选择性痔上粘膜切除吻合术与吻合器痔上黏膜切除术治疗混合痔对照研究的系统评价
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摘要
目的评价选择性痔上粘膜切除吻合术(TST)与吻合器痔上黏膜环形切除术(PPH)在混合痔治疗中的安全性和有效性。方法检索中国知网、万方数据、维普资讯、PubMed、Cochrane Library、EMBASE等数据库中比较TST和PPH治疗混合痔的临床研究,研究采用Newcastle-Ottawa Scale(NOS)量表评价文献质量,评分≥5分的研究纳入该系统评价。采用Review Manager 5.3软件的固定效应模型和随机效应模型对两种术式的安全性和有效性指标进行Meta分析。结果共检索到158篇相关文献,经过筛选,最终纳入45篇文献。合计纳入4695例患者,TST组2359例,PPH组2336例。Meta分析显示:与PPH相比,TST在减少术中出血、缩短术后愈合时间、减轻术后并发症、增加患者有效率等方面拥有明显优势,分析结果存在统计学意义。结论对于混合痔的治疗,TST与PPH两种术式相比较,TST具有较好的疗效,更小的并发症风险。
Objective To compare the safety and efficacy of TST(Tissue-Selecting Therapy Stapler) and PPH(Procedure for Prolapse and Hemorrhoids) in the treatment of the mixed hemorrhoids. Methods CNKI、WANFANG data、VIP、PubMed, Cochrane Library and EMBASE database were searched for clinical studies comparing the TST(Tissue-Selecting Therapy Stapler) and PPH(Procedure for Prolapse and Hemorrhoids) for mixed hemorrhoids. The Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of the studies and the score not less than 5 points was the inclusion criteria. Data of safety and efficacy in clinical trials were Metaanalyzed using fixed effect model or random effect model by Review Manager 5.3 software. Results A total of 158 articles were retrieved and 45 articles were enrolled finally. A total of 4695 patients were enrolled, including 2359 cases of TST and 2336 cases of PPH. Meta-analysis revealed that there was reasonably clear evidence in favor of TST for intraoperative bleeding, postoperative healing time, postoperative complications and patient satisfaction. And there were statistical differences between the analysis results.Conclusions In the treatment of mixed hemorrhoids, TST has a good effect, the risk of minor complications, compared with PPH.However, considering the extent to be a surrogate for PPH as a new standard for treatment of hemorrhoids, more rigorous studies with multicenter large scale and high-quality randomized controlled trials are required to validate the current results.
Objective To compare the safety and efficacy of TST(Tissue-Selecting Therapy Stapler) and PPH(Procedure for Prolapse and Hemorrhoids) in the treatment of the mixed hemorrhoids. Methods CNKI、WANFANG data、VIP、PubMed, Cochrane Library and EMBASE database were searched for clinical studies comparing the TST(Tissue-Selecting Therapy Stapler) and PPH(Procedure for Prolapse and Hemorrhoids) for mixed hemorrhoids. The Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of the studies and the score not less than 5 points was the inclusion criteria. Data of safety and efficacy in clinical trials were Metaanalyzed using fixed effect model or random effect model by Review Manager 5.3 software. Results A total of 158 articles were retrieved and 45 articles were enrolled finally. A total of 4695 patients were enrolled, including 2359 cases of TST and 2336 cases of PPH. Meta-analysis revealed that there was reasonably clear evidence in favor of TST for intraoperative bleeding, postoperative healing time, postoperative complications and patient satisfaction. And there were statistical differences between the analysis results.Conclusions In the treatment of mixed hemorrhoids, TST has a good effect, the risk of minor complications, compared with PPH.However, considering the extent to be a surrogate for PPH as a new standard for treatment of hemorrhoids, more rigorous studies with multicenter large scale and high-quality randomized controlled trials are required to validate the current results.
引文
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