Bhatti Muhammad I, Sajid Muhammad Shafique, Baig Mirza K
Department of General & Colorectal Surgery, NHS Foundation Trust, Queen Elizabeth Hospital, King's Lynn, Gayton Road, King's Lynn, Norfolk, PE30 4ET, UK.
Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals, NHS Foundation Trust, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK.
World J Surg. 2016 Jun;40(6):1509-19. doi: 10.1007/s00268-016-3419-z.
The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD).
RCTs on the effectiveness of CH and OH in the management of HD were analysed systematically using RevMan(®), and combined outcome was expressed as odds ratio (OR) and standardized mean difference.
Eleven CRTs encompassing 1326 patients were analysed systematically. There was significant heterogeneity among included trials. Therefore, in the random effects model, CH was associated with a reduced post-operative pain (SMD, -0.36; 95 % CI, -0.64, -0.07; z = 2.45; p = 0.01), faster wound healing (OR, 0.08; 95 % CI, 0.02, 0.24; z = 4.33; p < 0.0001), lesser risk of post-operative bleeding (OR, 0.50; 95 % CI, 0.27, 0.91; z = 2.27; p < 0.02) and prolonged duration of operation (SMD, 6.10; 95 % CI, 3.21, 8.98; z = 4.13; p < 0.0001). But the variables such as pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups.
CH has clinically measurable advantages over OH in terms of reduced post-operative pain, lower risk of post-operative bleeding and faster wound healing.
本文旨在系统分析比较弗格森或闭合式痔切除术（CH）与开放式痔切除术（OH）或Milligan-Morgan痔切除术治疗痔病（HD）的随机对照试验（RCT）。
使用RevMan（®）系统分析CH和OH治疗HD有效性的RCT，并将合并结果表示为比值比（OR）和标准化均数差。
系统分析了11项包含1326例患者的CRT。纳入试验间存在显著异质性。因此，在随机效应模型中，CH与术后疼痛减轻（标准化均数差，-0.36；95%可信区间，-0.64，-0.07；z = 2.45；p = 0.01）、伤口愈合更快（OR，0.08；95%可信区间，0.02，0.24；z = 4.33；p < 0.0001）、术后出血风险更低（OR，0.50；95%可信区间，0.27，0.91；z = 2.27；p < 0.02）和手术时间延长（标准化均数差，6.10；95%可信区间，3.21，8.98；z = 4.13；p < 0.0001）相关。但两组在排便疼痛（标准化均数差，-0.33；95%可信区间，-0.68，-0.03；z = 1.82；p = 0.07）、住院时间、术后并发症、HD复发及手术部位感染风险等变量方面相似。
在减轻术后疼痛、降低术后出血风险和加快伤口愈合方面，CH相对于OH具有临床可测量的优势。
