中西医结合治疗重度直肠前突合并直肠内脱垂型便秘的临床研究

发布时间：2018-06-14 21:22

本文选题：直肠前突 + 手术　；参考：《河北医科大学》2012年硕士论文

【摘要】：目的：便秘严重影响着患者的生活质量，极大地危害着患者的身心健康，因此对本病的研究日益受到人们的重视。临床医生提出了多种手术方式来纠正异常的解剖结构，各有特色，但近远期疗效不稳定，易复发，，尤其对于重度直肠前突合并直肠内脱垂的出口梗阻型便秘。排便过程是人体中一系列复杂而协调的生理反射活动，人的全身功能状态和高级神经活动对其有很大的影响。因此中医的辩证论治、整体观念，能对重度直肠前突合并直肠内脱垂的出口梗阻型便秘起到标本兼治的作用。此论文旨在探讨“STARR术+消痔灵柱状注射+温肾运肠汤口服”联合治疗重度直肠前突合并直肠内脱垂所致出口梗阻型便秘的近远期疗效。方法:临床选择河北医科大学中医院肛肠科住院病人中经症状、体征、排粪造影示为重度直肠前突合并直肠内脱垂型便秘患者80例，采用“STARR术+消痔灵柱状注射+温肾运肠汤口服”，即先行STARR+消痔灵柱状注射术，术后将科室自拟中药方温肾运肠方制成袋装汤剂200ml每日两次，共服10天。观察治疗前后排便频率、排便时间、便不尽感、肛门下坠感、应用缓泻剂、排粪造影示前突深度等指标的改变情况。全部数据采用SPSS13.0软件统计包进行统计学处理，全部计量资料以平均值加减标准差（x士S）表示，符合正态分布采用配对t检验，不符合正态分布采用配对秩和检验。P0.05为显著性差异的标准。通过统计学原理分析统计来判定近远期疗效。结果：80例患者经治疗后,治愈60例（75%），显效14例（17.5%），好转6例（7.5%），总有效率为100%。 1、患者治疗前后排便频率积分数据经配对秩和检验得出P0.05，具有显著性差异。治疗后患者的排便频率比治疗前明显增多。 2、患者治疗前后排便时间积分数据经配对秩和检验得出P0.05，具有显著性差异。治疗后患者的排便时间比治疗前明显缩短。 3、患者治疗前后肛门下坠感积分数据经配对秩和检验得出P0.05具有显著性差异。治疗后患者的肛门下坠感比治疗前明显减轻。 4、患者治疗前后便不尽感积分数据经配对秩和检验得出P0.05，具有显著性差异。治疗后患者的便不尽感比治疗前明显减轻。 5、患者治疗前后应用缓泻剂积分数据经配对秩和检验得出P0.05具有显著性差异。治疗后患者应用缓泻剂比治疗前明显减少。 6、患者治疗前后前突深度数据经配对t检验得出P0.05，具有显著性差异。治疗后患者的前突深度比治疗前明显缩小。结论：该治疗方案消除了直肠前突的囊袋样松弛粘膜，重构了直肠中下段的直肠内解剖结构，加强了直肠阴道隔。同时配合中药口服，补肾温阳、益气养血、润肠通便，改善了患者体质，增强了包括排便能力在内的内脏机能。充分发挥了中西医结合的优势，标本皆治，治疗效果显著，近远期疗效好。
[Abstract]:Objective: constipation seriously affects the quality of life of patients and greatly endangers the physical and mental health of patients, so people pay more and more attention to the study of this disease. A variety of surgical methods have been proposed to correct the abnormal anatomical structure, each of which has its own characteristics, but the short-term and long-term results are unstable and easy to recur, especially for the outlet obstructive constipation with severe prolapse of the rectum and prolapse of the rectum. Defecation is a series of complex and coordinated physiological reflex activities in human body. Therefore, the dialectical treatment and the whole concept of TCM can play a role in treating the outlet obstruction constipation of severe protrusion of rectum with prolapse of rectum. The purpose of this study was to investigate the short and long-term effect of combined treatment of severe prolapse of rectum combined with outlet obstruction constipation caused by rectum prolapse by columnar injection of Wenshenyunchang decoction (WYT). Methods: 80 patients with severe prolapse of rectum associated with rectum prolapse constipation were selected clinically in the anorectal department of the Hospital of traditional Chinese Medicine, Hebei Medical University, with symptoms, signs, defecography and defecography. The columnar injection of Wenshenyunchang decoction for Ruozhouxiaoling was used, that is, the columnar injection of Starr and Xiaozhiling. After the operation, 200ml was made into a bag decoction twice a day, taking it for 10 days. The changes of defecation frequency, defecation time, anus falling feeling and the depth of protrusion were observed before and after treatment. All the data were processed by SPSS 13.0 software statistical package, all the measurement data were expressed as the average value plus or minus the standard deviation (S), and the normal distribution was matched t test. Nonconformance normal distribution using pairing rank sum test. P05 as the standard of significant difference. To judge the short-and long-term curative effect by analyzing the statistics principle. Results after treatment, 60 cases were cured, 14 cases were significantly effective, 6 cases were improved, the total effective rate was 100.1. The data of defecation frequency integral before and after treatment were obtained by pairing rank sum test (P0.05), with significant difference. The defecation frequency of patients after treatment was significantly higher than that before treatment. 2. The score data of defecation time before and after treatment showed significant difference by pairing rank sum test (P0.05). After treatment, the defecation time of the patients was significantly shorter than that before treatment. 3. The anus drop score data before and after treatment were significantly different by pairing rank sum test (P0.05). After treatment, the anus drop feeling of the patients was significantly less than that before and after treatment. 4. Before and after treatment, the scores of insensitive scores of the patients were found to be significantly different by pairing rank sum test (P0.05). After treatment, the feces of the patients were significantly reduced than before treatment. 5, patients before and after treatment with laxative integration data by pairing rank sum test showed that P0.05 has significant difference. After treatment, the number of patients treated with laxative was significantly lower than that before treatment. 6. The depth of protrusion before and after treatment was significantly different from that before and after treatment by paired t test (P0.05). The protrusion depth of patients after treatment was significantly smaller than that before treatment. Conclusion: this treatment scheme eliminates the saccular sachelike mucous membrane of anterior rectal protrusion, reconstructs the internal anatomy of the middle and lower rectum, and strengthens the rectovaginal septum. At the same time, combined with oral Chinese medicine, tonifying kidney and warming yang, tonifying qi and nourishing blood, moistening intestines and defecating, improving patients' physique and enhancing visceral function including defecation ability. Give full play to the advantages of integrated Chinese and western medicine, all specimens are treated, the treatment effect is remarkable, the short-and long-term effect is good.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R657.1

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