不同包皮环切术治疗包皮过长或包茎的网状Meta分析

王晓甫; 黄垂国; 赵兴华; 王若凡; 宋攀; 许长宝

doi:10.13201/j.issn.1001-1420.2018.08.013

不同包皮环切术治疗包皮过长或包茎的网状Meta分析

- 1. 郑州大学第二附属医院泌尿外科(郑州, 450014);
- 2. 郑州大学第一附属医院泌尿外科

详细信息

通讯作者: 许长宝,E-mail

中图分类号: R697.12

收稿日期: 2017-07-05

Network meta-analysis of different circumcisions for redundant prepuce or phimosis

- 1. Department of Urology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China;
- 2. Department of Urology, First Affiliated Hospital of Zhengzhou University

More Information

Corresponding author: XU Changbao

Received Date: 05 July 2017

摘要

摘要: 目的:采用网状Meta分析方法评价不同包皮环切术治疗包皮过长或包茎的疗效及安全性。方法:检索PubMed、Embase、中国知网(CNKI)、维普(VIP)、中国生物医学文献(CBM)和万方数据库,搜集不同包皮环切术治疗包皮过长或包茎的随机对照试验(RCT),按纳入和排除标准进行筛选和质量评价,采用ADDIS软件统计分析数据。结果:共纳入3种包皮环切术方式,12篇研究共计3 449例患者,网状Meta分析结果提示:与传统手术方式(CC)比较,一次性包皮环切缝合器(DCSD)和商环(SRC)手术时间明显缩短,切口完全愈合时间明显缩短,术后外观满意度较好;DCSD不良事件发生率明显低于CC和SRC;然而三者术后24h疼痛分数差异无统计学意义;节点分析结果显示不存在统计学不一致性(P>0.05)。结论:基于网状Meta分析结果,DCSD可以作为最有效和最安全的包皮环切术方式,但本研究尚存在缺陷,研究结论需更多高质量多中心RCT进行验证。
- 包皮环切 /
- 包皮过长 /
- 包茎 /
- 网状Meta分析
Abstract: Objective:To evaluate the effects of different circumcisions for redundant prepuce by network meta-analysis.Method:Electronic databases including PubMed, Embase, Wan Fang, VIP, CNKI and CBM database were researched for randomized controlled trials (RCTs).The retrieved results were screened by the inclusion and exclusion criteria, and the statistical software ADDIS was used for data analysis.Result:Three methods of circumcisions, twelve researches with 3 449 participants were included.The network analysis results showed that compared with the conventional circumcision (CC), the disposable circumcision suture device (DCSD) and Shang Ring circumcision (SRC) provided significantly shorter operation time, shorter wound healing time and better postoperative penile appearance.Additionally, DCSD showed a lower adverse events rate than other two treatments.However, no significant difference was shown in all surgeries for 24 hpostoperative pain score.Node-splitting analysis showed that no significant inconsistency existed (P>0.05).Conclusion:Based on the results of our meta-analysis, DCSD may be the most effective and safest choice for phimosis and redundant prepuce, but more multi-center high-quality RCTs are needed.
- circumcision /
- redundant prepuce /
- phimosis /
- network meta-analysis

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参考文献(27)

[1]	王吉安, 于建国.实用微创泌尿外科学[M].上海:第二军医大学出版社, 2003:382-384.
[2]	Morris B J, Wiswell T E.Circumcision and lifetime risk of urinary tract infection:a systematic review and metaanalysis[J].J Urol, 2013, 189 (6):2118-2124.
[3]	Bailey R C, Moses S, Parker C B, et al.Male circumcision for HIV prevention in young men in Kisumu, Kenya:a randomised controlled trial[J].Lancet, 2007, 369 (9562):643-656.
[4]	Weiss H A, Thomas S L, Munabi S K, et al.Male circumcision and risk of syphilis, chancroid, and genital herpes:a systematic review and meta-analysis[J].Sex Transm Infect, 2006 82 (2):101-109.
[5]	刘昉凝, 刘丹丹, 夏秋翔, 等.商环包皮环切术要点讨论[J].临床泌尿外科杂志, 2018, 33 (4):302-305.
[6]	Kigozi G, Musoke R, Watya S, et al.The safety and acceptance of the PrePex device for non-surgical adult male circumcision in Rakai, Uganda.A non-randomized observational study[J].PLoS One, 2014, 9 (8):e100008.
[7]	Buwembo D R, Musoke R, Kigozi G, et al.Evaluation of the safety and efficiency of the dorsal slit and sleeve methods of male circumcision provided by physicians and clinical officers in Rakai, Uganda[J].BJU Int, 2012, 109 (1):104-108.
[8]	Lei J H, Liu L R, Wei Q, et al.Circumcision with"noflip Shang Ring"and"Dorsal Slit"methods for adult males:a single-centered, prospective, clinical study[J].Asian J Androl, 2016, 18 (5):798-802.
[9]	Wang J, Zhou Y, Xia S, et al.Safety and efficacy of a novel disposable circumcision device:apilot randomized controlled clinical trial at 2centers[J].Med Sci Monit, 2014, 20:454-462.
[10]	Useem J, Brennan A, LaValley M, et al.Systematic Differences between Cochrane and Non-Cochrane MetaAnalyses on the Same Topic:A Matched Pair Analysis[J].Plos One, 2015:b0149980.
[11]	Valkenhoef G V, Tervonen T, Zwinkels T, et al.ADDIS:a decision support system for evidence-based medicine[J].Decis Support Syst, 2013, 55 (2):459-475
[12]	Jansen J P, Crawford B, Bergman G, et al.Bayesian meta-analysis of multiple treatment comparisons:an introduction to mixed treatment comparisons[J].Value Health, 2008, 11 (5):956-964.
[13]	Salanti G, Higgins J P, Ades A E, et al.Evaluation of networks of randomized trials[J].Stat Method Med Res, 2008, 17 (3):279-301.
[14]	曹赟杰, 何小舟, 宋广来, 等.新式包皮环切缝合器临床效果观察[J].中华临床医师杂志 (电子版), 2013, 7 (14):6526-6529.
[15]	Lv B D, Zhang S G, Zhu X W, et al.Disposable circumcision suture device:clinical effect and patient satisfaction[J].Asian J Androl, 2014, 16 (3):453-456.
[16]	缪惠东, 陆佳伟, 陆福年, 等.一次性包皮环切缝合器手术与包皮环扎术、传统包皮环切术的临床疗效比较[J].中华男科学杂志, 2015, 21 (4):334-337.
[17]	吴刚峰, 阎家骏.一次性包皮环切缝合器与吻合器在包皮环切术中的临床疗效分析[J].中华男科学杂志, 2015, 21 (4):376-377.
[18]	杨介礼, 陈庆存, 王伟, 等.两种不同类型一次性包皮切割缝合器治疗包皮过长和包茎的疗效及安全性比较[J].中国性科学, 2016, 25 (1):33-35.
[19]	王世先, 章振保, 杨水法, 等.一次性包皮吻合器与缝合器行包皮环切术的临床疗效比较[J].中华男科学杂志, 2016, 22 (6):534-537.
[20]	Pan F, Pan L, Zhang A, et al.Circumcision with a novel disposable device in Chinese children:a randomized controlled trial[J].Int J Urol, 2013, 20 (2):220-226.
[21]	Kanyago S, Riding D M, Mutakooha E, et al.Shang Ring versus forceps-guided adult male circumcision:a randomized, controlled effectiveness study in southwestern Uganda[J].J Acquir Immune Defic Syndr, 2013, 64 (2):130-133.
[22]	Sokal D C, Li P S, Zulu R, et al.Randomized controlled trial of the shang ring versus conventional surgical techniques for adult male circumcision:safety and acceptability[J].J Acquir Immune Defic Syndr, 2014, 65 (4):447-455.
[23]	李会宁, 徐军, 屈栗明.商环包皮环切术与传统手术疗效比较[J].中华男科学杂志, 2010, 16 (4):325-327.
[24]	霍仲超, 刘刚, 王伟, 等.一次性包皮环切缝合器行包皮环切术的临床疗效观察[J].中华男科学杂志, 2015, 21 (4):330-333.
[25]	Dunsmuir W D, Gordon E M.The history of circumcision[J].BJU Int, 1999, 83 Suppl 1:1-12.
[26]	Zhang Z, Yang B, Yu W, et al.Application of a novel disposable suture device in circumcision:aprospective non-randomized controlled study[J].Int Urol Nephrol, 2016, 48 (4):465-473.
[27]	徐土珍, 朱红卫, 吕伯东, 等.一次性包皮环切缝合器行包皮环切术的护理体会[J].中华男科学杂志, 2014, 20 (6):572-573.