切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 459 -465. doi: 10.3877/cma.j.issn.1674-0793.2021.06.014

循证医学

痔上黏膜环切钉合术与多普勒超声引导下痔动脉结扎术治疗痔病的Meta分析
帕丽旦·热吉甫1, 张媛1, 杨武明1, 尼加提·塔西甫拉提1, 康蓓1, 韩瑞1, 路明1,†()   
  1. 1. 831100　昌吉，新疆医科大学第一附属医院昌吉分院肛肠科
  • 收稿日期:2021-04-07 出版日期:2021-12-01
  • 通信作者: 路明
  • 基金资助:
    新疆医科大学第一附属医院昌吉分院科研项目(202105)

Procedure for prolapse and hemorrhoids versus Doppler-guided hemorrhoidal artery ligation fortreatment of hemorrhoids: A Meta-analysis

Rejifu Palidan1, Yuan Zhang1, Wuming Yang1, Taxifulati Nijiati1, Bei Kang1, Rui Han1, Ming Lu1,†()   

  1. 1. Changji Branch, the First Affiliated Hospital, Xinjiang Medical University, Changji 831100, China
  • Received:2021-04-07 Published:2021-12-01
  • Corresponding author: Ming Lu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

帕丽旦·热吉甫, 张媛, 杨武明, 尼加提·塔西甫拉提, 康蓓, 韩瑞, 路明. 痔上黏膜环切钉合术与多普勒超声引导下痔动脉结扎术治疗痔病的Meta分析[J/OL]. 中华普通外科学文献(电子版), 2021, 15(06): 459-465.

Rejifu Palidan, Yuan Zhang, Wuming Yang, Taxifulati Nijiati, Bei Kang, Rui Han, Ming Lu. Procedure for prolapse and hemorrhoids versus Doppler-guided hemorrhoidal artery ligation fortreatment of hemorrhoids: A Meta-analysis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 459-465.

目的

系统分析目前活跃应用于临床上的痔上黏膜环切钉合术（PPH）与多普勒超声引导下痔动脉结扎术（DGHAL）的手术时间、住院天数、疼痛评分、术后复发率和相关并发症发生率等数据，比较两种术式治疗痔病的有效性和安全性，为临床提供依据。

方法

检索建库至2020年12月中国知网、万方、中国生物医学网、Pubmed、Cochrane Library、Embase，收集所有PPH和DGHAL治疗痔病的临床研究。由两名评价员独立进行文献筛选和数据提取，对纳入的研究进行异质性分析。

结果

最终纳入14项研究共1 316例患者，其中PPH组646例，DGHAL组670例。两组患者手术时间（WMD=1.58，95% CI：-2.40~5.55，P=0.44）、术后出血（OR=1.75，95% CI：0.96~3.19，P=0.07）及术后尿潴留（OR=1.47，95% CI：0.91~2.38，P=0.11）方面差异无统计学意义。DGHAL组住院天数（WMD=1.39，95% CI：0.59~2.20，P=0.000 7）和术后24 h疼痛评分（WMD=2.34，95% CI：1.10~3.58，P=0.000 2）均明显低于PPH组，差异均有统计学意义。DGHAL组术后复发率明显高于PPH组，差异有统计学意义（OR=0.62，95% CI：0.43~0.88，P=0.007）。PPH组术后肛门狭窄发生率13.68%（26/190），高于DGHAL组的5.79%（11/190），差异有统计学意义（OR=2.79，95% CI：1.31~5.98，P=0.008）。

结论

DGHAL术后肛门狭窄发生率低，术后恢复快，舒适度明显优于PPH，而在远期疗效方面PPH优于DGHAL。

关键词: 痔, 吻合器痔上黏膜环切钉合术, 多普勒超声引导下痔动脉结扎术, Meta分析
Objective

To evaluate the effectiveness and safety of procedure for prolapse and hemorrhoids (PPH) and Doppler-guided hemorrhoidal artery ligation (DGHAL) in the treatment of hemorrhoids by systematically analyzing the data of operation time, hospital stay, pain score, postoperative recurrence rate and related complication rates.

Methods

The full-text database of CNKI, Wanfang database, CBMdisc, Pubmed, Cochrane Library and Embase were retrieved from the date of their establishment to December 2020. All clinical studies of PPH and DGHAL in the treatment of hemorrhoids were collected. Two reviewers independently screened the literature and extracted the data, and analyzed the heterogeneity of the included studies.

Results

A total of 1 316 patients were included in 14 studies, including 646 in PPH group and 670 in DGHAL group. Meta analysis showed that there were no significant differences between the two groups in terms of operative time (WMD=1.58, 95% CI: -2.40-5.55; P=0.44), bleeding (OR=1.75, 95% CI: 0.96-3.19; P=0.07) and urinary retention (OR=1.47, 95% CI: 0.91-2.38; P=0.11). There were significant differences in the length of hospital stay (WMD=1.39, 95% CI: 0.59-2.20; P=0.000 7), and 24-hour pain score (WMD=2.34, 95% CI: 1.10-3.58, P=0.000 2). The recurrence rate of DGHAL group was significantly higher (OR=0.62, 95% CI:0.43-0.88, P=0.007). The incidence of anal stenosis in PPH group was 13.68% (26/190), which was higher than that in DGHAL group (5.79%, 11/190) (OR=2.79, 95% CI: 1.31-5.98, P=0.008).

Conclusions

DGHAL therapy is associated with significantly less rectal stenosis rate, postoperative recovery and pain. However, PPH is better than DGHAL in the long-term efficacy.

Key words: Hemorrhoid, Procedure for prolapse and hemorrhoids, Doppler-guided hemorrhoidal artery ligation, Meta analysis
表1 纳入研究的一般情况
序号 第一作者 发表年份（年） 国家 样本量（例） 年龄（岁） 性别（例） 随访（月）
PPH组 DGHAL组 PPH组 DGHAL组 男 女
1 Festen S[4] 2009 新西兰 18 23 35 39 29 12 26
2 Giordano P[5] 2011 英国 24 28 48 (35~78) 54 (23-73) 36 16 36
3 Infantino A[6] 2012 意大利 85 84 47.6±11.9 46.2±11.5 116 53 35
4 Lucarelii R[7] 2013 意大利 61 63 56 (52.7~59) 58 (56.6~60) 61 63 42
5 Tsang YP[8] 2014 中国 37 40 50.05±11.48 54.3±10.94 51 26 48
6 Beliard A[9] 2014 法国 27 54 47.4±9.7 51.2±12.6 45 36 24
7 Venturi M[10] 2016 意大利 35 35 50.2±4.4 49.5±5.3 35 35 36
8 魏巍[11] 2016 中国 58 54 56.5±21.5 48.0±25.0 82 30 33~38
9 Leardi S[12] 2016 意大利 50 50 56.3(36~78) 56.3(36~78) 未提 未提 84
10 董伍真[13] 2017 中国 48 48 45.79±11.65 45.81±11.66 44 52 18
11 金育雯[14] 2017 中国 63 51 52±3.2 50±7.3 55 59 18
12 于伟刚[15] 2018 中国 30 30 36.3±2.5 36.8±2.2 43 17 未提
13 袁泉良[16] 2018 中国 60 60 39.60±4.83 37.87±4.71 48 72 12
14 Giarratano [17] 2018 意大利 50 50 56±10.5 56±9.9 52 48 33.7
图1 偏倚风险图　A为总体偏倚，B为个体偏倚
图2 两组手术时间的Meta分析森林图　痔上黏膜环切钉合术（PPH）；多普勒超声引导下痔动脉结扎术（DGHAL）
图3 两组住院天数的Meta分析森林图　痔上黏膜环切钉合术（PPH）；多普勒超声引导下痔动脉结扎术（DGHAL）
图4 两组术后24 h VAS肛门疼痛评分的Meta分析森林图　痔上黏膜环切钉合术（PPH）；多普勒超声引导下痔动脉结扎术（DGHAL）
图5 两组术后复发率的Meta分析森林图　痔上黏膜环切钉合术（PPH）；多普勒超声引导下痔动脉结扎术（DGHAL）
图6 两组术后出血情况的Meta分析森林图　痔上黏膜环切钉合术（PPH）；多普勒超声引导下痔动脉结扎术（DGHAL）
图7 两组术后尿潴留发生率的Meta分析森林图　痔上黏膜环切钉合术（PPH）；多普勒超声引导下痔动脉结扎术（DGHAL）
图8 两组术后发生肛门狭窄情况的Meta分析森林图　痔上黏膜环切钉合术（PPH）；多普勒超声引导下痔动脉结扎术（DGHAL）
图9 痔上黏膜环切钉合术（PPH）组和多普勒超声引导下痔动脉结扎术（DGHAL）组术后24 h疼痛评分漏斗图
图10 痔上黏膜环切钉合术（PPH）组和多普勒超声引导下痔动脉结扎术（DGHAL）组术后复发率漏斗图
图11 痔上黏膜环切钉合术（PPH）组和多普勒超声引导下痔动脉结扎术（DGHAL）组术后肛门狭窄发生率漏斗图
[1]
Watson AJM, Hudson J, Wood J, et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (sTHoS): A pragmatic, multicentre, randomisedcontrolled trial[J]. Lancet, 2016, 388(10058): 2375-2385.
[2]
吕军. PPH配合外痔切除治疗混合痔疗效研究[J]. 现代消化及介入诊疗, 2016, 21(2): 254-255.
[3]
Guttenplan M. The evaluation and office management of hemorrhoids for the gastroenterologist[J]. Curr Gastroenterol Rep, 2017, 19(7): 30.
[4]
Festen S, van Hoogstraten MJ, van Geloven AA, et al. Treatment of grade Ⅲ and Ⅳ haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results[J]. Int J Colorectal Dis, 2009, 24: 1401-1405.
[5]
Giordano P, Nastro P, Davies A, et al. Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage Ⅱ and Ⅲ haemorrhoids: three-year outcomes[J]. Tech Coloproctol , 2011, 15: 67-73.
[6]
Infantino A, Altomare DF, Bottini C, et al. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Dopplerguided transanal haemorrhoid dearterialization for third-degree haemorrhoids [J]. Colorectal Dis, 2012, 14: 205-211.
[7]
Lucarelii R, Picchio M, Caporossi M, et al. Transanal haemorrhoidal dearterialisation with mucopexy versus stapler haemorrhoidopexy: A randomised trial with long-term follow-up[J]. Ann R Coll Surg Engl, 2013, 95(4): 246-251.
[8]
Tsang YP, Fok KL, Cheung YS, et al. Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease: A retrospective study and literature review [J]. Tech Coloproctol, 2014, 18(11): 1017-1022.
[9]
Beliard A, Labbe F, de Faucal D, et al. A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy[J]. J Visc Surg, 2014, 151(4): 257-262.
[10]
Venturi M, Salamina G, Vergani C. Stapled anopexy versus transanal hemorrhoidal dearterialization for hemorrhoidal disease: A three-year follow-up from a randomized study[J]. Minerva Chir, 2016, 71: 365-371.
[11]
魏巍，魏东，李荣先, 等. 吻合器痔上黏膜环切钉合术与多普勒超声引导下痔动脉结扎术治疗Ⅱ~Ⅲ度痔病的效果比较[J]. 中国当代医药, 2016, 23(8): 24-27.
[12]
Leardi S, Pessia B, Mascio M, et al. Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) versus stapled hemorrhoidopexy (SH) in the treatment of third-degree hemorrhoids: clinical results at short and long-term follow-up[J]. J Gastrointest Durg, 2016, 20(11): 1886-1890.
[13]
董伍真，蔡成，王建平, 等. PPH和DG-HAL用于混合痔治疗的效果比较[J]. 健康研究, 2017, 37(2): 160-163.
[14]
金育雯. 超声多普勒引导下痔动脉微创结扎术与吻合器痔切除术治疗Ⅲ度痔患者的疗效比较[J]. 医学临床研究, 2017, 34(2): 345-347.
[15]
于伟刚，王志刚. 超声多普勒引导下痔动脉结扎术治疗痔病的临床疗效观察[J]. 贵州医药, 2018, 42(9): 1073-1074.
[16]
袁泉良，张庆东. 超声多普勒痔动脉结扎术与吻合器上黏膜环切术治疗Ⅲ度混合痔的临床疗效比较[J]. 安徽医学, 2018, 39(12): 1475-1478.
[17]
Giarratano G, Toscana E, Toscana C, et al. Transanal hemorrhoidal dearterialization versus stapled hemorrhoidopexy: long-term follow-up of a prospective randomized study[J]. Surg Innov, 2018, 25(3): 236-241.
[18]
Picchio M, Greco E, Di Filippo A, et al. Clinical outcome following hemorrhoid surgery: A narrative review[J]. Indian J Surg, 2015, 77(Suppl 3): 1301-1307.
[19]
Avital S, Inbar R, Karin E, et al. Five-year follow-up of Doppler-guided hemorrhoidal artery ligation[J]. Tech Coloproctol, 2012, 16(1): 61-65.
[20]
Greenberg R, Karin E, Avital S, et al. First 100 cases with Doppler-guided hemorrhoidal artery ligation[J]. Dis Colon Rectum, 2006, 49(4): 485-489.
[21]
Avital S, Itah R, Skornick Y, et al. Outcome of stapled hemorrhoidopexy versus Doppler-guided hemorrhoidal artery ligation for grade Ⅲ hemorrhoids[J]. Tech Coloproctol, 2011, 15(3): 267-271.
[22]
Cheetham MJ, Mortensen NJ, Nystrom PO, et al. Persistent pain and faecal urgency after stapled haemorrhoidectomy[J]. Lancet, 2000, 356(9231): 730-733.
[23]
Porrett LJ, Porrett JK, Ho YH. Documented complications of staple hemorrhoidopexy: A systematic review[J]. Int Surg, 2015, 100(1): 44-57.
[24]
Jongen J, Bock J. Pain after stapled haemorrhoidectomy[J]. Lancet, 2000, 356(9248): 2187.
[25]
Khubchandani I, Fealk MH, Reed JF. Is there a post-PPH syndrome?[J]. Tech Coloproctol, 2009, 13(2): 141-144.
[26]
Porrett LJ, Porrett JK, Ho YH. Documented complications of staple hemorrhoidopexy: A systematic review[J]. Int Surg, 2015, 100(1): 44-57.
[27]
Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter[J]. Am J Gastroenterol, 1995, 90(4): 610-613.
[28]
Liu H, Yang C, Chen B, et al. Clinical outcomes of Doppler - guided haemorrhoids artery ligation: A Meta analysis[J]. Int J Clin Exp Med, 2015, 8(4): 4932-4939.
[29]
Ratto C, De PV. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future[J]. J Visc Surg, 2015, 152(Suppl 2): S15-21.
[30]
Ravo B, Amato A, Bianco V, et al. Complications after stapled hemorrhoidectomy, can they be prevented[J]. Tech Coloproctol, 2002, 6: 83-88.
[31]
Petersen S, Hellmich G, Schumann D, et al. Early rectal stenosis following stapled rectal mucosectomy for hemorrhoids[J]. BMC Surger, 2004, 4(1): 6-10.
[32]
孙壮，杨宇慎，宫爱民, 等.肠镜下长城式切开环切法治疗吻合器痔上黏膜环切术术后重度吻合口狭窄的临床疗效[J]. 实用医学杂志, 2020, 36(4): 475-478.
[1] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[3] 吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[4] 程鹏, 杨道鸿, 邓文君, 钟宇琼, 胡晓雪, 黄小银, 周道扬. 纤维蛋白原治疗创伤性凝血病有效性和安全性的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 225-231.
[5] 沈皓, 张驰, 韩旻轩, 陆晓庆, 周愉, 周莉丽. 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 175-184.
[6] 郭仁凯, 武慧铭, 李辉宇. 机器人辅助全系膜切除术治疗右半结肠癌有效性和安全性的Meta分析及试验序贯分析[J/OL]. 中华普通外科学文献(电子版), 2024, 18(03): 234-240.
[7] 朱俊佳, 孙琦, 徐文龙, 陆天宇, 冯强, 储涛, 邢春根, 高春冬, 俞一峰, 赵振国. 永久性结肠造口预防性补片置入对预防造口旁疝价值的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 336-342.
[8] 王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[9] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[10] 龚财芳, 赵俊宇, 游川. 围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 551-556.
[11] 刘蕊, 李乐, 陈金明, 李鑫. 急性胆管炎严重程度与血清标志物相关性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 176-181.
[12] 郁凯, 曾保起, 杨剑, 杨杰, 张殿英, 孙凤. 全关节镜与切开手术治疗肩袖撕裂疗效比较的系统综述与Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 238-245.
[13] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[14] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
[15] 周宁, 尹晓岳, 孙琢玉, 杨学礼, 鲍颖慧, 赵敏, 李伯妍, 刘淼, 谢娟. 腹腔镜与开腹结直肠癌根治术的成本和临床疗效Meta分析[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(02): 105-111.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号