|
|
Meta-analysis on comparison of clinical effect of harmonic scalpel and electro-cautery in mixed hemorrhoid surgery |
XIONG Caiwen1 ZENG Xiangyun1▲ LUO Zhanbin2 GU Haimei1 |
1.The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangdong Province, Guangzhou 510405, China;
2.Department of Anorectum, Traditional Chinese Medical Hospital of Guangdong Province, Guangdong Province, Guangzhou 510120, China |
|
|
Abstract Objective To compare and analyze the clinical effect of harmonic scalpel and electro-cautery in the treatment of mixed hemorrhoids. Methods Domestic and foreign randomized controlled trial literatures on the treatment of mixed hemorrhoids with harmonic scalpel and electro-cautery were collected by searching domestic and foreign databases (PubMed, Medline, Embase, CNKI, Vip, Wanfang, etc), websites (The british library, etc), grey literatures and retrospecting literatures, which were published from January 2001 to December 2008. According to the article evaluation quality and screening methods, qualified articles were filtered, relevant clinical effect indexes were extracted. RevMan 5.2 software was used for Meta-analysis. Results A total of 8 randomized controlled trials (854 patients with mixed hemorrhoids) were included, the Meta-analysis showed that the average operation time, hospitalization time, postoperative pain time in the harmonic scalpel group were shorter than those in the electro-cautery group, the amount of bleeding in the operation, pain scores at day 1 and 3 after surgery were lower than those in the electro-cautery group, the incidence of short-term postoperative complications (urinary retention, anal edema, postoperative secondary bleeding, anal distenation) and postoperative anal stenosis were lower than those in the electro-cautery group, the differences were statistically significant (P < 0.05 or P < 0.01). However, there was no statistically significant difference in the incidence of anus incontinence between the two groups (P > 0.05). Conclusion Compared with electro-cautery, harmonic scalpel has the advantages of short operation time, less intraoperative blood loss, low incidence of postoperative complications and short hospitalization time in the treatment of mixed hemorrhoids, it is safer and more effective, and is worthy of clinical application.
|
|
|
|
|
[1] Armstrong DN,Ambroze WL,Schertzer ME,et al. Harmonic Scalpel vs. electrocautery hemorrhoidectomy:a prospective evaluation [J]. Dis Colon Rectum,2001,44(4):558-564.
[2] Jadad AR,Moore RA,Carroll D,et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials,1996,17(1):1-12.
[3] Abo-hashem AA,Sarhan A,Aly AM. Harmonic Scalpel compared with bipolar electro-cautery hemorrhoidectomy:A randomized controlled trial [J]. Int J Surg,2010,8(3):243-247.
[4] Hakan B,Adnan T,Ali C,et al. Evaluation of two hemorrhoidectomy techniques:harmonic scalpel and Ferguson's with electrocautery [J]. Asian J Surg,2014,37(1):20-23.
[5] 朱勇,刘飞,樊志敏,等.FOCUS超声刀与高频电刀切除混合痔疗效对比[J].实用临床医药杂志,2012,16(3):73-75.
[6] 张力,于林冲,陈兴元.FOCUS超声刀在脾虚气陷型中重度贫血痔手术中的应用研究[J].新中医,2017,49(1):81-83.
[7] 刘轩良,杨中权,何苏云.超声刀和电刀对伴重度贫血的Ⅲ~Ⅳ度混合痔患者的临床疗效比较[J].结直肠肛门外科,2017,23(6):771-773.
[8] 杜章,李丽军,陈腾高,等.超声刀混合痔切除术后并发症的临床研究[J].全科医学临床与教育,2015,13(2):164-166.
[9] 陈玲,卢敏,何彩群,等.超声刀与电刀运用于混合痔术后对比观察与护理[J].岭南现代临床外科,2015,15(5):643-644.
[10] 陆明,赵浩翔,蒋荣刚,等.超声刀与电刀在切除混合痔临床比较[J].中外医学研究,2018,16(2):129-130.
[11] Thomson WH. The nature of haemorrhoids [J]. Br J Surg,1975,62(7):542-552.
[12] 宋冀涛,王全玉.直肠上动脉介入栓塞加外痔切除治疗混合痔1例[J].临床医药文献电子杂志,2018,5(11):169-174.
[13] 陆淼炯,李省吾,褚卫建,等.PPH术结合外痔切除一期缝合术治疗环状混合痔50例的临床分析[J].中国现代医生,2017,55(25):56-59.
[14] 赵文静.吻合器痔上黏膜环切术加外痔切除术治疗重度混合痔的临床效果观察[J].中外医学研究,2017,15(6):123-125.
[15] Lin G,Ge Q,He X,et al. A novel technique for the treatment of stages Ⅲ to Ⅳ hemorrhoids:Homemade anal cushion suspension clamp combined with harmonic scalpel [J]. Medicine,2017,96(26):e7309.
[16] Talha A,Bessa S,Wahab MA. Ligasure,Harmonic Scalpel versus conventional diathermy in excisional haemorrhoidectomy:a randomized controlled trial [J]. Anz J Surg,2017,87(4):252.
[17] 丁超,王琛.混合痔手术治疗的研究进展[J].中国当代医药,2017,24(14):12-14.
[18] 黄国锋,邱光明,周明珠.选择性痔上黏膜切除钉合术和痔上黏膜环切钉合术治疗环状混合痔的优劣差异[J].中国医药科学,2018,8(2):199-201,246.
[19] 王健,李丁.痔的病理生理学研究进展[J].中国病理生理杂志,2010,26(1):193-196.
[20] 刘涛,曹洋,王歆猛,等.PPH联合肛裂挂线术治疗混合痔合并肛裂[J].中国医药科学,2017,7(18):223-225.
[21] 邓建宏,张涛,曹佳芹,等.吻合器痔上黏膜环切术治疗环状混合痔120例临床观察[J].中国现代医生,2018, 56(1):82-84.
[22] Rao SS. Current and Emerging Treatment Options for Fecal Incontinence [J]. J Clin Gastroenterology,2014,48(9):752-764.
[23] 刘一萍,黎笑欢,杨萍,等.PPH与外剥内扎术手术方法治疗环状混合痔临床比较[J].当代医学,2017,23(35):109-111.
[24] Rao SS,Benninga MA,Bharucha AE,et al. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders [J]. Neurogastroenterol Motil,2015,27(5):594-609.
[25] Eto K,Omura N,Haruki K,et al. A comparison of laparoscopic energy devices on charges in thermal power after application to porcine mesentery [J]. Surg Laparosc Endosc Percutan Tech,2015,25(1):e37.
[26] 谭健鹏.开放甲状腺手术中应用超声刀与传统方法的疗效对比分析[J].当代医学,2018,24(12):162-164.
[27] Kim JH,Kim DH,Yong PL,et al. Long-term follow-up of StarionTM versus Harmonic ScalpelTM hemorrhoidectomy for grade Ⅲ and Ⅳ hemorrhoids [J]. Asian J Surg,2018. [Epub ahead of print] |
|
|
|