目的 探讨“Y”形切剥加内痔柱状缝扎悬吊术(Y-shaped incision and dissection combined with internal hemorrhoid ligation and suspension,YID-IHLS)在治疗环状混合痔中的临床效果,并与传统外剥内扎术(milligan-morgan hemorrhoidec...目的 探讨“Y”形切剥加内痔柱状缝扎悬吊术(Y-shaped incision and dissection combined with internal hemorrhoid ligation and suspension,YID-IHLS)在治疗环状混合痔中的临床效果,并与传统外剥内扎术(milligan-morgan hemorrhoidectomy,MMH)进行对比分析。方法 选取2023年9月—2024年9月都江堰市中医医院肛肠科收治的134例环状混合痔患者作为研究对象,根据患者手术方式的不同分组,每组67例。观察组采用YID-IHLS治疗,而对照组则采用MMH治疗。比较两组术后康复情况、术后症状评分及术后肛门功能。结果 观察组住院时间、创面愈合时间均短于对照组,差异均有统计学意义(P均<0.05)。术后,观察组肛门疼痛、肛门出血、创面水肿、排便情况评分均低于对照组,差异均有统计学意义(P均<0.05)。术后3个月,观察组肛门狭窄(0.37±0.09)分和控便能力评分(0.49±0.10)分低于对照组的(1.58±0.24)分、(1.09±0.14)分,差异均有统计学意义(t=38.640,28.546;P均<0.05)。结论 YID-IHLS治疗环状混合痔相较于传统MMH手术,在缩短住院时间和创面愈合时间、减轻术后症状以及改善肛门功能方面表现出显著优势。展开更多
目的:了解混合痔患者术后发生尿潴留的危险因素,构建预测模型并进行内部验证。方法:选取2023年1月1日—5月31日就诊于宜昌市中心人民医院的517例Ⅲ~Ⅳ级混合痔患者,按术后是否需要进行导尿分为尿潴留组(n=86)与非尿潴留组(n=431)。采用L...目的:了解混合痔患者术后发生尿潴留的危险因素,构建预测模型并进行内部验证。方法:选取2023年1月1日—5月31日就诊于宜昌市中心人民医院的517例Ⅲ~Ⅳ级混合痔患者,按术后是否需要进行导尿分为尿潴留组(n=86)与非尿潴留组(n=431)。采用Lasso回归与多因素Logistic回归分析混合痔患者术后发生尿潴留的独立影响因素,构建列线图预测模型并进行内部验证。结果:Lasso回归筛选出11个特征变量,多因素Logistic回归分析发现,男性(OR=2.588,95%CI:1.526,4.389)、身体质量指数(BMI)≥24 kg/m2(OR=5.254,95%CI:3.028,9.116)、手术当天补液量>700 m L(OR=2.207,95%CI:1.194,4.078)、脊髓麻醉(OR=4.058,95%CI:2.295,7.175)及术后疼痛>5分(OR=2.114,95%CI:1.115,4.010)为混合痔患者术后发生尿潴留的独立危险因素(均P<0.05)。构建列线图预测模型并绘制受试者工作特征曲线(ROC),联合预测曲线下面积(AUC)为0.799,校准曲线与Bootstrap内部验证后校准曲线均表明风险拟合曲线与理想曲线接近。当尿潴留发生阈值概率处于0%~95%时,模型具有良好的临床适用性。结论:男性、BMI≥24 kg/m2、手术当天补液量>700 m L、脊髓麻醉及术后疼痛>5分为混合痔患者术后发生尿潴留的独立危险因素,构建的列线图预测模型具有较好的区分度、校准度及临床适用性。展开更多
BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different tre...BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.展开更多
文摘目的:了解混合痔患者术后发生尿潴留的危险因素,构建预测模型并进行内部验证。方法:选取2023年1月1日—5月31日就诊于宜昌市中心人民医院的517例Ⅲ~Ⅳ级混合痔患者,按术后是否需要进行导尿分为尿潴留组(n=86)与非尿潴留组(n=431)。采用Lasso回归与多因素Logistic回归分析混合痔患者术后发生尿潴留的独立影响因素,构建列线图预测模型并进行内部验证。结果:Lasso回归筛选出11个特征变量,多因素Logistic回归分析发现,男性(OR=2.588,95%CI:1.526,4.389)、身体质量指数(BMI)≥24 kg/m2(OR=5.254,95%CI:3.028,9.116)、手术当天补液量>700 m L(OR=2.207,95%CI:1.194,4.078)、脊髓麻醉(OR=4.058,95%CI:2.295,7.175)及术后疼痛>5分(OR=2.114,95%CI:1.115,4.010)为混合痔患者术后发生尿潴留的独立危险因素(均P<0.05)。构建列线图预测模型并绘制受试者工作特征曲线(ROC),联合预测曲线下面积(AUC)为0.799,校准曲线与Bootstrap内部验证后校准曲线均表明风险拟合曲线与理想曲线接近。当尿潴留发生阈值概率处于0%~95%时,模型具有良好的临床适用性。结论:男性、BMI≥24 kg/m2、手术当天补液量>700 m L、脊髓麻醉及术后疼痛>5分为混合痔患者术后发生尿潴留的独立危险因素,构建的列线图预测模型具有较好的区分度、校准度及临床适用性。
文摘BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.
