Study On The First Defecation Time Of Postoperative Patients With Circumferential Mixed Hemorrhoid And The Degree Of Surgical Complications

Background:Circumferential mixed hemorrhoid is a week of hemorrhoid around the anus and can be cured by surgical method at present.However,the incidence rate of postoperative pain,bleeding,anal edema,anal stenosis and other complications has been high.The occurrence of these complications is related to many factors,among which only the defecation factor can be controlled by nurses.The first postoperative defecation is very influential on patients.The earlier first defecation causes bleeding and infection when stool passes the fresh wound;the later first defecation causes pain and anal stenosis when the stool becomes dry.But there is no consistent conclusion about when the first defecation is better.Therefore,the most suitable first time postoperative defecation for patients with circumferential mixed hemorrhoid remains to be further studied.Objective:To analyze the differences between the first defecation time and the degree of postoperative complications in patients with circumferential mixed hemorrhoid.Methods:This study is a descriptive study.From January 2017 to May 2017,411 patients who accepted circumferential mixed hemorrhoids Milligan-Morgan surgery under intravenous anesthesia were enrolled from an anorectal department of a tertiary hospital in Beijing.Patients were divided into three groups according to their first postoperative defecation time in natural condition:<24h(first group),24-48h(second group),>48h(third group).The patients,stool properties,hemorrhage and pain were collected during the first postoperative defecation.Patiens' degree of anal edema was collected during wound dressing change.Patients' wound healing time and anal stenosis data were collected at wound heal.Comparisons in 3 groups of patients were used Kruskal-Wallis rank test.Results:A total of 411 study subjects were enrolled,including 87 in first group,241 in second group and 83 in third group.The results showed that:(1)The pain intensity of the patients in first group with circumferential mixed hemorrhoids after the first defecation were significantly lower than those in second group and third group(P<0.05);(2)The hemorrhage degree of the patients in second group with circumferential mixed hemorrhoids after the first defecation were significantly lower than those in the first group and third group(P<0.05);(3)The anal edema degree of the patients in second group with circumferential mixed hemorrhoids after the first defecation were significantly lower than those in the first group and third group(P<0.05);(4)The stool shape of the patients in second group with circumferential mixed hemorrhoids after the first defecation were significantly better than those in the first group and third group(P<0.05);(5)There was no difference between first group,second group and third group in the postoperative anal stenosis of the patients with circumferential mixed hemorrhoids(P>0.05);(6)The healing time of patients in second group with circumferential mixed hemorrhoids was significantly shorter than that in the first and third groups(P<0.05).Conclusions:(1)No matter what period of the patients after the operation of mixed hemorrhoids,pain and bleeding are the most common complications after the first defecation.(2)The patients with the first defecation within 24 hours after operation had the lowest pain intensity.(3)The patients who had the first defecation within 24-48 hours after operation had the least bleeding.(4)The patients who had the first defecation within 24-48 hours after operation had the least degree of anal edema.(5)There was no difference in the incidence of anal stenosis no matter what period of the patients had their first defecation after the operation of mixed hemorrhoids.(6)The patients who had the first defecation within 24-48 hours after operation had the best stool shape.(7)The wound healing time of the patients who had the first defecation in 24-48h after operation was shorter than those who had the first defecation in other time periods.In summary,the time for the first defecation of circumferential mixed hemorrhoids can choose between 24-48h,and the complications of the patients during this period are lowest,the wound healing time is shortest and the stool shape is best.This study provides a scientific basis for reducing postoperative complications of circumferential mixed hemorrhoid and accelerating rehabilitation of patients.