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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
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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]. 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]. 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
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