混合痔PPH术后吻合口原发性出血影响因素及对其预后的影响  

Influencing Factors of Primary Bleeding at Anastomotic Site after Mixed Hemorrhoid PPH Surgery and Its Prognosis Effect

作　　者：崔皖晋 王彬[1] 邓锐[1] CUI Wanjin;WANG Bin;DENG Rui(General Surgery Department,Bengbu Medical College the Second Affiliated Hospital,Bengbu,Anhui 233000)

机构地区：[1]蚌埠医学院第二附属医院普外科,安徽蚌埠233000

出　　处：《智慧健康》2024年第7期56-60,共5页Smart Healthcare

摘　　要：目的 分析混合痔吻合器痔上黏膜切除术(PPH)术后吻合口原发性出血影响因素及对其预后的影响。方法 将2019年1月—2022年12月本院收治的100例混合痔手术患者作为观察对象,对其进行回顾性分析,患者均行PPH治疗,收集相关资料,以是否发生原发性出血分为出血组及未出血组,对两组相关资料行Logistic单因素及多因素分析,评估导致出血的相关风险因素;对术前、术后7d及术后2个月时的疾病不确定感量表(MUIS)及焦虑自评量表(SAS)进行预后评估,并统计术后1年内的所有复发病例。结果 黏膜切除宽度<1.5cm、黏膜切除不完整、吻合钉宽密度较低、术后大便干结、术前合并高血压及术前血红蛋白(HGB)较低均与术后原发性出血有关联。出血组手术后7d时MUIS、SAS得分均高于未出血组,且术后2个月时出血组SAS得分高于未出血组,差异均具有统计学意义(P<0.05);两组术后2个月时MUIS得分及术后1年复发率比较,差异无意义(P>0.05)。结论 导致混合痔PPH术后吻合口原发性出血的风险因子较多,既往合并高血压、HGB较低或术后大便干结均可导致出血风险增加,主要危险因素则是术中操作,如吻合钉宽密度较低、黏膜切除宽度不足等。出血对患者预后存在一定影响。Objective To analyze primary bleeding at anastomotic site.Methods The paper reviewed and analyzed 100 patients with mixed hemorrhoid surgery in our hospital from January 2019 to December 2022,treated with PPH treatment,collected relevant data,and divided them into bleeding group and non bleeding group based on whether primary bleeding occurred.Logistic univariate and multivariate analyse were carried out on relevant data between two groups to evaluate risk factors of bleeding.Prognostic evaluation was conducted with Disease Uncertainty Scale(MUIS)and Self Rating Anxiety Scale(SAS) before surgery,7 days after surgery,and 2 months after surgery,all recurrent cases within 1 year after surgery were counted.Results Mucosal resection width<1.5cm,incomplete mucosal resection,low density of anastomotic nails,postoperative dry stool,preoperative concomitant hypertension,and low preoperative hemoglobin(HGB) was associated with postoperative primary bleeding.MUIS and SAS scores of bleeding group were higher than non bleeding group 7days after surgery,and SAS scores of bleeding group were higher than non bleeding group 2 months after surgery,with statistical significance(P< 0.05).There was no significant difference in MUIS scores and 1-year postoperative recurrence rate at 2 months after surgery(P>0.05).Conclusion There are many factors related to primary bleeding at anastomotic site of mixed hemorrhoids after PPH surgery,including intraoperative factors(insufficient mucosal resection width,insufficient density of anastomotic nails,etc.),preoperative factors(concomitant hypertension),and postoperative factors(dry stools,etc.).Bleeding does not significantly increase incidence of disease recurrence,but is more detrimental to mental health of patients.

关 键 词：混合痔 吻合口原发性出血 预后 相关因素 吻合器痔上黏膜环切术 

分 类 号：R657.18[医药卫生—外科学]