.38~1.01,P=0.05) and (RR=0.62,95%Cl:0.15~ 0.99P0. 05). There was no significant difference in other major postoperative complications between the two groups. In long-term follow-up, PPH patients had higher satisfaction (OR=2.36,95%CI:1.36~4.07,P=0.04) and higher recurrence and prolapse rate than MMH. Conclusion PPH has more advantages in short-term treatment. There is no significant difference between the two groups in the main postoperative complications and the safety is similar. PPH was higher in recurrent prolapse rate.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.18

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