实用医学杂志 ›› 2022, Vol. 38 ›› Issue (23): 2988-2990.doi: 10.3969/j.issn.1006⁃5725.2022.23.017

• 临床研究 • 上一篇    下一篇

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 

邵继华 黄英 陈芳    

  1. 武汉市第八医院肛肠二科(武汉 430024)

  • 出版日期:2022-12-10 发布日期:2022-12-10
  • 通讯作者: 陈芳 E⁃mail:242946674@qq.com

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

SHAO Jihua,HUANG Ying,CHEN Fang.   

  1. The Second Department of Anorectal Medicine,Wuhan No.8 Hospital,Wuhan 430024,China

  • Online:2022-12-10 Published:2022-12-10
  • Contact: CHEN Fang E⁃mail:242946674@qq.com

摘要:

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 1 月至 2019 1 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 26 例和 Non⁃UR 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 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 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。

关键词:

吻合器痔上黏膜环切术, 环状脱垂痔, 尿潴留, Lasso 回归模型

Abstract:

Objective To investigate the efficacy of stapling procedure for prolapse and hemorrhoids (PPH)in the treatment of stage Ⅲ~Ⅳ circumferential prolapsed hemorrhoids and the influencing factors of postop⁃ erative urinary retention(UR). Methods From January 2018 to January 2019,a total of 120 patients with stage Ⅲ ~ Ⅳ circular prolapse hemorrhoids were enrolled in the Second Department of Anorectal Surgery,Wuhan Eighth Hospital and were randomly assigned to training set(= 90)and verification set(= 30). According to the occurrence of UR after operation,the training set was divided into UR group(= 26)and Non⁃UR group(= 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 serum β⁃EP,IL⁃17,IL⁃6,5⁃HT,CRP and TNF⁃α were significantly lower than those before operation. Multivariate analysis showed that age(OR = 1.118,= 0.006), intravenous infusion volume(OR = 1.780,= 0.007),postoperative SAS score(OR = 1.879,= 0.002),post⁃ operative analgesic pump(OR = 1.218,= 0.001)and postoperative 24hVAS score(OR = 1.547,= 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 verifica⁃ tion set fits well with the actual value. Conclusion The clinical efficacy of PPH in the treatment of stage Ⅲ~Ⅳ circumferential 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.

Key words:

procedure for prolapse and hemorrhoids, circular prolapsed hemorrhoids, urinary reten? tion, Lasso regression model