Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, UK.
Microsurgery. 2012 Mar;32(3):240-50. doi: 10.1002/micr.20971. Epub 2012 Mar 8.
Although there are numerous case reports and small case series describing the experiences of leech therapy in various circumstances, there are relatively few large studies evaluating the effectiveness of leeching to relieve venous congestion. The therapeutic value of leeching is illustrated by these reports but the current literature lacks a cohesive summary of previous experiences.
An electronic search of PubMed, the Cochrane library and the Centre for Reviews and Dissemination between 1966 and 2009 was used to retrieve human studies published in the English language evaluating outcomes following leech therapy. The "success" and "failure" of leech therapy were the primary outcome measures and secondary outcomes included complications, number of leeches used, pharmacological adjuncts and blood transfusion requirements.
In total, out of 461 articles, 394 articles met the exclusion criteria. The 67 included papers reported on 277 cases of leech use with an age range of 2-81 years and a male to female ratio of almost 2:1. The overall reported "success" rate following leech therapy was 77.98% (216/277). In terms of secondary outcome measures, 49.75% of cases (N = 101) required blood transfusions, 79.05% received antibiotics (N = 166) and 54.29% received concomitant anticoagulant therapy. The overall complication rate was 21.8%.
In the absence of robust randomized controlled trials on which the evidence may be based, this synthesis of current best evidence guides clinicians during the process of consenting patients and using leeches in their practice.
尽管有许多病例报告和小病例系列描述了在各种情况下使用水蛭疗法的经验，但评估水蛭缓解静脉充血的有效性的大型研究相对较少。这些报告说明了水蛭疗法的治疗价值，但目前的文献缺乏对以往经验的综合总结。
通过电子检索 1966 年至 2009 年间在 PubMed、Cochrane 图书馆和综述传播中心发表的英文人类研究，以检索评估水蛭疗法后结果的研究。水蛭治疗的“成功”和“失败”是主要的观察指标，次要结果包括并发症、使用的水蛭数量、药理学辅助治疗和输血需求。
在总共 461 篇文章中，有 394 篇文章符合排除标准。纳入的 67 篇论文报告了 277 例使用水蛭的病例，年龄范围为 2-81 岁，男女比例接近 2:1。水蛭治疗后总体报告的“成功率”为 77.98%（216/277）。就次要观察指标而言，49.75%的病例（N=101）需要输血，79.05%的病例（N=166）接受抗生素治疗，54.29%的病例（N=166）接受同时抗凝治疗。总的并发症发生率为 21.8%。
由于缺乏基于证据的稳健随机对照试验，因此目前最佳证据的综合总结可指导临床医生在同意患者并在实践中使用水蛭时的过程。
