Ⅲ~Ⅳ度混合痔合并直肠肛管静息高压的预后相关影响因素及应用MMH术的治疗效果  

Prognostic factors of gradeⅢ-Ⅳmixed hemorrhoids with anorectal resting hypertension and the therapeutic effect of MMH

作　　者：季小健 彭澎 刘利华 施艳姣 张振帮 Ji Xiaojian;Peng Peng;Liu Lihua;Shi Yanjiao;Zhang Zhenbang(Department of Anal Enterology,Nanjing Jiangbei People′s Hospital,Nantong University,Nanjing 210048,China;Shuangqiao District Maternal and Child Health Hospital,Chengde 067022,China)

机构地区：[1]南通大学附属南京江北人民医院肛肠科,南京210048 [2]承德市双桥区妇幼保健院,承德067022

出　　处：《国际外科学杂志》2022年第2期98-102,共5页International Journal of Surgery

摘　　要：目的探讨外剥内扎术(MMH)治疗Ⅲ~Ⅳ度混合痔合并直肠肛管静息高压患者的效果及其预后相关危险因素。方法回顾性分析南通大学附属南京江北人民医院2018年2月-2020年2月间经MMH术治疗的48例Ⅲ~Ⅳ度混合痔合并直肠肛管静息高压患者临床资料(观察组),其中男24例,女24例;年龄22~55岁,平均年龄(41.87±7.52)岁,另选择同期经PPH术治疗的48例Ⅲ~Ⅳ度混合痔合并直肠肛管静息高压患者为对照组,其中男20例,女28例,年龄22~55岁,平均年龄(42.68±7.14)岁。比较两组临床疗效,术后6、24、72 h疼痛程度评分及术后并发症情况,采用多元logistic回归法分析影响预后的相关危险因素。结果两组术后6 h时视觉模拟评分(VAS)评分比较差异无统计学意义(t=0.25,P=0.807);观察组术后24、72 h时VAS评分均低于对照组(t=7.04,P<0.001;t=5.31,P<0.001);观察组总有效率高于对照组(93.75%比77.08%,χ^(2)=5.35,P=0.021),观察组术后肛门水肿、排便困难、便血、肛门疼痛及排便失禁等并发症总发生率为低于对照组,差异有统计学意义(12.50%比33.33%,χ^(2)=5.88,P=0.015);年龄、病程、内痔分度及治疗方法为患者预后相关因素(P<0.05);经logistic回归分析显示:年龄(>45岁)、病程(>10年)、内痔分度(Ⅳ度)及治疗方法(PPH术)为影响患者预后的独立危险因素(P<0.05)。结论MMH术治疗Ⅲ~Ⅳ度混合痔合并直肠肛管静息高压患者的并发症少,术后疼痛程度轻,疗效满意。患者年龄越大、病程越长、内痔分度越高及治疗方法的选择为影响预后的危险因素。临床上通过早诊断,选择合理治疗手段,有利于改善患者预后。Objective To investigate the effect of external dissection and internal ligation(MMH)in the treatment of gradeⅢtoⅣmixed hemorrhoids with anorectal resting hypertension and its prognostic risk factors.Methods The clinical data of 48 patients with gradeⅢ-Ⅳmixed hemorrhoids complicated with rectal and anal resting hypertension treated by MMH in Nanjing Jiangbei people′s Hospital Affiliated to Nantong University from February 2018 to February 2020 were analyzed retrospectively(observation group),including 24 males and 24 females;The age ranged from 22 to 55(41.87±7.52)years.Another 48 patients with gradeⅢ-Ⅳmixed hemorrhoids complicated with anorectal resting hypertension treated by PPH were selected as the control group,including 20 males and 28 females;The average age was(42.68±7.14)years.The clinical effective rates,pain score at 6,24 and 72 h after operation,postoperative complications were compared between the two groups.Multiple logistic regression was used to analyze the related risk factors affecting the prognosis.Results There was no significant difference in VAS score between the two groups at 6 h after operation(t=0.25,P=0.807);the VAS score of the observation group at 24 h and 72 h after operation was lower than that of the control group(t=7.044,P<0.001;t=5.307,P<0.001);the total effective rate of the observation group was higher than that of the control group(93.75%vs 77.08%,χ^(2)=5.35,P=0.021);the total incidence of postoperative anal edema,defecation difficulty,bloody stool,anal pain and fecal incontinence in the observation group was lower than that in the control group,the difference was statistically significant(12.50%vs 33.33%,χ^(2)=5.879,P=0.015).Age,course of disease,grading of internal hemorrhoids and treatment methods were related to the prognosis of patients(P<0.05);logistic regression analysis showed that age(>45 years),course of disease(>10 years),grade of internal hemorrhoids(gradeⅣ)and treatment(PPH)were independent risk factors for prognosis of patients(P<0.05).Conclusi

关 键 词：外科手术 治疗结果 痔 静息高压 

分 类 号：R657.18[医药卫生—外科学]