Department of Anorectal Surgery, Panjin Central Hospital, Panjin, 124000, China.
Department of Anorectal Surgery, The First Hospital of China Medical University, Shenyang, 110000, China.
Int J Colorectal Dis. 2019 Jun;34(6):1001-1012. doi: 10.1007/s00384-019-03288-0. Epub 2019 Mar 30.
This study aimed to investigate the complications and recurrence rates of the different surgical procedures implemented in recent years for the treatment of grade III and IV hemorrhoids using a network meta-analysis approach.
A systematic literature search was conducted for randomized clinical trials (RCTs) published from January 2013 to August 2018, via PubMed, Embase, the Cochrane Library, and Web of Science. Data related to anal stenosis, fecal incontinence, hemorrhoids thrombosis, and recurrence rates were extracted from the included studies, which were selected based on associations with surgical procedures for grade III and IV hemorrhoids. A network meta-analysis was conducted by using the automated software Aggregate Data Drug Information System (ADDIS) 1.16.8 to evaluate and rank the safety and efficacy of the different surgical methods.
Twenty-one studies with 2799 participants involving nine surgical procedures for grade III and IV hemorrhoids were ultimately analyzed. Transanal hemorrhoidal dearterialization (THD) and stapled hemorrhoidectomy (SH) exhibited fewer anal stenosis than open hemorrhoidectomy (OH) and Harmonic scalpel (Harmonic). SH presented the highest fecal incontinence rates. OH and Harmonic presented lower hemorrhoids thrombosis than SH and THD. Importantly, SH and THD exhibited the highest recurrence rates, when compared with the other hemorrhoidectomy surgical procedures.
In summary, THD and SH were found to be associated with more complications and higher recurrence rates. In addition, the use of OH treatments resulted in less hemorrhoids thrombosis rate but higher recurrence rate. The use of Harmonic resulted in higher anal stenosis rate but lower recurrence rate.
本研究旨在采用网络荟萃分析方法调查近年来用于治疗 III 度和 IV 度痔的不同手术方法的并发症和复发率。
通过 PubMed、Embase、Cochrane 图书馆和 Web of Science 对 2013 年 1 月至 2018 年 8 月发表的随机临床试验（RCT）进行了系统的文献检索。从纳入的研究中提取与肛门狭窄、粪便失禁、痔血栓形成和复发率相关的数据，这些研究是根据与 III 度和 IV 度痔的手术程序的关联而选择的。使用自动软件 Aggregate Data Drug Information System (ADDIS) 1.16.8 进行网络荟萃分析，以评估和排名不同手术方法的安全性和疗效。
最终分析了 21 项研究，共 2799 名参与者，涉及 9 种 III 度和 IV 度痔的手术方法。经肛门直肠动脉结扎术（THD）和吻合器痔切除术（SH）比开放式痔切除术（OH）和 Harmonic 刀（Harmonic）引起的肛门狭窄更少。SH 的粪便失禁发生率最高。OH 和 Harmonic 的痔血栓形成率低于 SH 和 THD。重要的是，与其他痔手术程序相比，SH 和 THD 表现出最高的复发率。
总之，THD 和 SH 与更多的并发症和更高的复发率相关。此外，OH 治疗导致痔血栓形成率较低但复发率较高。使用 Harmonic 导致肛门狭窄率较高但复发率较低。
