中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (12): 1012-1017.

• 论著 • 上一篇    下一篇

PPH术后复发与皮赘残留：应注意区分两者

高显华1，傅传刚1， Paul Fallah?wandalachi Nabieu2   

  1. 1第二军医大学附属长海医院肛肠外科，上海200433；2 塞拉利昂 弗里敦市第34陆军医院
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-12-18 发布日期:2009-12-18

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-12-18 Published:2009-12-18

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摘要：

目的 探讨吻合器痔上黏膜环形切除钉合术（PPH）术后痔复发的定义。方法 通过多种途径收集2001年1月至2008年10月相关中英文文献，用Meta分析比较两者痔的复发率和术后皮赘残留率。结果 对中文文献的汇总结果显示，PPH术后皮赘残留率为13.94%，PPH术后平均复发率为3.23%（0.40%～26.44%）。中文文献的Meta分析结果显示PPH术后的复发率低于传统痔切除术（CH）［13个研究，OR 0.27, 95%CI（0.17，0.42），P<0.00001］，PPH术后皮赘残留率高于CH［6个研究，OR 3.42，95%CI（0.49，24.04），P=0.22］。对英文文献的Meta分析结果显示PPH术后复发率高于CH［17个研究，PPH组636例，CH组625例，OR 2.96，95%CI（1.57，5.56）；P=0.0008］，PPH术后皮赘残留率高于CH［8个研究，PPH组297例，CH组289例，OR 1.88，95%CI（1.15, 3.05）；P=0.01］。但是只有6个英文研究说明了PPH术后痔脱垂复发经过了肛门直肠检查确诊，对这6个研究的Meta分析显示PPH术后复发率并不比CH高［6个研究，PPH组230例，CH组220例， OR 1.87，95%CI（0.70，5.00）； P=0.22］。结论 PPH术后皮赘残留率高于传统痔切除术（CH），而复发率并不比CH高。文献中报道的PPH的高复发率很有可能是因为把残留的皮赘当成复发所致。痔脱垂复发应当由外科医师在肛门直肠检查之后进行判断而不是根据病人的主诉来判断。

关键词: 吻合器痔上黏膜环形切除钉合术, 传统痔切除术, 皮赘残留, Meta分析

Abstract:

Residual skin tags following procedure for prolapse and hemorrhoids should be differentiated from recurrence GAO Xian-hua*, FU Chuan-gang, NABIEU Paul Fallah-wandalachi. *Department of Colorectal Surgery of Changhai Hospital, the Second Military Medical University, Shanghai 200433, China Corresponding author: FU Chuan-gang, E-mail: fugang416@126.com. Abstract Objective To explore the definition of recurrence after PPH. Methods Related Chinese and English literature admitted between January 2001 and October 2008 was collected with multi-methods. Meta-analysis was used to compare the incidence of recurrence and residual skin tag of PPH vs. CH. Results In China, 13.94% of hemorrhoids had residual skin tag after PPH. The mean recurrence rate after PPH was 3.23%, ranging from 0.40% to 26.44%. The Meta-analysis of PPH vs. CH of Chinese studies showed that PPH had a significantly lower recurrence rate (13 studies, OR 0.27, 95%CI (0.17，0.42), P<0.00001), and a higher incidence of skin tag with no significance (6 studies, OR 3.42, 95%CI (0.49，24.04), P=0.22). The Meta-analysis of PPH vs. CH of English studies showed that PPH had a significantly higher recurrence rate (17 studies, 636 patients in PPH group vs. 625 patients in CH group; OR 2.96, 95%CI (1.57, 5.56); P=0.0008) and a significantly higher incidence of residual skin tag (8 studies, 297 patients in PPH group vs. 289 patients in CH group; OR 1.88, 95%CI (1.15, 3.05); P=0.01). However, the recurrence of prolapse was stated to be ascertained by anorectal examination in only 6 studies. The Meta-analysis of the 6 studies showed that PPH was not associated with a higher recurrence (6studies, 230 patients in PPH group vs. 220 patients in CH group; OR 1.87, 95%CI (0.70, 5.00); P=0.22). Conclusion PPH is not associated with a higher recurrence rate but a higher incidence of skin tag compared with CH. The reported high recurrence rates are probably caused by the improper inclusion of residual skin tag into recurrence. Anorectal examination should be performed by surgeons to differentiate residual skin tag from recurrence.

Key words: procedure for prolapse and hemorrhoids, conventional hemorrhoidectomy, residual skin tag, Meta-analysis