老年混合痔患者术后水肿疼痛现状及影响因素

Status quo of postoperative edema and pain and influencing factors in elderly patients with mixed hemorrhoids

目的评估老年混合痔患者术后水肿疼痛现状,并分析其影响因素。方法回顾性分析2020年1月至2022年12月于淮南市第一人民医院行外剥内扎术治疗的92例老年混合痔患者的临床资料。术后5 d,采用球体体积公式及视觉模拟评分法(VAS)评估患者肛缘水肿及疼痛情况。肛缘水肿Ⅱ级及以上及(或)疼痛程度中重度为阳性,纳入水肿疼痛组(29例),非阳性患者纳入非水肿疼痛组(63例)。采用SPSS 24.0统计软件进行数据处理。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用二元logistic回归分析患者外剥内扎术后5 d肛缘水肿疼痛的影响因素。结果术后5 d,老年混合痔患者肛缘水肿0级29例、1级35例、2级22例、3级6例,无肛缘水肿4级者;疼痛程度,无32例,轻度34例、中度21例、重度5例。二元logistic回归分析结果显示,环状混合痔(OR=4.802,95%CI 2.965~7.776;P<0.05)、手术皮瓣对合不良(OR=2.672,95%CI 1.510~4.729;P<0.05)及术后便秘/腹泻(OR=2.818,95%CI 1.611~4.929;P<0.05)是老年混合痔患者术后5 d肛缘水肿疼痛的危险因素;术后中药坐浴/熏洗是保护因素(OR=0.373,95%CI 0.014~0.765;P<0.05)。结论外剥内扎术后5 d,部分患者存在肛缘水肿疼痛,环状混合痔、手术操作不合理及术后排便异常可增加肛缘水肿疼痛风险,术后行中药坐浴/熏洗对缓解肛缘水肿疼痛有利。

Objective To evaluate the status quo of postoperative edema and pain in the elderly patients with mixed hemorrhoids and to analyze its influencing factors.Methods A retrospective analysis was made of the clinical data of 92 elderly patients with mixed hemorrhoids,who were treated with external stripping and internal ligation at Huainan First People′s Hospital from January 2020 to December 2022.The patients′perianal edema and pain were evaluated using sphere volume formula and visual analogue scale(VAS)at five days after surgery.Patients with perianal edema gradeⅡand above and/or moderate-to-severe pain were positive and were included in the edema-pain group(29 cases),and non-positive patients were included in the non-edema pain group(63 cases).SPSS 24.0 was used for data processing.According to the data type,t test or Chi-square test was performed for comparison between groups.Binary logistic regression analysis was used to evaluate the influencing factors of perianal edema and pain at five days after external stripping and internal ligation.Results At five days after surgery,29 cases of grade 0,35 cases of grade 1,22 cases of grade 2,6 cases of grade 3 and no case of grade 4 of anal margin edema in elderly patients with mixed hemorrhoids,and there were 32 cases of no pain,34 cases of mild pain,21 cases of moderate pain and 5 cases of severe pain.Binary logistic regression analysis showed that annular mixed hemorrhoids(OR=4.802,95%CI 2.965-7.776;P<0.05),surgical flap malalignment(OR=2.672,95%CI 1.510-4.729;P<0.05)and postoperative constipation/diarrhea(OR=2.818,95%CI 1.611-4.929;P<0.05)were risk factors for anal margin edema and pain at five days after surgery in elderly patients with mixed hemorrhoids,and postoperative traditional Chinese medicine sitz bath/fumigation was a protective factor(OR=0.373,95%CI 0.014-0.765;P<0.05).Conclusion Some elderly patients with mixed hemorrhoids have anal margin edema and pain at five days after external stripping and internal ligation.Annular mixed hemorrhoids,unreasonable operation and abnormal postoperative defecation can increase the risk of anal margin edema and pain.Traditional Chinese medicine sitz bath/fumigation after surgery is beneficial to relieving the anal margin edema and pain.