| 摘要: |
| 目的 评价经肛括约肌间切开术(TROPIS)治疗高位肛瘘的疗效及安全性。方法:计算机检索万方、中国知网、维普数据库及Pubmed、Web of science、Cochrane library，搜集所有比较TROPIS术与瘘管切开挂线术治疗高位肛瘘的随机对照试验，检索语种包括中文和英文，中文检索词包括:经肛括约肌间切开术、括约肌间切开术、高位肛瘘；英文检索词包括:Transanal opening of intersphincteric space、TROPIS、Anal fistula、Seton、Incision and drainage，检索时限均从建库至2023年2月1日。按照纳入标准选择文献、提取数据和系统评价纳入研究的方法学质量后，共纳入9篇文献，包含1 587例患者，采用Review Manager 5.3软件对TROPIS术治疗高位肛瘘的临床研究进行系统评价，对结果进行异质性分析，并对纳入的文献进行敏感性分析和发表偏倚分析。结果:瘘管切开挂线术的治愈率高于TROPIS术(OR=1.78，95%CI:0.46~6.90，P=0.40)，差异有统计学意义。TROPIS术在创面愈合时间(MD=-12.83，95%CI:-15.31~-10.35，P＜0.05)、不良事件发生率(OR=0.22，95%CI:0.10~0.47，P＜0.05)、疼痛程度评分(MD=-1.67，95%CI:-1.92~-1.41，P＜0.05)、肛门失禁评分(MD=-1.67，95%CI:-1.92~-1.41，P＜0.01)方面优于瘘管切开挂线术，差异有统计学意义。结论:瘘管切开挂线术治愈率高，但TROPIS术与其相比，术后创面愈合快、并发症少、疼痛程度减轻、肛门功能保护良好，应用于临床更安全。 |
| 关键词: 直肠瘘 Meta分析 随机对照试验 切开挂线疗法 |
| DOI：10.3969/j.issn.1007-6948.2023.05.012 |
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| 基金项目:南京市卫生科技发展专项资金项目(YKK21197)；南京市卫生科技发展专项资金项目(YKK22175)；2022年江苏省研究生实践创新计划(SJCX22_0819) |
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| Meta-analysis of efficacy and safety of TROPIS in the treatment of high anal fistula |
| WANG Yan，HOU Yi，ZHENG Xue-ping |
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| Abstract: |
| Objective To evaluate the efficacy and safety of transanal opening of intersphincteric space (TROPIS) for the treatment of higher anal fistula. Methods Wanfang, CNKI, VIP database, Pubmed, Web of science and Cochrane library were searched by computer to collect all the randomized controlled trials comparing TROPIS and fistulae incision and anastomosing in the treatment of high anal fistula. The search languages included Chinese and English, and the Chinese search terms included: Transanal opening of intersphincteric space, high anal fistula; English search terms included Transanal opening of intersphincteric space, TROPIS, Anal fistula, Seton, Incision and drainage. The retrieval period was from the database establishment to February 1, 2023. After literature selection, data extraction and methodological quality of included studies were systematically evaluated according to inclusion criteria, a total of 9 literatures including 1 587 patients were included. Review Manager 5.3 software was used to conduct meta-analysis on the clinical studies of TROPIS for the treatment of high anal fistula, and the results were analyzed for heterogeneity. Sensitivity analysis and publication bias analysis were carried out for the included literatures. Results The cure rate of fistula incision was higher than TROPIS (OR=1.78, 95%CI: 0.46~6.90, P=0.40), and the difference was statistically significant. TROPIS was associated with wound healing time (MD=-12.83, 95%CI: -15.31-10.35, P < 0.05), incidence of adverse events (OR=0.22, 95%CI: 0.10-0.47, P < 0.05) and pain severity score (MD=-1.67, 95%CI: -1.92~-1.41, P < 0.05) and anal incontinence score (MD=-1.67, 95%CI: -1.92~-1.41, P < 0.01) were better than fistulas incision and hanging, and the difference was statistically significant. Conclusion The cure rate of fistula incision and stringing is high, but TROPIS has faster wound healing, less complications, less pain, and better anal function protection, which is safer for clinical application. |
| Key words: Rectal fistula randomized controlled trial Meta-analysis incision-thread-drawing procedure |
