| Part I Meta-analysis and systematic evaluation of RPH combined with external hemorrhoidectomy in the treatment of mixed hemorrhoidsObjective:To compare the efficacy of RPH combined with external hemorrhoidectomy versus traditional Milligan-MorganHemorrhoidectomy for the treatment of hemorrhoids by a meta-analysis method.Methods:According to the pre-established search strategy,computer search and manual search were adopted.Computer search databases include Cochrane Search Trials,Cochrane Library,PubMed,CBM,CNKI,WANFANG,CQVIP,retrieves all randomized controlled trials(RCTs)comparing Ruiyun procedure for hemorrhoids(RPH)and Milligan-Morgan Hemorrhoidectomy(MMH)comparison From January 1998 to October 2019.At the same time,three professional related magazines including "Chinese Journal of Anorectal Diseases","Colorectal and Anal Surgery" and "Chinese Journal of Gastrointestinal Surgery" were searched by manual.In addition,relevant reviews,systematic reviews and their references were also searched.Literature search,screeningand methodological quality evaluation were independently performed by two individuals.The meta-analysis software RveMan 5.3 recommended by the CochraneLibrary was used for combined analysis.The sensitivity analysis was used to evaluate the publication bias of the research literature and the reliability of the results.Finally,the analysis results were collated and reported.Results:A total of 18 eligible randomized controlled trials(RCTs)were included.A total of 1979 patients were included in the study.Meta-analysis results show that the cure rate[OR=1.98,95%CI(1.46,2.70),P<0.0001]and hospitalstay[MD=-2.98,95%CI(-4.06,-3.83),P<0.00001],operationtime[MD=-5.34,95%CI(-7.40,-3.29),P<0.00001],intraoperative blood loss[MD=-5.28,95%CI(-9.46,-1.09),P=0.01],Wound healing time[MD=-4.67,95%CI(-6.09,-3.25),P<0.00001],postoperative complications {pain[MD=-4.49,95%CI(-5.86,-3.11),P<0.00001)],bleeding[OR=0.38,95%CI(0.25,0.58),P<0,001],urinary retention[OR=0.39,95%CI(0.17,0.89),P=0.03],anal marginal edema[OR=0.35,95%CI(0.24,0.51),P<0.00001],anal stenosis[OR=0.26,95%CI(0.07,0.95),P=0.04]} were better than Milligan-Morgan Hemorrhoidectomy.Conclusion:RPH combined with external hemorrhoidectomy is more advantageous than Milligan-Morgan Hemorrhoidectomy in the treatment of mixed hemorrhoids and deserves further study.Part Ⅱ Clinical Efficacy and Quality of Life of RPH Combined with External Hemorrhoidectomy for Mixed HemorrhoidsObjective:To compare the postoperative curative effect and quality of life of patients with mixed hemorrhoids by comparing RPHcombined with external hemorrhoidectomy andMilligan-Morgan Hemorrhoidectomy.Methods:80 patients who met the inclusion criteria were randomly divided into observation group and control group,with 40 cases in each group.The observation group was treated with RPH combined with external hemorrhoidectomy,and the control group was treated with Milligan-Morgan Hemorrhoidectomy.SF-36 was used to investigate the quality of life of the two groups of patients before and 1 month after surgery,and the collected data were summarized and analyzed.At the same time,the total effective rate,operation time,intraoperative blood loss and number of incisions,and postoperative related complications were compared between the two groups of patients.Statistical analysis was performed using statistical software SPSS 23.0.Results:(1)The general data of the two groups of patients were compared by t test and χ2test,and the difference was not statistically significant(P>0.05),which is comparable.(2)The total effective rate of the observation group and the control group was 100%,and there was no significant difference between the two groups(P>0.05).(3)The difference in the operation time between the two groups was statistically significant(P<0.05),and the operation time was shorter in the observation group.(4)The difference in loss of intraoperative blood between the two groups was statistically significant(P<0.05),and the intraoperative blood loss was lesin the observation group.(5)The difference in the number of incisions in the two groups was statistically significant(P<0.05),and the number of incisions in the observation group was less.(6)There was no significant difference in the effective rate at one month after surgery between the two groups(P>0.05).(7)On the 1st,3rd,and 7th days after surgery,the observation group had less postoperative anal pain than the control group,and the difference was statistically significant(all P<0.05).There was no significant difference in anal pain between the two groups after one month(P>0.05).(8)The scores of the worst bleeding within 14 days after surgery were the same in the two groups,and the difference was not statistically significant(P>0.05).(9)There was no significant difference in the anal marginal edema score on the 3rd day after surgery between the two groups.(P>0.05).(10)There was no significant difference in the SF-36 observation indexes between the two groups of patients before surgery.(P>0.05);The difference between PF,GH,VT,RE,and MH in the two groups of patients at one month after surgery was statistically significant.(P<0.05).Patients in the observation group scored higher in terms of PF,GH,VT,RE,and MH at one month after surgery.The comparison results between the two groups of patients showed that the scores in all dimensions of the two groups of patients were improved compared with those before the operation,and the difference was statistically significant(P<0.05).The quality of life of the two groups was improved after operation.Conclusion:RPH combined with external hemorrhoidectomy for mixed hemorrhoids is effective,safe,reliable,and easy to operate.It can significantly reduce the operation time,reduce intraoperative and postoperative bleeding,and reduce the incidence of complications such as postoperative pain and anal edema.And can further improve the quality of life of patients after surgery,and it is worthy of further clinical research and promotion. |
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