痔瘘裂术后常见并发症及危险因素分析

Common complications and risk factors after hemorrhoid fistula surgery

目的统计痔瘘裂术后常见并发症,分析术后并发症发生的危险因素。方法该研究为回顾性研究,选择2020年1月至2021年12月南阳医学高等专科学校附属中医院收治的180例痔瘘裂手术患者为研究对象,统计入组患者术后并发症发生情况,并将其分为发生组(50例)和未发生组(130例),收集、对比两组患者一般资料、临床资料,经统计学单因素分析、Logistic多因素回归分析归纳可导致术后并发症发生的危险因素,依据分析结果探讨临床干预对策。结果经统计,180例患者中术后并发症发生率为27.78%(50/180),其中以肛缘水肿70.00%(35/50)最为常见;统计学单因素分析结果显示,50例发生组中女性、年龄≥60岁、合并糖尿病、病灶位于肛门正中、环状混合痔、术前未预防性应用抗生素、术中未松解括约肌、术后切口未缝合、术后引流不畅、术后感染、术后排便不畅占比分别为60.00%(30/50)、72.00%(36/50)、44.00%(22/50)、72.00%(36/50)、70.00%(35/50)、60.00%(30/50)、68.00%(34/50)、66.00%(33/50)、84.00%(42/50)、70.00%(35/50)、36.00%(18/50)、72.00%(36/50),均高于未发生组[38.46%(50/130)、42.31%(55/130)、23.08%(30/130)、46.15%(60/130)、44.62%(58/130)、30.77%(40/130)、42.31%(55/130)、43.85%(57/130)、47.69%(62/130)、38.46%(50/130)、17.69%(23/130)、44.62%(58/130)],差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,年龄≥60岁、合并糖尿病、肛门正中环状混合痔、术前未预防性应用抗生素、术中未松解括约肌、术后切口未缝合、术后引流不畅、术后感染、术后排便不畅等均为痔瘘裂术后发生并发症的危险因素。结论合并糖尿病、病灶位于肛门正中的环状混合痔患者可由于围手术期处理不当或术后感染、排便不畅而发生肛缘水肿等术后并发症,积极治疗原发病、规范手术操作、加强术后管理均是降低痔瘘裂患者手术风险的重要措施。

【Objective】To analyze the common complications after hemorrhoid and fistula surgery and the risk factors for postoperative complications.【Methods】This study is a retrospective study,selecting 180 patients who underwent hemorrhoid and fistula surgery from January 2020 to December 2021 as the study subjects.The incidence of postoperative complications in the enrolled patients was statistically analyzed and the patients were divided into the occurrence group(n=50)and the non-occurrence group(n=130).General and clinical data of the two groups of patients were collected and compared,and risk factors that can lead to postoperative complications were summarized through statistical univariate analysis and logistic multiple factor regression analysis.Clinical intervention strategies based on the analysis results were explored.【Results】According to statistics,the incidence of postoperative complications in 180 patients was 27.78%(50/180),with anal edema being the most common at 70.00%(35/50).The results of statistical single factor analysis showed that in the 50 cases of occurrence group,women,age≥60 years old,with diabetes,the focus was located in the middle of the anus,circular mixed hemorrhoids,no preventive use of antibiotics before surgery,no release of sphincter during surgery,no suture of incision after surgery,poor postoperative drainage,postoperative infection,poor postoperative defecation accounted for 60.00%(30/50),72.00%(36/50),44.00%(22/50),72.00%(36/50),70.00%(35/50),60.00%(30/50),68.00%(34/50),66.00%(33/50),84.00%(42/50),70.00%(35/50),36.00%(18/50),72.00%(36/50)were higher than those in the non-occurring group[38.46%(50/130),42.31%(55/130),23.08%(30/130),46.15%(60/130),44.62%(58/130),30.77%(40/130),42.31%(55/130),43.85%(57/130),47.69%(62/130),38.46%(50/130),17.69%(23/130),44.62%(58/130)](P<0.05).Logistic regression analysis showed that age≥60 years old,combined with diabetes,mixed hemorrhoids in the middle of the anus,no preventive use of antibiotics before surgery,no release of sphincter during surgery,no suture of incision after surgery,poor drainage after surgery,postoperative infection,and poor defecation after surgery were all risk factors for complications after hemorrhoid fistula surgery.【Conclusion】Circumferential mixed hemorrhoid patients with diabetes and the focus in the middle of the anus may have postoperative complications such as anal edema due to improper perioperative treatment or postoperative infection and poor defecation.Active treatment of the primary disease,standardized operation,and strengthened postoperative management are all important measures to reduce the risk of hemorrhoid fistula surgery.