Ho Y H, Buettner P G
School of Medicine and North Queensland Centre for Cancer Research, James Cook University, Townsville, QLD 4811, Australia.
Tech Coloproctol. 2007 Jun;11(2):135-43. doi: 10.1007/s10151-007-0343-0. Epub 2007 May 25.
This review compares the most popular techniques in managing the wounds after excisional haemorrhoidectomy, which are either to lay the wounds open or to close them.
Randomized controlled trials were identified from the major electronic databases using the search terms "hemorrhoid*" and "haemorrhoid*." Duration of operation, pain, length of hospital stay, time off work, time for wound healing, patient satisfaction, continence, manometry findings and complications were assessed. Quantitative meta-analysis was performed as appropriate or possible.
Six trials including 686 patients met the inclusion criteria. The median follow-up time ranged from 1.5 to 19.5 months. Quantitative meta-analysis showed that there was no significant difference in cure rates between the two techniques (relative risk, 1.4; 95% CI, 0.86 to 2.2; p=0.191). Open haemor-rhoidectomy was more quickly performed (weighted mean difference, 1.03 min; 95% CI, 0.51 to 1.54; p<0.001). Closed haemorrhoidectomy wounds showed faster healing (weighted mean difference, 1.2 weeks; 95% CI, 0.88 to 1.55; p<0.001). Hospital stay, maximum pain score, total and individual complication rates were not significantly different.
Apart from faster wound healing after closed haemorrhoidectomy, open and closed techniques appeared equally effective and safe. However, there were only a few studies which presented information in different ways, and statistical heterogeneity was high.
本综述比较了痔切除术后伤口处理最常用的两种方法，即开放伤口和闭合伤口。
通过检索主要电子数据库，使用检索词“hemorrhoid*”和“haemorrhoid*”来识别随机对照试验。评估手术持续时间、疼痛程度、住院时间、误工时间、伤口愈合时间、患者满意度、控便能力、测压结果及并发症情况。酌情或尽可能进行定量荟萃分析。
六项试验共686例患者符合纳入标准。中位随访时间为1.5至19.5个月。定量荟萃分析表明，两种技术的治愈率无显著差异（相对危险度为1.4；95%可信区间为0.86至2.2；p = 0.191）。开放式痔切除术的手术速度更快（加权平均差为1.03分钟；95%可信区间为0.51至1.54；p < 0.001）。闭合式痔切除术的伤口愈合更快（加权平均差为1.2周；95%可信区间为0.88至1.55；p < 0.001）。住院时间、最大疼痛评分、总体及个体并发症发生率无显著差异。
除闭合式痔切除术后伤口愈合更快外，开放式和闭合式技术似乎同样有效且安全。然而，仅有少数研究以不同方式呈现信息，且统计异质性较高。
