吻合器痔上黏膜环形切除术与Milligan-Morgan术的安全性和有效性随机对照研究的系统评价

目的比较吻合器痔上黏膜环形切除术(PPH)与Milligan-Morgan术(MMH)的安全性和有效性。方法共检索出符合入选标准的随机对照临床实验10项,采用固定效应模型和随机效应模型对PPH与MMH的安全性和有效性指标进行Meta分析。结果与MMH相比,PPH在缩短手术时间和住院时间、减轻术后疼痛、肛门分泌物、患者满意度等有效性方面有一定优势;但术后残留皮赘和痔脱垂复发更为常见。在术后出血、尿潴留、排便困难、肛裂、肛门狭窄、内括约肌损伤、正常活动的恢复、肛门失禁和瘙痒、肛管静息压和收缩压变化及镇痛的需求方面未见明显优势。结论PPH至少和MMH一样安全。其有效性仍需有长期随访的更大宗病例研究进一步证实。

Safety and efficacy of procedure for prolapse and hemorrhoids in the treatment of severe hemorrhoids:a systematic review of 10 randomized controlled trials

Objective To compare the safety and efficacy of procedure for prolapse and hemorrhoids (PPH)with Milligan-Morgan haemorrhoidectomy (MMH) in the treatment of severe hemorrhoids. Methods Data of safety and efficacy in 10 randomized controlled trials were meta-analyzed using fixed effect model or random effect model. Results There was reasonably clear evidence in favor of PPH for operating time, hospital stay, pain, anal discharge, and patients satisfaction. However, acrochordons and prolapse were more common in PPH group. PPH was not more superior than MMH as bleeding, urinary retention, difficult defecating, anal fissure and stenosis, sphincter damage, resumption of normal activities, incontinence, pruritus, anal resting and squeeze pressures, analgesia. Conclusions PPH may be at least as safe as MMH. However, the efficacy of PPH compared with MMH could not be determined absolutely. More rigorous studies with longer follow-up and larger sample size need to be conducted.