Quan Longfang, Bai Xuelian, Cheng Fang, Chen Jin, Ma Hangkun, Wang Pengfei, Yao Ling, Bei Shaosheng, Jia Xiaoqiang
Department of Anorectal, Xiyuan Hospital of China Academy of Traditional Chinese Medicine, No. 1 Road Xi Yuan Cao Chang, Haidian District, Beijing, 100091, China.
Department of Management, Xiyuan Hospital of China Academy of Traditional Chinese Medicine 100091, Beijing, China.
BMC Gastroenterol. 2025 Jul 1;25(1):492. doi: 10.1186/s12876-025-04089-2.
OBJECTIVES: Hemorrhoids, a common anorectal condition, can be managed through surgical or conservative treatments. The aim of this meta-analysis is to compare the efficacy and safety of surgical and conservative treatments for hemorrhoids. METHODS: A systematic search was conducted from of PubMed, Embase, the Cochrane Library, and Web of Science from their inception to September 25, 2024. Eligible studies compared surgical treatments with non-invasive conservative treatments in hemorrhoids. Statistical analyses included pooled odds ratios (ORs) and mean differences (MDs)/standard mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS: Seven studies, including 760 patients, were analyzed. Surgery achieved higher rates of complete symptom resolution than conservative therapy (OR = 2.96, 95% CI: 1.66-5.28, p < 0.001). Overall pain scores favored surgery (SMD = -0.93, 95% CI: 1.73 to -0.13, p = 0.02). Subgroup analysis showed clear superiority within four days (SMD = -1.26, 95% CI -1.84 to -0.68) but parity beyond ten days (SMD = 0.00, 95% CI -0.44 to 0.44; p = 0.99). Comparable patterns were observed in pregnant women with thrombosed external hemorrhoids. Rates of postoperative bleeding (OR: 1.09; 95% CI: 0.42 to 2.82, p = 0.86; I2 = 41%, p = 0.15) and urinary retention (OR: 1.75; 95% CI: 0.30 to 10.31, p = 0.54; I2 = 45%, p = 0.18) did not differ significantly between groups. Surgical-specific adverse events were infrequent (incontinence 3%, persistent pain 5%, watery discharge 6%). Surgery shortened recovery in pregnant thrombosed cases by approximately seven days (MD: -6.80; 95% CI: -7.64 to -5.96, p < 0.001; I2 = 55%, p = 0.14) and reduced overall recurrence (95% CI: 0.10 to 0.37, p < 0.001; I2 = 0%, p = 0.97). CONCLUSION: Surgical treatments provide superior symptom relief, faster recovery, and lower recurrence but with some specific post-treatment complications, while conservative treatments are safer and less invasive but with provides slower symptom relief and higher recurrence rates. Individualized treatment should consider symptom severity, patient preferences, and risk tolerance.
目的：痔疮是一种常见的肛肠疾病，可通过手术或保守治疗。本荟萃分析的目的是比较痔疮手术治疗和保守治疗的疗效及安全性。 方法：从PubMed、Embase、Cochrane图书馆和Web of Science数据库建库至2024年9月25日进行系统检索。纳入的研究比较了痔疮的手术治疗与非侵入性保守治疗。统计分析包括合并比值比（OR）和平均差（MD）/标准化平均差（SMD）及95%置信区间（CI）。 结果：分析了7项研究，共760例患者。手术治疗比保守治疗实现完全症状缓解的比例更高（OR = 2.96，95% CI：1.66 - 5.28，p < 0.001）。总体疼痛评分倾向于手术治疗（SMD = -0.93，95% CI：-1.73至-0.13，p = 0.02）。亚组分析显示，4天内手术明显更具优势（SMD = -1.26，95% CI -1.84至-0.68），但10天后两者相当（SMD = 0.00，95% CI -0.44至0.44；p = 0.99）。血栓性外痔孕妇中观察到类似模式。术后出血率（OR：1.09；95% CI：0.42至2.82，p = 0.86；I² = 41%，p = 0.15）和尿潴留率（OR：1.75；95% CI：0.30至10.31，p = 0.54；I² = 45%，p = 0.18）在两组间无显著差异。手术特有的不良事件较少见（大便失禁3%，持续性疼痛5%，分泌物增多6%）。手术使血栓性外痔孕妇的恢复时间缩短约7天（MD：-6.80；95% CI：-7.64至-5.96，p < 0.001；I² = 55%，p = 0.14），并降低了总体复发率（95% CI：0.10至0.37，p < 0.001；I² = 0%，p = 0.97）。 结论：手术治疗能提供更好的症状缓解、更快的恢复和更低的复发率，但存在一些特定的治疗后并发症，而保守治疗更安全、侵入性更小，但症状缓解较慢且复发率较高。个体化治疗应考虑症状严重程度、患者偏好和风险承受能力。
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