| Background: Bowel Obstruction(BO)refers to Acute Abdomen.It has multiple aetiology and complex pethogenic mechanism.It’s common but vital in abdominal surgical treatments.Traditional Chinese Medicine(TCM)has made great contributions from the past life in treating symptoms like bellyache,vomition,no anal defecation or exhaustion.These symptoms are also majorly performed in bowel obstruction.In this way we use TCM therapy to treat patients suffered from bowel obstruction by learning enlightenedly from our ancestors’ great experience.The TCM therapy in treating bowel obstruction is effective and has been proved by numerous domestic clinical trials.It has shown that based on western medicine treatment such as abrosia,gastrointestinal decompression,anti-infection and fluid infusion to resume homeostasis,application of TCM can make great improvement in curing bowel obstruction.And the TCM treatments for BO nowadays have presented a trend of integrated and comprehended,means that solo TCM treatment has been increasingly linked together in clinical practice.However,these clinical experience so far has not been confirmed convincingly by systematic review.Objectives: To evaluate the efficacy and feasibility of combined acup-moxibustion and medicinal herbs in TCM treatments of bowel obstructions.So as to provide evidence for the practice in Combined TCM Therapy by methods of systematic review.Methods: The following databases are the source of included studies: CNKI,VIP,Wanfang Database,CBM,MEDLINE(Pub Med),EMBASE,CENTRAL(The Cochrane Library).The studies’ re all published clinical trials about combined acup-moxibustion with medicinal herbs in TCM treatments of BO,and were all been searched out by specific strategies or plans with inclusion and exclusion criteria.To make systematic evaluation of included clinical trials,we firstly made assessment about methodological quality and then picked up relevant information from each trials.After that,used the Meta-analysis to make judgements about all the attached clinical outcomes that the number of included studies is more than three.Draw the forest plots,made Homogeneity test and did sensitive analysis by using the Review Manager 5.3.5 Software.For other clinical outcomes that failed to complete Meta-analysis,used the descriptive statistics for illustration.If some potential outcomes that the number of included studies is more than 10,used the inverted funnel plot to check their possibility of selective bias.The final conclusion of this systematic review should be linked with the retrospective summary of the BO treatment in the general surgical department of Affiliated Hospital of SDUTCM(recent 5 years from May 1st 2013 to April 30 th 2018).We hope it can contribute more on discussions and explanations about BO outcome indicators.Results: 1.The results of retrospective summary: 288 related cases had been searched out by the record room,25 cases were replenished manually,so the subtotal number of retrived cases is 313.We excluded 8 of them who had been suffered emergency surgery just after hospitalization,the final subtotal number of included cases is 305.To classify them by TCM therapy methods,we set up experiment group A(by combined acup-moxibustion and medicinal herbs treatment)with 90 cases,condition controlled group B(by solo TCM treatment for BO)with 125 cases,blank controlled group C(by western routine therapy for BO)with 90 cases.We used Chi-square Test to verify the validity of dichotomous outcomes and t test for continuous outcomes.The improved rate about clinical efficacy for group A is 75.56%,group B is 72%,group C is 53.33%,Chi-square test between group A and B is χ2=0.34(P>0.5),Chi-square test between group A and C is χ2=9.70(P<0.005).The improved rate about no anal exhaustion for group A is 84.13%,group B is 82.86%,group C is 66.67%,Chi-square test between group A and B is χ2=0.04(P>0.5),Chi-square test between group A and C is χ2=4.75(P<0.05).The improved rate about no anal defecation for group A is 86.08%,group B is 81.40%,group C is 56.90%,Chi-square test between group A and B is χ2=0.66(0.25<P<0.5),Chi-square test between group A and C is χ2= 14.70(P<0.005).Improve rate of BO characteristic symptoms allevation for group A is 86.36%,group B is 82.79%,group C is 62.50%,Chi-square test between group A and B is χ2=0.49(0.25<P<0.5),Chi-square test between group A and C is χ2=13.17(P<0.005).Death rate for group A is 4.44%,group B is 4.00%,group C is 12.22%,Chi-square test between group A and B is χ2=0.03(P>0.5),Chi-square test between group A and C is χ2=3.56(0.05<P<0.1).Transfer operation rate for group A is 6.67%,group B is 9.60%,group C is 16.67%,Chi-square test between group A and B is χ2=0.59(0.25<P<0.5),Chi-square test between group A and C is χ2=4.37(P<0.05).First anal exhaustion time for group A is 4.69±3.49 d,group B is 4.67±4.41 d,group C is 3.74±3.22 d,t test value between group A and B is 0.89,between group A and C is 0.23(P>0.05).First anal defecation time for group A is 4.19±3.92 d,group B is 4.16±2.40 d,group C is 4.73±4.06 d,t test value between group A and B is 0.11,between group A and C is 0.92(P>0.05).First BO symptoms allevation time for group A is 4.76±3.79 d,group B is 4.34±3.55 d,group C is 4.16±2.89 d,t test value between group A and B is 0.41,between group A and C is 0.46(P>0.05).Hospitalized time for group A is 14.97±12.07 d,group B is 15.20±14.75 d,group C is 12.91±11.91 d,t test value between group A and B is 0.25,between group A and C is 0.90(P>0.05).2.The results of Systematic Review: 42 clinical trials with 3123 subjects(1609 to experiment group while 1514 to blank controlled group)had been concluded within the review.Total number of outcome indicators is 44,from which 18 indicators can be meta-analyzed.12 outcome indicators can lead to conclusions via Meta-analysis and here’s the following expainations: After sensitive analysis,10 studies were included in transfer operation rate(RR=0.31,95%CI=[0.19,0.51],I2=0%,P=0.99),37 studies were included in total improved rate(RR=1.19,95%CI=[1.16,1.23],I2=10%,P=0.30),31 studies were included in total marked improved rate(RR=1.42,95%CI=[1.33,1.51],I2 =18%,P=0.19),17 studies were included in anal exhaustion time(SMD =-1.57,95%CI= [-1.96,-1.18],I2=88%,P<0.00001),12 studies were included in anal defecation time(SMD=-1.33,95%CI=[-1.67,-0.99],I2=80%,P<0.00001),6 studies were included in abdominal pain disappear time(SMD=-1.16,95%CI=[-1.37,-0.96],I2 =6%,P= 0.38),7 studies were included in ventosity disappear time(SMD =-1.27,95%CI=[-1.45,-1.10],I2=0%,P=0.60);7 studies were included in hospitalized time(SMD=-1.16,95%CI= [-1.34,-0.98],I2=45%,P=0.09),7 studies were included in TNF-α level after therapy(SMD=-2.31,95%CI=[-2.86,-1.75],I2=83%,P<0.00001),3 studies were included in ventosity allevation time(SMD=-1.11,95%CI =[-1.38,-0.84],I2=45%,P=0.16),4 studies were included in air-fluid level disappear time(SMD=-1.18,95%CI=[-1.47,-0.89],I2=0%,P=0.73),4 studies were included in IL-6 level after therapy(SMD =-1.59,95%CI =[-1.83,-1.35],I~2=0%,P= 0.87).Conclusion: The results of retrospective summary show that compared to western medicine treatments,combined acup-moxibustion and medicinal herbs can appearently improve clinical efficacy by alleviate BO characteristic symptoms and lower the transfer operation rate and death rate in TCM treatment of BO.However,we failed to find any positive results in the efficiency of reducing defecation function recovery time,BO symptoms allevation time and hospitalized time.As some of bias can not be fitly controlled by using methods of retrospective summary,and information within the cases wasn’t recorded precisely,the conclusion of this summary needs to be more convincing.The results of systematic review prove that combined acup-moxibustion and medicinal herbs can lead to positive conclusion in TCM treatment of BO by improving overall(marked)clinical efficacy,lowering transfer operation rate and TNF-α level,reducing amounts of time in anal defecation/exhaustion recovery and BO symptoms disappearation and hosipitalization,which is fairly supported by the Evidence-based Medicine.However,Meta-analysis results in shorten time of BO symptoms allevation and air-fluid level disappearation,lower the IL-6 level are failed to reach satisfaction due to lack of clinical evidence.Therefore these evidence can’t be recommended with high degree of certainty as the RCTs quality of included studies within the review is generally low and needs to be improved. |
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