吻合器痔上黏膜环切术治疗环状脱垂痔的疗效及术后发生尿潴留的影响因素

Efficacy of PPH in the treatment of circumferential prolapsed hemorrhoids and the influencing factors of postoperative urinary retention

目的探讨吻合器痔上黏膜环切术(PPH)治疗Ⅲ~Ⅳ期环状脱垂痔的疗效及术后尿潴留(UR)的影响因素分析。方法纳入武汉市第八医院肛肠科2018年1月至2019年1月PPH术治疗的120例Ⅲ~Ⅳ期环状脱垂痔患者,随机分为训练集90例和验证集30例,根据术后是否发生UR将训练集分为UR组26例和Non-UR组64例。比较两组临床资料,Lasso-logistic回归筛选危险因素,建立列线图模型并以验证集验证。结果PPH术疗效总有效率89.17%,术后便血评分、β-EP、IL-17、IL-6、5-HT、CRP、TNF-α水平降低。多因素分析显示,年龄(OR=1.118,P=0.006)、静脉补液量(OR=1.780,P=0.007)、术后SAS评分(OR=1.879,P=0.002)、术后镇痛泵(OR=1.218,P=0.001)、术后24 h VAS评分(OR=1.547,P=0.003)是UR危险因素。列线图模型预测风险值为0.93。训练集和验证集ROC线下面积分别为0.889和0.878,验证集校准曲线的预测值与实际值拟合度良好。结论PPH术治疗Ⅲ~Ⅳ期环状脱垂痔疗效较好,高龄、静脉补液量多、术后SAS和VAS评分高、使用镇痛泵是UR的危险因素,以此构建的列线图模型工作效能较好。

Objective To investigate the efficacy of stapling procedure for prolapse and hemorrhoids(PPH)in the treatment of stageⅢ~Ⅳcircumferential prolapsed hemorrhoids and the influencing factors of postoperative urinary retention(UR).Methods From January 2018 to January 2019,a total of 120 patients with stageⅢ~Ⅳcircular prolapse hemorrhoids were enrolled in the Second Department of Anorectal Surgery,Wuhan Eighth Hospital and were randomly assigned to training set(n=90)and verification set(n=30).According to the occurrence of UR after operation,the training set was divided into UR group(n=26)and Non-UR group(n=64).The clinical data of the two groups were compared.Lasso-Logistic regression was used to screen the risk factors and establish a line chart model to validate it with a verification set.Results The total effective rate of PPH was 89.17%.The postoperative hematochezia score and the levels of serumβ-EP,IL-17,IL-6,5-HT,CRP and TNF-αwere significantly lower than those before operation.Multivariate analysis showed that age(OR=1.118,P=0.006),intravenous infusion volume(OR=1.780,P=0.007),postoperative SAS score(OR=1.879,P=0.002),postoperative analgesic pump(OR=1.218,P=0.001)and postoperative 24hVAS score(OR=1.547,P=0.003)were risk factors for UR.The risk value predicted by the line chart model is 0.93.The offline areas of training set and verification set ROC are 0.889 and 0.878 respectively.The predicted value of the calibration curve of the verification set fits well with the actual value.Conclusion The clinical efficacy of PPH in the treatment of stageⅢ~Ⅳcircumferential prolapse hemorrhoids was better.Advanced age,large amount of intravenous fluid replacement,high postoperative SAS and VAS scores,and use of analgesic pump were the risk factors of UR.The working efficiency of the line diagram model was good.