内扎外剥缝合术与外剥内扎术治疗混合痔疗效及安全性的Meta分析  

The efficacy and safety of ferguson hemorrhoidectomy(closed)versus milligan-morgan hemorrhoidectomy(open)in the treatment of mixed hemorrhoids:a Meta-analysis

作　　者：任航军 孙毅 敖小青 申燕 张佳敏[1] 陆森[2] Hangjun Ren;Yi Sun;Xiaoqing Ao;Yan Shen;Jiamin Zhang;Sen Lu(Department of General Surgery,the First Affiliated Hospital of Zhejiang University School of Medicine,Liangzhu Branch(The First People's Hospital of Yuhang District,Hangzhou),Hangzhou 311113,China;Department of Colorectal Surgery,the First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 311100,China)

机构地区：[1]浙江大学医学院附属第一医院良渚分院(杭州市余杭区第一人民医院)普外科,311113 [2]浙江大学医学院附属第一医院结直肠外科,杭州311100

出　　处：《中华结直肠疾病电子杂志》2025年第1期71-82,共12页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：浙江省中医药科技计划项目(No.2023ZL611)。

摘　　要：目的系统评价外剥内扎术与内扎外剥缝合术治疗混合痔的疗效性和安全性,为术式选择提供循证证据。方法检索知网、万方、维普、CBM、PubMed数据库,收集内扎外剥缝合术(研究组)对比外剥内扎术(对照组)的随机对照试验(RCT),检索年限为2000年1月至2024年5月。筛选并提取文献信息后用Cochrane系统评价推荐的偏倚评估工具评估文献质量;用STATA 17.0软件做Meta分析、敏感性分析、发表偏倚分析及回归分析。结果共纳入30个RCT,共3505例患者。Meta分析显示:与对照组相比,内扎外剥缝合术治愈率更高[RR=1.16,95%CI(1.08~1.25),P<0.01]、创面愈合时间更短[SMD=-1.90,95%CI(-2.32~-1.48),P<0.01]、手术时间更短[SMD=-2.68,95%CI(-4.70~-0.65),P=0.01]、术中出血量更少[SMD=-6.94,95%CI(-10.96~-2.91),P<0.01]、术后第一次排便VAS评分更低[SMD=-0.85,95%CI(-1.42~-0.29),P<0.01]、术后出血概率较低[RR=0.65,95%CI(0.51~0.82),P<0.01]、住院时间更短[SMD=-0.92,95%CI(-1.63~-0.22),P=0.01]、术后大便困难少见[RR=0.24,95%CI(0.07~0.81),P=0.02],但术后发生创面裂开的概率较高[RR=7.66,95%CI(2.56~22.97),P<0.01]。两种术式的切口感染发生率、术后疼痛、水肿、尿潴留、肛裂、肛门清洁度、肛门狭窄、术后24小时VAS评分、恢复工作时间、复发率经比较,差异均无统计学意义(均P>0.05)。敏感性分析结果显示,本研究结果稳健性较好。发表偏倚风险分析显示可能存在发表偏倚。结论内扎外剥缝合术疗效整体优于外剥内扎术,内扎外剥缝合术治愈率更高、创面愈合时间短,并不增加切口感染发生率及肛门狭窄率,是一个安全有效的术式。Objective To systematically evaluate the efficacy and safety of Ferguson Hemorrhoidectomy(Closed)versus Milligan-Morgan Hemorrhoidectomy(Open)for the treatment of mixed hemorrhoids and to provide an evidence-based basis for surgical protocols.Methods CNKI,Wanfang,WIP,CBM and PubMed databases were searched to collect randomized controlled trials(RCTs)of closed hemorrhoidectomy(the study group)versus open hemorrhoidectomy(the control group),and the years of searching were from January 2000 to May 2024.The quality of the literature was assessed using the bias assessment tool recommended by Cochrane Systematic Reviews after screening and extracting the literature information;Meta-analysis,sensitivity analysis,publication bias analysis and regression analysis were done using STATA 17.0 software.Results A total of 30 RCTs with 3505 patients were included.Meta-analysis showed that compared with open hemorrhoidectomy,closed hemorrhoidectomy had a higher cure rate[RR=1.16,95%CI(1.08~1.25),P<0.01],shorter wound healing time[SMD=-1.90,95%CI(-2.32~-1.48),P<0.01],shorter operative time[SMD=-2.68,95%CI(-4.70~-0.65),P=0.01],less intermediate bleeding[SMD=-6.94,95%CI(-10.96~-2.91),P<0.01],and lower VAS scores on the first postoperative bowel movement[SMD=-0.85,95%CI(-1.42~-0.29),P<0.01],lower probability of postoperative bleeding[RR=0.65,95%CI(0.51~0.82),P<0.01],shorter hospital stay[SMD=-0.92,95%CI(-1.63~-0.22),P=0.01]and less frequent postoperative bowel difficulties[RR=0.24,95%CI(0.07~0.81),P=0.02],but the probability of postoperative trabecular dehiscence was higher[RR=7.66,95%CI(2.56~22.97),P<0.01].The differences in the rates of trabecular infection,postoperative pain,edema,urinary retention,anal fissure,anal cleanliness,anal stenosis,24-hour postoperative VAS scores,return to work time,and recurrence rates between the two surgical procedures were not statistically significant(all P>0.05).The results of sensitivity analysis showed that the robustness of the results of this study was good.The risk of publication bias analys

关 键 词：痔 混合痔 外剥内扎术 内扎外剥缝合术 META 分析 

分 类 号：R65[医药卫生—外科学]