目的 观察混合痔患者术后尿潴留(UR)发生情况,探讨其发生的影响因素.方法 2023年1月-2023年12月郑州大学附属郑州中心医院行外剥内扎联合内痔硬化剂注射术的混合痔患者974例,有肛裂、肛瘘、肛乳头纤维瘤等疾病者同时行相应手术进行处理.术后发生尿潴留者68例为尿潴留组,未发生尿潴留者906例中随机选取68例为非尿潴留组.比较2组性别、年龄、体质量指数(BMI)、痔疮病程、痔疮分度、基础疾病及术前血红蛋白、白蛋白水平;记录联合手术比率、套扎内痔点数、外痔切除点数、手术时间、术中液体入量、术后3 h视觉模拟评分(VAS);采用多因素logistic回归分析混合痔术后发生尿潴留的影响因素.结果 (1)尿潴留组BMI[(22.91±2.94)kg/m2]小于非尿潴留组[(24.58±4.11)kg/m2](t=-2.730,P=0.007),联合手术比率(77.9％)高于非尿潴留组(23.5％)(x2=38.126,P＜0.001),手术时间[60.5(49.5,75.0)min]长于非尿潴留组[45.0(40.0,58.0)min](U=-3.936,P＜0.001),套扎内痔点数[3.0(3.0,4.0)]、外痔切除点数[3.0(1.0,3.0)]均多于非尿潴留组[2.0(2.0,3.0)、2.0(1.0,3.0)](U=-4.030,P＜0.001;U=-2.805,P=0.005),术后 3 h VAS[3.5(2.0,4.0)分]高于非尿潴留组[(2.0(2.0,2.0)分](U=-7.282,P＜0.001),性别比例、年龄、痔疮病程、痔疮分度及合并高血压、糖尿病比率、术中液体入量与非尿潴留组比较差异均无统计学意义(P＞0.05).(2)BMI(OR=0.801,95％CI:0.668～0.961,P=0.017)、术后 3 h VAS(OR=10.245,95％CI:3.769～19.180,P=0.001)、联合手术(OR=8.502,95％CI:3.460～30.338,P=0.001)是混合痔患者术后发生尿潴留的影响因素.结论 BMI小、行联合手术、术后VAS高的混合痔患者行外剥内扎联合内痔硬化剂注射术后尿潴留的发生风险增大.
Influencing factors of urinary retention after mixed haemorrhoid surgery
Objective To observe the occurrence of urinary retention(UR)in patients after mixed haemorrhoid surgery,and to explore its influencing factors.Methods Totally 974 patients with mixed haemorrhoid received external stripping and internal ligation combined with internal haemorrhoid sclerosing agent injection in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January,2023 to December,2023,and the corresponding procedures were performed at the same time if the patients were complicated anal fuses,anal fistulas,anal papillary fibroma and other diseases.UR developed in 68 patients after surgery(UR group),and another 68 patients from 906 patients without UR were randomly selected as no-UR group.The gender,age,body mass index(BMI),course of haemorrhoids,grading of haemorrhoids,underlying diseases,and preoperative levels of haemoglobin and albumin were compared between two groups.The rate of combined surgery,the number of intraoperative haemorrhoid ligation points,the number of external haemorrhoid excision points,the operative time,the intraoperative fluid intake,and the visual analogue score(VAS)3 h after surgery were recorded.Multivariate logistic regression was used to analyze the influencing factors of UR after mixed haemorrhoid surgery.Results(1)The BMI was lower in UR group[(22.91±2.94)kg/m2]than that in no-UR group[(24.58±4.11)kg/m2](t=-2.730,P=0.007).The rate of combined surgery was higher in UR group(77.9％)than that in no-UR group(23.5％)(X2=38.126,P＜0.001).The operative time was longer in UR group[60.5(49.5,75.0)min]than that in no-UR group[45.0(40.0,58.0)min](U=-3.936,P＜0.001).The numbers of haemorrhoid ligation points and external haemorrhoid excision points were more in UR group[3.0(3.0,4.0),3.0(1.0,3.0)]than those in no-UR group[2.0(2.0,3.0),2.0(1.0,3.0)](U=4.030,P＜0.001;U=-2.805,P=0.005).The VAS score 3 h after surgery was higher in UR group[3.5(2.0,4.0)]than that in no-UR group[(2.0(2.0,2.0)](U=-7.282,P＜0.001).There were no significant differences in the gender ratio,age,course of haemorrhoids,grading of haemorrhoids,proportions of hypertension and diabetes,and intraoperative fluid intake between two groups(P＞0.05).(2)BMI(OR=0.801,95％CI:0.668-0.961,P=0.017),VAS score 3 h after surgery(OR=10.245,95％CI:3.769-19.180,P=0.001),and combined surgery(OR=8.502,95％CI:3.460-30.338,P=0.001)were the influencing factors of UR after mixed haemorrhoid surgery.Conclusion Mixed haemorrhoid patients with low BMI,combined surgery,and high postoperative VAS score are at a high risk of UR after mixed haemorrhoid external stripping and internal ligation combined with internal haemorrhoid sclerosing agent injection.
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