自拟结肠舒方辅助STARR术治疗更年期女性直肠前突型便秘的疗效及对血清性激素的影响  

Efficacy of self-made Jiechangshu prescription assisted by STARR in the treatment of menopausal women with rectal prolapse constipation and its effect on serum sex hormones

作　　者：刘子毅 高记华 王冉 田茂生 戚文月 裴岩 段冰倩 吴琼 Liu Ziyi;Gao Jihua;Wang Ran;Tian Maosheng;Qi Wenyue;Pei Yan;Duan Bingqian;Wu Qiong(Department of Colorectal Surgery, the First Affiliated Hospital of Hebei University of Chinese Medicine, Hebei Province, Shijiazhuang 050011, China)

机构地区：[1]河北中医学院第一附属医院肛肠一科,石家庄050011

出　　处：《疑难病杂志》2022年第7期731-735,741,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省中医药管理局科研计划项目(2020109);河北中医学院科研能力提升重点项目(KTZ2019033)。

摘　　要：目的探讨自拟结肠舒方辅助经肛门吻合器直肠切除术(STARR)治疗更年期女性直肠前突型便秘的临床疗效及对血清性激素的影响。方法选取2019年11月—2021年5月河北中医学院第一附属医院肛肠一科收治的更年期女性中重度直肠前突患者60例,按随机数字表法分成观察组和对照组,每组30例。观察组行STARR术加服自拟结肠舒方,对照组单纯行STARR术,比较2组临床疗效及复发率,治疗前后排便梗阻症状学评分、排粪造影检查直肠前突深度、血清性激素水平,以及并发症发生情况。结果观察组临床有效率高于对照组(96.67%vs.73.33%,χ^(2)=6.405,P=0.011),而复发率低于对照组(3.33%vs.26.67%,χ^(2)=6.405,P=0.011)。2组术后7 d及术后3个月排便梗阻症状积分较治疗前均下降,且术后3个月观察组积分下降较对照组更明显(t=6.298,P<0.001)。2组术后3个月直肠前突深度较治疗前均降低,但2组比较差异无统计学意义(P>0.05)。观察组治疗1个月后血清促卵泡生成素(FSH)、促黄体生成素(LH)下降,雌二醇(E_(2))水平升高(P<0.01),且观察组FSH、LH水平低于对照组,E2水平高于对照组(t/P=5.618/<0.001、5.263/<0.001、6.283/<0.001)。观察组术后14 d的术后并发症发生率低于对照组(χ^(2)=5.079,P=0.024)。结论STARR术后口服自拟结肠舒方治疗更年期女性直肠前突型便秘,可从远期改善便秘症状,降低术后并发症的发生率和复发率,调节机体性激素水平,巩固和提高手术治疗效果。Objective To investigate the clinical efficacy of self-made Jiechangshu prescription assisted by transanal stapled rectal resection(STARR)in the treatment of menopausal women with rectocele constipation and its effect on serum sex hormones.Methods A total of 60 climacteric female patients with moderate to severe rectocele who were admitted to the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine from November 2019 to May 2021 were selected and divided into an observation group and a control group according to the random number table method,with 30 cases in each group.The observation group was treated with STARR surgery plus self-made Jiechangshu prescription,and the control group was treated with STARR surgery alone.The clinical efficacy and recurrence rate of the two groups were compared,the symptom score of defecation obstruction before and after treatment,the depth of rectocele and serum sex hormone levels were examined by defecography.Results The clinical effective rate of the observation group was higher than that of the control group(96.67%vs.73.33%,χ^(2)=6.405,P=0.011),and the recurrence rate of the observation group was lower than that of the control group(3.33%vs.26.67%,χ^(2)=6.405,P=0.011).The symptom scores of defecation obstruction in both groups at 7 days after operation and at 3 months after operation were all decreased compared with those before treatment,and the decrease of the scores in the observation group was more obvious than that in the control group at 3 months after operation(t=6.298,P<0.001).3 months after operation,the depth of rectocele in both groups was lower than that before treatment,but there was no significant difference between the two groups(P>0.05).After 1 month of treatment in the observation group,serum follicle-stimulating hormone(FSH)and luteinizing hormone(LH)decreased,while estradiol(E_(2))levels increased(P<0.01),and the levels of FSH and LH in the observation group were lower than those in the control group The level of E2 in the control gr

关 键 词：便秘 直肠前突型 更年期女性 自拟结肠舒方 经肛门吻合器直肠切除术 性激素 

分 类 号：R256.35[医药卫生—中医内科学] R711.51[医药卫生—中医学]