中重度痔疮手术后复发原因及对策

Reasons and Countermeasures for Recurrence of Moderate to Severe Hemorrhoids After Operation

目的探讨中重度痔疮手术后复发的原因及对策。方法选取我院2016年1月~2018年8月行外剥内扎术(M-M)和痔上粘膜环切术(PPH)联合外剥内扎术治疗的中重度痔疮患者136例为研究对象,分析两种手术术后复发原因。结果136例患者术后均得到6个月以上随访,术后出现痔脱垂及出血复发症状患者24例,复发率17.65%,其中MM手术62例,复发15例(24.19%),PPH联合外剥内扎术手术74例,复发9例(12.16%),复发的原因分别为术后Treitz肌松弛、静脉曲张、肛缘水肿及血栓形成。多因素回归分析显示,过早排便、久蹲久坐、排便次数增多、便秘或腹泻、进食辛辣食物以及局部卫生差等是引起中重度痔疮手术后复发的危险因素。结论中重度痔疮手术后复发可能与过早排便、久蹲久坐、排便次数增多、便秘或腹泻、进食辛辣食物以及局部卫生差有关,及时了解中重度痔疮术后复发原因及相关因素是预防术后复发的重要步骤。

Objective To explore the causes and countermeasures of recurrence of moderate to severe hemorrhoids after surgery.Methods 136 patients with moderate to severe hemorrhoids who underwent external stripping and internal ligation(M-M)and hemorrhoid circumcision(PPH)combined with external stripping and internal ligation in our hospital from January 2016 to August 2018 were selected as the research objects.Analyze the causes of recurrence after two kinds of surgery.Results 136 patients were followed up for more than 6 months after operation.24 patients had symptoms of hemorrhoid prolapse and bleeding recurrence after operation.The recurrence rate was 17.65%.Among them,there were 62 cases of MM surgery and 15 cases of recurrence(24.19%).There were 74 cases of PPH combined with external stripping and internal ligation,and 9 cases(12.16%)recurred.The reasons for the recurrence were Treitz muscle relaxation,varicose veins,anal edema and thrombosis.Multivariate regression analysis showed that premature defecation,prolonged squatting,increased defecation frequency,constipation or diarrhea,eating spicy food,and poor local hygiene were risk factors for recurrence of moderate to severe hemorrhoids after surgery.Conclusion The recurrence of moderate to severe hemorrhoids after surgery might be related to premature defecation,prolonged squatting,increased bowel frequency,constipation or diarrhea,eating spicy food,and poor local hygiene.Timely understanding of the causes of recurrence of moderate to severe hemorrhoids and related factors were preventive surgery an important step after recurrence.