自动痔疮套扎术对Ⅲ、Ⅳ度混合痔患者肛门功能和机体应激的影响及手术效果的影响因素分析

Effect of Ruiyun Procedure for Hemorrhoid on Anal Function and Body Stress in Patients with Grade Ⅲ and Ⅳ Mixed Hemorrhoids and Analysis of Influencing Factors of Surgical Effect

目的:观察自动痔疮套扎术(RPH)对Ⅲ、Ⅳ度混合痔患者肛门功能和机体应激的影响,并分析手术效果的影响因素。方法:回顾性选择重庆医科大学附属永川医院2020年1月~2022年1月期间收治的Ⅲ、Ⅳ度混合痔患者200例的临床资料,按照治疗方式的不同将患者分为A组[外剥内扎术(M-M)治疗,97例]和B组(RPH治疗,103例),对比两组围术期指标、肛门功能、应激指标、并发症发生率。所有RPH患者评估治疗效果,采用单因素和多因素Logistic回归分析手术效果的影响因素。结果:两组手术时间、住院时间组间对比无统计学差异(P>0.05);B组的术中出血量少于A组,创面愈合时间短于A组,术后疼痛视觉模拟(VAS)评分小于A组(P<0.05)。两组术后肛管静息压、肛管最大收缩压、Wexner评分均下降,且B组低于A组(P<0.05)。两组术后促肾上腺皮质激素(ACTH)、皮质醇(COR)均升高,但B组低于A组(P<0.05)。B组的并发症总发生率低于A组(P<0.05)。单因素分析结果显示,RPH的手术效果与便秘、糖尿病史、病灶直径、手术后感染、手术切口有关(P<0.05)。多因素Logistic回归分析结果显示,便秘、糖尿病史、病灶直径偏长、手术后感染、手术切口不对称是RPH手术效果无效的危险因素(P<0.05)。结论:与传统M-M治疗Ⅲ、Ⅳ度混合痔患者相比,RPH可减轻术中出血量,减轻对机体肛门功能和应激的影响,促进患者术后恢复。病灶直径偏长、便秘、糖尿病史、手术后感染、手术切口不对称等问题可能导致RPH患者治疗后无效,临床需要重点关注。

Objective: To observe the effects of ruiyun procedure for hemorrhoid(RPH) on anal function and body stress in patients with grade Ⅲ and Ⅳ mixed hemorrhoids, and to analyze the influencing factors of surgical effect. Methods: The clinical data of 200 patients with grade Ⅲ and Ⅳ mixed hemorrhoids who were admitted to Yongchuan Hospital of Chongqing Medical University from January 2020 to January 2022 were retrospectively selected. According to different treatment methods, the patients were divided into group A [external stripping and internal ligation(M-M) treatment, 97 cases] and group B(RPH treatment, 103 cases). Perioperative indexes, anal function, stress indexes and complication rate were compared in the two groups. All patients with RPH were evaluated for treatment effect, and univariate and multivariate Logistic regression were used to analyze the influencing factors of surgical effect.Results: There were no significant differences in operation time and hospitalization time between the two groups(P>0.05). The intraoperative blood loss in the group B was less than that in the group A, the wound healing time was shorter than that in the group A, and the postoperative visual analog scale(VAS) score was less than that in the group A(P<0.05). Postoperative anal resting pressure, anal maximum systolic pressure and Wexner score were all decreased in the two groups, and group B was lower than group A(P<0.05). Adrenocorticotropic hormone(ACTH) and cortisol(COR) were increased in the two groups, but group B was lower than group A(P<0.05). The total complication rate in the group B was lower than that in the group A(P<0.05). Univariate analysis showed that the operative effect of RPH was related to constipation, diabetes history, lesion diameter, postoperative infection and surgical incision(P<0.05). Multivariate Logistic regression analysis showed that constipation, diabetes history, longer lesion diameter, postoperative infection, and asymmetric surgical incision were risk factors for operative ineffective RPH(P<0.05). Conclusion: Compared with the traditional M-M treatment for patients with grade III and IV mixed hemorrhoids, RPH can reduce the intraoperative blood loss, reduce the impact on the body’s anal function and stress, and promote the postoperative recovery of patients. Problems such as longer lesion diameter, constipation, diabetes history, postoperative infection, asymmetric surgical incision, etc. may lead to ineffective treatment for patients with RPH, which should be paid more attention to clinically.