基于倾向性评分匹配的消痔灵单层八步与双层四步注射治疗直肠脱垂的疗效比较  

Comparison of the efficacy of single-layer, eight-step versus double-layer, four-step injections of Xiaozhiling for rectal prolapse based on propensity score matching

作　　者：陈琴[1,2] 王晓锋 贝绍生[1] 李华山[1] CHEN Qin;WANG Xiao-feng;BEI Shao-sheng;LI Hua-shan(Guang anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Kunming Municipal Hospital of Traditional Chinese Medicine,Kunming 650011,China)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]昆明市中医医院,昆明650011

出　　处：《中华中医药杂志》2022年第10期6148-6152,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(No.81673988)。

摘　　要：目的:比较消痔灵单层八步与双层四步注射治疗直肠脱垂的疗效差异。方法:采用回顾性队列研究,纳入2009年1月至2019年12月于中国中医科学院广安门医院行消痔灵注射的150例直肠脱垂患者,分为单层八步组(84例)和双层四步组(66例),对两组患者进行1∶1倾向性评分匹配,比较两组患者近期治愈率、总有效率,并发症和不良事件的发生,及远期复发情况。结果:经倾向性评分匹配后,两组各纳入49例患者,近期总有效率相当。与双层四步组比较,单层八步组治愈率显著提高(P<0.05)。两组并发症、不良事件的发生等级均为轻度,并发症的总发生率差异无统计学意义。在不良事件的总发生率方面,单层八步组略高于双层四步组(P<0.05),其中单层八步组发生小腹坠痛例数多于双层四步组(P<0.05)。远期随访中,单层八步组与双层四步组总复发率差异无统计学意义(P=0.152)。单层八步组术后3个月、6个月、1年、2年、3年、5年累积无复发生存率分别为95.9%、91.8%、87.6%、73.4%、58.2%、31.0%,双层四步组则分别为87.8%、79.6%、66.7%、49.4%、38.4%、25.8%,差异有统计学意义(P<0.05)。单层八步组无复发中位生存时间为60个月[95%CI(45.2,74.8)],双层四步组则为24个月[95%CI(11.4,36.6)]。结论:消痔灵单层八步注射虽然会增加轻度小腹坠痛的发生,但仍然安全有效,且近期治愈率更高,远期累积无复发生存率更高,无复发中位生存时间更长,较双层四步注射具有一定的优势。Objective:To compare the difference in efficacy between single-layer eight-step and double-layer four-step injections of Xiaozhiling for rectal prolapse.Methods:A retrospective cohort study was used to include 150 patients with rectal prolapse who underwent Xiaozhiling in Guang’anmen Hospital,China Academy of Chinese Medical Sciences from January 2009to December 2019,divided into a single-layer eight-step group(84 patients)and a double-layer four-step group(66 patients),and patients in both groups were matched on a 1:1 propensity score to compare the recent cure rate,total effective rate,complications and adverse events in both groups occurrence,and distant recurrence.Results:After propensity score matching,49 patients were included in each of the two groups.The recent overall effective rate was comparable in both groups.The cure rate was significantly higher in the single-layer eight-step group compared with the double-layer four-step group(P<0.05).The grade of complications and adverse events were mild in both groups,and the total incidence of complications was not statistically different.Regarding the total incidence of adverse events,the single-layer eight-step group was slightly higher than the double-layer four-step group(P<0.05),with more cases of small abdominal cramps in the single-layer eight-step group than in the double-layer four-step group(P<0.05).In the long-term follow-up,there was no difference in the overall recurrence rate between the single-layer eight-step group and the double-layer four-step group(P=0.152).The cumulative recurrence-free survival rates in the single-layer eight-step group at 3 months,6 months,1 year,2 years,3 years,and 5 years after surgery were 95.9%,91.8%,87.6%,73.4%,58.2%,and 31.0%,respectively.For the double-layer four-step group,87.8%,79.6%,66.7%,49.4%,38.4%,and 25.8%,respectively,with statistically significant differences(P<0.05).The median survival time without recurrence was 60 months[95%CI(45.2,74.8)]in the single-layer eight-step group and 24 months[95%CI(11.4,36.

关 键 词：消痔灵 直肠脱垂 单层八步注射 双层四步注射 倾向性评分匹配 

分 类 号：R266[医药卫生—中医外科学]