Milligan-Morgan术后出现胃肠道症状危险因素Logistic回归分析

doi:10.3969/j.issn.1000-8535.2020.02.018

摘要/Abstract

摘要： 目的回顾分析我医院近8年混合痔行Milligan-Morgan术式治疗的患者的临床病历资料,探索术后出现胃肠道症状的危险因素。方法选取我医院2012年1月—2019年6年期间行Milligan-Morgan术式治疗的混合痔患者1 221例,分成术后胃肠道症状组和未出现胃肠道症状组,比较两组间的差异,分析其相关危险因素。结果 1 221例混合痔患者中出现胃肠道症状的为168例,发生率为13.8%(168/1 221);单因素分析结果显示,高血压、全麻麻醉方式是术后出现胃肠道症状的相关因素,差异有统计学意义;多因素Logistic回归分析结果显示,高血压、全麻麻醉方式是术后出现胃肠道症状的独立危险因素。结论混合痔患者行Milligan-Morgan术式治疗出现胃肠道症状率较高;围手术期控制患者血压,以及慎重选择全麻麻醉方式可能有效减少胃肠道症状发生率。

关键词: Milligan-Morgan术, 胃肠道症状, 危险因素, Logistic回归分析

Abstract: Objective To explored the risk factors of gastrointestinal symptoms after operation by retrospectively analyzing the clinical records of patients with mixed hemorrhoids treated by Milligan-Morgan operation in our hospital in recent 8 years. Methods 1 221 patients with mixed hemorrhoids treated by Milligan-Morgan operation in our hospital from January 2012 to June 2016 were divided into two groups: the group with digestive tract symptoms after operation and the group without digestive tract symptoms. The differences between the two groups were compared and the related risk factors were analyzed. Results Among 1 221 patients with mixed hemorrhoids, 168 had gastrointestinal symptoms, whose incidence was 13.8%(168/1 221). Univariate analysis showed that hypertension and general anesthesia were the related factors of gastrointestinal symptoms after operation, and the difference was statistically significant. Multivariate logistic regression analysis showed that hypertension and general anesthesia were the independent risk factors. Conclusion Milligan-Morgan operation for mixed hemorrhoids has a high incidence of digestive tract symptoms. Perioperative blood pressure control and careful selection of general anesthesia may effectively reduce the incidence of digestive tract symptoms.

Key words: Milligan-Morgan, Gastrointestinal symptoms, Risk factors, Logistic regression analysis

余显畅, 钟雄东. Milligan-Morgan术后出现胃肠道症状危险因素Logistic回归分析[J]. 广州医药, 2020, 51(2): 81-84.

YU Xianchang, ZHONG Xiongdong. Logistic regression analysis of risk factors for gastrointestinal symptoms after Milligan-Morgan operation[J]. Guangzhou Medical Journal, 2020, 51(2): 81-84.

参考文献

[1] 李心洁,田雅军,罗毅. 2013～2015年70 430例体检人群电子直乙结肠镜结果探讨[J]. 安徽医科大学学报,2018,53(10):1562-1566.
[2] 张慧,史圣华,莫日根, 等. 痔病发病原因的总结与分析[J]. 世界最新医学信息文摘,2019,19(05):43-44.
[3] 夏佳毅, 刘访, 李志, 等. 外剥内注肛垫回缩固定术治疗混合痔的临床研究[J]. 中华胃肠外科杂志, 2018,21(12):1443-1445.
[4] YADAV S, KHANDELWAL R G, OM P, et al. A prospective randomized double-blind study of pain control by topical calcium channel blockers versus placebo after milligan-morgan hemorrhoidectomy[J]. Int J Colorectal Dis, 2018,33(7):895-899.
[5] MEDINA-GALLARDO A, CURBELO-PENA Y, de CASTRO X, et al. Is the severe pain after milligan-morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? a case series of 117 consecutive patients[J]. Int J Surg Case Rep, 2017(30):73-75.
[6] NADERAN M, SHOAR S, NAZARI M, et al. A randomized controlled trial comparing laser intra-hemorrhoidal coagulation and milligan-morgan hemorrhoidectomy[J]. J Invest Surg, 2017,30(5):325-331.
[7] HE Y H, TANG Z J, XU X T, et al. A randomized multicenter clinical trial of rph with the simplified milligan-morgan hemorrhoidectomy in the treatment of mixed hemorrhoids[J]. Surg Innov, 2017,24(6):574-581.
[8] SIDDIQUI M R, ABRAHAM-IGWE C, SHANGUMANANDAN A, et al. A literature review on the role of chemical sphincterotomy after milligan-morgan hemorrhoidectomy[J]. Int J Colorectal Dis,2011,26(6):685-692.
[9] BENNETT-GUERRERO E, WELSBY I, DUNN T J, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery[J]. Anesth Analg, 1999,89(2):514-519.
[10] 姚学敏, 叶必星, 周烨, 等. 功能性消化不良罗马Ⅲ和罗马Ⅱ标准的比较及精神心理状况调查[J]. 中华消化杂志,2012,32(5):303-306.
[11] 李勇. 从最新高血压指南看我国高血压治疗如何破局[J]. 中华高血压杂志,2019,27(6):512-515.
[12] 丁叶舟,王晖. 乙肝防治指南在我国临床应用中的现状和思考[J]. 胃肠病学和肝病学杂志,2018,27(9):972-975.
[13] 王国强, 刘扬, 刘青, 等. 吻合器痔上黏膜环切术的近远期疗效及安全性的meta分析[J]. 中华外科杂志, 2013,51(11):1034-1038.
[14] LAUGHLAN K, JAYNE D G, JACKSON D, et al. Stapled haemorrhoidopexy compared to milligan-morgan and ferguson haemorrhoidectomy: A systematic review[J]. Int J Colorectal Dis, 2009,24(3):335-344.
[15] BHATTI M I, SAJID M S, BAIG M K. Milligan-morgan(open) versus ferguson haemorrhoidectomy(closed): A systematic review and meta-analysis of published randomized, controlled trials[J]. World J Surg, 2016,40(6):1509-1519.
[16] MARISCAL M, LLORCA J, PRIETO D, et al. Determinants of the interval between the onset of symptoms and diagnosis in patients with digestive tract cancers[J]. Cancer Detect Prev, 2001,25(5):420-429.
[17] ABRAHAM S, KELLOW J E. Do the digestive tract symptoms in eating disorder patients represent functional gastrointestinal disorders?[J]. BMC Gastroenterol, 2013(13):38.
[18] MARTIN B. Prevention of gastrointestinal complications in the critically ill patient[J]. AACN Adv Crit Care, 2007,18(2):158-166.
[19] LOGANATHAN A K, BAL H S. Intramural duodenal haematoma with mucosal prolapse causing intestinal obstruction[J]. BMJ Case Rep,2019,12(4): e228276.
[20] XIE F, XIE L, LI X, et al. prevalence and risk factors of hypertension combined with diabetes in middle and elder population in nan'an district of chongqing[J]. Zhonghua Liu Xing Bing Xue Za Zhi,2019,40(6):666-669.
[21] WANG K, YIN Y. Risk factors and prognosis of reintubation following surgeries under general anesthesia[J]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2017,39(1):145-149.