痔术后继发性大出血相关危险因素分析

目的 初步探讨痔术后继定性大出血的相关危险因素.方法 回顾性分析2971例痔手术患者的临床资料,比较年龄、性别、手术方式、手术医生、手术医生年资及预防感染措施等因素与继发性大出血的关系.结果 21例发生术后继发性大出血,发生率为0.7％,平均出血时间7.9d(2～21d).单因素分析显示痔术后继发性大出血与手术方式相关,多因素分析显示吻合器痔上粘膜环切术发生PHSH的概率显然高于传统的外剥内扎术,RR:0.6,95％可信区间:0.5～0.7;P =0.011.结论 手术方式是痔术后继发性大出血的独立危险因素,吻合器痔上粘膜环切术式较之传统外剥内扎术更易发生继发性大出血.

Risk factors associated with posthemorrhoidectomy secondary hemorrhage

Objective To investigate the risk factors associated with posthemorrhoidectomy secondary hemorrhage.Methods From Jan 2006 to Dec 2010,a retrospective analysis was done on clinical data of 2,971 cases with hemorrhoids.The variables included age,gender,surgical procedure,surgeon,surgeon’s seniority,aseptic preparation,and use of antibiotics.The logistic regression model was used to assess the independent association of variables with posthemorrhoidectomy secondary hemorrhage.Results Among the 2,971 patients,21(0.7percent) developed posthemorrhoidectomy secondary hemorrhage.The mean interval from operation to the onset of secondary hemorrhage was 7.9(range,2～21) days.Multivariate analysis revealed that surgical procedure was independently associated with risk of hemorrhage.Procedure for prolapse and hemorrhoids were more likely than closed hemorrhoidectomy to develop post-hemorrhoidectomy secondary hemorrhage(relative risk,0.6;95 percent confidence interval,0.5-0.7;P=0.011).Conclusion Our data suggest that surgical procedure is highly correlated with this risk and that Procedure for prolapse and hemorrhoids are more likely to develop posthemorrhoidectomy secondary hemorrhage than closed hemorrhoidectomy.