中医与西医手术操作治疗混合痔近期疗效及远期复发率的比较OA
Short-Term Efficacy and Long-Term Recurrence Rate of Traditional Chinese Medicine Versus Western Surgical Treatment for Mixed Hemorrhoids:A Multi-Center Retrospective Cohort Study Based on Real-World Data
目的 观察中医手术操作治疗混合痔患者的近期及远期疗效.方法 采用多中心回顾性队列研究,从江苏省8家三级甲等中医医院收集17 831例混合痔手术患者的诊疗数据,并通过人工智能大模型获得标准化和结构化数据集,将接受西医手术治疗的患者作为西医手术组(11 646例),接受中医手术操作治疗的为中医手术操作组(6185例).采用倾向性评分匹配法(1∶1匹配)平衡两组基线资料,主要结局指标为1年复发率,次要结局指标包括患者出院后第7、28、60天的主要症状(便血、肛内肿物脱出程度)和次要症状(肛门坠胀、肛缘水肿、创面分泌物及渗出物、肛门狭窄、肛门皮赘残留突起、肛周瘙痒程度、肛门疼痛程度)评分.结果 匹配后两组各纳入2194例患者.症状评分显示,出院后28天中医手术操作组在改善便血程度[OR=5.786,95％CI(3.092,10.827)]、肛内肿物脱出程度[OR=4.510,95％CI(1.649,12.333)]及肛缘水肿[OR=3.188,95％CI(1.295,7.845)]方面均优于西医手术组;出院后60天中医组在便血[OR=5.237,95％CI(1.077,25.464)]和肛门疼痛[OR=11.697,95％CI(1.186,115.336)]的改善方面仍保持优势(P＜0.05).远期随访显示,中医手术操作组一年复发率为1.1％(8/726),西医手术组为2.3％(10/444),两组复发率比较差异无统计学意义(P＞0.05).结论 基于真实世界数据中医手术操作治疗混合痔具有显著的近期症状改善优势,尤其在止血、消肿和减轻肛内肿物脱出方面效果更佳.
Objective To observe the short-term and long-term efficacy of traditional Chinese medicine(TCM)surgical operations in treating mixed hemorrhoids.Methods A multi-center retrospective cohort study was conducted,collecting clinical data from 17,831 mixed hemorrhoid surgery patients in 8 top-tier TCM hospitals in Jiangsu Province.Standardized and structured datasets were obtained through artificial intelligence models.Patients who underwent western surgical treatment were categorized into the western surgery group(11,646 cases),and those receiving TCM surgical operations were categorized into the TCM surgery group(6185 cases).Propensity score matching(1∶1 matching)was used to balance baseline data between groups.The primary outcome was the one-year recurrence rate,and sec-ondary outcomes included the main symptoms(rectal bleeding,degree of prolapse)and secondary symptoms(anal distension,anal edema,wound secretion and exudation,anal stenosis,residual skin tags,perianal itching,and anal pain)measured on days 7,28,and 60 after discharge.Results After matching,2194 patients were included in each group.Symptom scores showed that at 28 days after discharge,the TCM surgical group had superior improvement in rectal bleeding[OR=5.786,95％CI(3.092,10.827)],degree of prolapse[OR=4.510,95％CI(1.649,12.333)],and anal edema[OR=3.188,95％CI(1.295,7.845)]compared to the western surgical group.At 60 days post-discharge,the TCM group still showed advantages in improving rectal bleeding[OR=5.237,95％CI(1.077,25.464)]and anal pain[OR=11.697,95％CI(1.186,115.336)](P＜0.05).Long-term follow-up showed that the one-year recurrence rate in the TCM surgery group was 1.1％(8/726),while that in the western surgery group was 2.3％(10/444),with no statistically significant difference between the two groups(P＞0.05).Conclusion Based on real-world data,TCM surgical treatment for mixed hemorrhoids shows significant short-term symptom improvement,particularly in terms of hemostasis,reducing swelling,and alleviating prolapse of anal masses.
丁康;黄士财;章阳;樊志敏;周小杰;王晓骁;葛媛媛;朱慧婷;朱雨欣;杨霞;杜骏
南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022昆山市中西医结合医院南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022江苏省中医院临床研究院南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022南京中医药大学附属南京市中医院,江苏省南京市秦淮区大明路157号,210022苏州市中医医院
混合痔混合痔外剥内扎术枯痔注射内痔套扎
mixed hemorrhoidsexcision of external hemorrhoids and ligation of internal hemorrhoidsatrophied hemorrhoids injectioninternal hemorrhoid ligation
《中医杂志》 2026 (7)
747-754,8
南京市医疗机构中药制剂研究项目(NJCC-ZJ-202413)江苏省中医肛肠疾病临床医学创新中心重点项目(苏中医科教函[2023]1号)江苏省医院协会医院管理创新课题(JSYGY-3-2023-515,JSYGY-2-2023-507)江苏省中医药学会项目(XYLD2024003)江苏省中医药科技发展计划项目(ZD202226)
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