系统评价痔疮自动套扎术（RPH）联合外剥内扎术（MMH）对比吻合器痔上黏膜环切术（PPH）治疗重度混合痔的疗效与安全性。

通过计算机检索PubMed、Cochrane、Web of science、CNKI、万方和维普等数据库，收集对比RPH联合MMH与PPH治疗重度混合痔的随机对照临床试验（RCT），统计相关数据后应用RevMan5.3软件进行Meta分析。

共纳入11项随机对照临床试验，共2 762例患者。Meta分析结果显示，RPH+MMH与PPH两组之间在手术时间［MD=-6.20，95%CI（-12.81~0.40）；P＞0.05］、术后感染［OR=2.18，95% CI（0.77~6.18）；P＞0.05］、创面愈合时间［MD=1.56，95% CI（-6.84，9.96）；P＞0.05］等方面差异无统计学意义。两组在手术总有效率［OR=4.67，95% CI（3.09~7.04）］、术后肛门功能评价总分［MD=-3.47，95%（-3.75~-3.21）］、术中出血量［MD=-14.94，95% CI（-25.07~-4.81）］、住院时间［MD=-0.29，95% CI（-0.44~-0.13）］、术后伤口水肿［OR=0.21，95% CI（0.08~0.55）］、术后尿潴留［OR=0.50，95% CI（0.39~0.64）］、术后疼痛［OR=0.30，95% CI（0.11~0.82）］、术后出血［OR=0.19，95% CI（0.09~0.40）］、术后肛门残留赘皮［OR=0.17，95% CI（0.05~0.62）］、术后肛门坠胀［OR=0.29，95% CI（0.19~0.45）］、术后肛门直肠狭窄［OR=0.20，95% CI（0.09~0.45）］等差异均具有统计学意义（均P＜0.05）。

与PPH相比，RPH联合MMH治疗重度混合痔有着总有效率高、术后肛门功能恢复较好、术中出血量少、住院时间短的优势，同时可减少术后伤口水肿、尿潴留、疼痛、出血、肛门残留赘皮、肛门坠胀、肛门直肠狭窄等并发症的发生。然而，因本研究有一定局限性，以上结论仍需更高质量的临床试验进行验证。

To systematically evaluate the efficacy and safety for RPH (automatic ligation of hemorrhoids) combined with MMH (milligan-morgan hemorrhoidectomy) versus PPH (procedure for prolapse and hemorrhoids) in the treatment of severe mixed hemorrhoids.

A computer search of PubMed, Cochrane, Web of Science, CNKI, Wanfang and Weipu and other databases, collected and compared RPH combined with MMH and PPH in the treatment of mixed hemorrhoids in randomized controlled trials (RCT), RevMan5.3 software were used for Meta analysis.

A total of 11 randomized controlled clinical trials with a total of 2 762 patients were included. Meta-analysis results showed that between the RPH+MMH and PPH groups, the difference of the operation time [MD=-6.20, 95% (-12.81~0.40); P＞0.05]and postoperative infection [OR=2.18, 95%CI(0.77~6.18); P＞0.05] , wound healing time [MD=1.56, 95%(-6.84~9.96); P＞0.05]was not statistically significant. There were no significant differences(P＜0.05) in the total effective rate of surgery [OR=4.67, 95%CI(3.09~7.04)], the total score of postoperative anal function evaluation [MD=-3.47, 95%CI(-3.75~-3.21)], intraoperative blood loss [MD=-14.94, 95%CI(-25.07~-4.81)], hospitalization time [MD=-0.29, 95%CI (-0.44~-0.13)], postoperative wound edema [OR=0.21, 95%CI(0.08~0.55)], postoperative urinary retention [OR=0.50, 95%CI(0.39~0.64)], postoperative pain [OR=0.30, 95%CI(0.11~0.82)], postoperative bleeding [OR=0.19, 95%CI(0.09~0.40)], postoperative anal epidermis [OR=0.17, 95%CI(0.05~0.62)], postoperative anal bulging [OR=0.29, 95%CI(0.19~0.45)], postoperative anorectal stenosis [OR=0.20, 95%CI(0.09~0.45)].

Compared with PPH, RPH combined with MMH in the treatment of severe mixed hemorrhoids has the advantages of higher total effective rate, better postoperative recovery of anal function, less intraoperative blood loss, shorter hospital stay. At the same time, it can reduce postoperative wound edema, urinary retention, pain, bleeding, and residual anal epidermis, anus bulging, anorectal stenosis and other complications. However, due to the limitations of this study, the above conclusions still need to be verified by higher-quality clinical trials.