关键词:

混合痔, 吻合器痔切除术, 术后出血, 预测模型

Abstract:

Objective　To find out the risk factors of postoperative bleeding after procedure for prolapse and hemorrhoids (PPH) combined with several examination indicators, and to formulate its bleeding prediction model in order to reduce the postoperative bleeding after PPH, improve the patients' prognosis, and alleviate the patients' pain. Methods　This study was a retrospective observational study. The clinical data of 258 patients who underwent PPH in Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage) from December 2016 to May 2021 were retrospectively analyzed. Among them, there were 115 males and 143 females, with an average age of 45.64 years old. The main observation indicators were whether there were complications of hypertension and diabetes, anal tube placement time, hemoglobin, leukocytes, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, uric acid, platelets, activated partial thrombin time (APTT), international normalized ratio (INR), prothrombin time (PT), thrombin time (TT), whether the intestinal preparation was adequate, whether the stool was dry, and whether the antibiotics are used. Univariate analysis was performed using t test and χ² test, and multivariate analysis was performed using logistic regression analysis. A predictive model for postoperative bleeding was established, and the receiver operating characteristic curve (ROC) was used to verify the predictive efficacy of the model. Results　In the multivariate analysis, dry stool (P=0.01), anal tube placement time (P=0.02), antibiotic use (P=0.02), intestinal preparation (P<0.01), and TT (P=0.01) all had statistically significant differences in predicting postoperative bleeding after PPH. The predictive model of postoperative bleeding after PPH was Y=1/[1+EXP (2.16× anal tube placement time -2.24× dry stool +1.97× no antibiotic use +2.92× inadequate intestinal preparation +1.64×TT -35.29)], the predictive power of the model was tested by ROC, and the area under the curve (AUC) was 0.987. Conclusions　Dry stool, anal tube placement time, antibiotic use, intestinal preparation, and TT are independent risk factors for postoperative bleeding after PPH, which are closely related to bleeding. The establishment of this predictive model is helpful to reduce the occurrence of this complication in clinical practice.

Key words:

Mixed hemorrhoids, Procedure for prolapse and hemorrhoids, Postoperative bleeding, Prediction model