改良直肠闭式修补术联合益气润肠汤治疗直肠前突型便秘研究  

Clinical effect of yiqi runchang decoction in the treatment of patients with rectocele constipation after modified block repair

作　　者：边屯 BIAN Tun(Department of Anorectal Surgery,Wenling Hospital of Traditional Chinese Medicine,Wenling,Zhejiang 317500,China)

机构地区：[1]温岭市中医院肛肠科,浙江温岭317500

出　　处：《中国预防医学杂志》2018年第10期778-782,共5页Chinese Preventive Medicine

摘　　要：目的观察改良直肠闭式修补术后应用益气润肠汤治疗直肠前突型便秘的疗效。方法选取2013年1月至2017年12月温岭市中医院确诊为中、重度直肠前突型便秘患者70例,随机分为观察组(n=35例)和对照组(n=35例),对照组采用改良直肠闭式修补术治疗,观察组术后2d口服益气润肠汤治疗,4周为1个疗程,治疗2个疗程。观察治疗前后中医症候变化情况,进行Longo ODS症状评分,记录术后疼痛持续时间和肛门坠胀感持续时间,进行肛管直肠压力测量,观察直肠前突深度,术后并发症发生情况。结果治疗后,观察组排便困难、排便不尽坠胀感、粪质/粪状、肛门阻塞感、手助排便评分低于对照组,差异有统计学意义(t=3.422、3.181、3.515、3.129、3.217,P<0.05)。观察组治疗后4、8周的Longo ODS症状评分低于对照组,差异有统计学意义(t=3.361、8.451,P<0.05)。治疗后,观察组与对照组肛管静息压、肛管最大收缩压、肛管舒张压组间差异有统计学意义(t=4.327、3.603、3.455,P<0.05)。治疗后,观察组静息位和用力排便时直肠前突深度低于对照组,差异有统计学意义(t=5.338、5.212,P<0.05)。观察组总有效率高于对照组,差异有统计学意义(Z=-2.224,P<0.05)。观察组术后疼痛持续时间和肛门坠胀感持续时间均较对照组缩短,差异有统计学意义(t=4.916、3.612,P<0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(χ~2=10.769,P<0.05)。结论改良直肠闭式修补术后应用益气润肠汤治疗直肠前突型便秘疗效确切,能有效改善中医症候,纠正直肠前突,改善肛管直肠压力,促进排便功能改善,降低术后并发症发生率。Objective To observe the clinical effect of yiqi runchang decoction in the treatment of patients with rectocele constipation after modified Block repair. Methods A total of 70 patients undergoing modified Block repair surgery due to moderate to severe rectocele constipation were enrolled into the study from January 2013 to December 2017 in Wenling Hospital of Traditional Chinese Medicine and were randomly divided into study group（n=35）and control group（n=35）.Patients in study group started taking yiqi runchang decoction twice a day on the 2 nd day after surgery for 8 weeks,while patients in control group received no specific treatment after surgery.The clinical manifestation,Longo ODS score,anorectic pressure and complications were recorded and compared between the two groups. Results After the treatment,the scores of obstructed defecation,rectal tenesmus and incomplete bowel emptying,fecal appearance,feeling of anal obstruction and manual fecal evacuation were significantly lower among patients in study group compared those in control group,the differences were statistically significant（t=3.422,3.181,3.515,3.129,3.217,P〈0.05）.The Longo ODS scores of study group were significantly lower at both 4 and 8 weeks of treatment than that of control group（t=3.361,8.451,P〈0.05）.The differences of anal canal resting pressure,anal maximal contraction pressure and anal diastolic pressure were all statistically significant between the two groups after treatment（t=4.327,3.603,3.455,P〈0.05）.The rectal protrusion depths during resting and forced defecation of patients in control group were deeper compared to study group（t=5.338,5.212,P〈0.05）.The overall clinical efficacy was significantly higher of patients taking yiqi runchang decoction compared to controls（Z=-2.224,P〈0.05）.Patients in control group experienced longer post-surgery pain and anal distention compared to study group（t=4.916,3.612,P〈0.05）.The incidence of postoperative complications in the study group was lower than that i

关 键 词：直肠前突型便秘 改良直肠闭式修补术 益气润肠汤 肛管直肠压力 

分 类 号：R657.1[医药卫生—外科学]