内镜下套扎联合硬化剂注射治疗痔疮术后不良预后的影响因素分析

Analysis of influencing factors of poor prognosis of patients with hemorrhoids treated by endoscopic ligation combined with sclerotherapy

[目的]研究内镜下套扎联合硬化剂注射治疗痔疮术后不良预后的影响因素,给临床手术提供决策建议。[方法]回顾性分析438例痔疮患者的临床资料,患者均采用内镜下套扎联合硬化剂注射治疗。采用单因素分析内镜下套扎联合硬化剂注射治疗痔疮术后不良预后的危险因素,并采用多因素Logistic分析对上述有差异的统计学资料进行进一步回归分析,最终探讨影响不良预后的独立危险因素。[结果]438例内镜下套扎联合硬化剂注射治疗痔疮患者,发生不良预后28例,发生率为6.4%,列为不良预后组,其余410例列为非不良预后组。单因素分析表明,不良预后组与非不良预后组性别、是否合并外痔、合并高血压、合并糖尿病、病程、BMI、出血量和术后VAS疼痛评分相比差异无统计学意义(P>0.05),2组在白蛋白是否≤35 g/L、手术时间是否>1 h、痔疮分期、术后首次排便时间及住院时间相比均差异有统计学意义(P<0.05)。将上述单因素分析差异具有统计学意义的纳入多因素分析显示,术前白蛋白≤35 g/L、手术时间>1 h、痔疮分期、术后首次排便时间及年龄为影响术后不良预后的高危因素(P<0.05)。[结论]内镜下套扎联合硬化剂注射治疗痔疮术后不良预后的高危因素包括术前白蛋白≤35 g/L、手术时间>1 h、痔疮分期、术后首次排便时间及年龄,临床上可针对上述因素采取针对性的预防措施。

[Objective]To study the factors influencing the poor prognosis of patients with hemorrhoids treated by endoscopic ligation combined with sclerotherapy injection,and to provide decision-making suggestions for clinical surgery.[Methods]Clinical data of 438 patients with hemorrhoids were retrospectively analyzed.All patients were treated with endoscopic ligation combined with sclerotherapy.The risk factors of poor prognosis after the treatment of hemorrhoids with endoscopic ligation combined with sclerosing agent injection were analyzed by single factor analysis,and the above statistical data with differences were further analyzed by multivariate Logistic analysis,and the independent risk factors affecting the poor prognosis were finally discussed.[Results]Among 438 patients with hemorrhoids treated with endoscopic ligation combined with sclerotherapy,28 cases(6.4%)had poor prognosis,and the other 410 cases were classified as non-poor prognosis group.Univariate analysis showed that there was no significant difference in gender,external hemorrhoids,hypertension,diabetes,course of disease,BMI,blood loss and postoperative VAS pain score between the poor prognosis group and the non-poor prognosis group(P>0.05).There were significant differences in albumin≤35 g/L,operation time>1 h,hemorrhoid stage,first postoperative defecation time and hospital stay between the two groups(P<0.05).Multivariate analysis showed that preoperative albumin≤35 g/L,operation time>1 h,hemorrhoid stage,time of first postoperative defecation and age were high risk factors affecting postoperative poor prognosis(P<0.05).[Conclusion]The high-risk factors for poor prognosis after the treatment of hemorrhoids with endoscopic ligation combined with sclerotherapy include preoperative albumin≤35 g/L,operation time>1 h,stage of hemorrhoids,time of first postoperative defecation and age.Targeted preventive measures can be taken clinically for these factors.