消痔灵直肠周围间隙八步注射法治疗完全性直肠脱垂疗效评价

发布时间：2018-03-12 17:20

本文选题：直肠脱垂　切入点：消痔灵　出处：《中国中医科学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的观察消痔灵直肠周围间隙八步注射法,对于治疗完全性直肠脱垂的临床疗效,并探索完全性直肠脱垂的发病机制,及消痔灵直肠周围间隙八步注射术治疗完全性直肠脱垂的可行性研究。方法本研究共收集2011.2--2015.10期间的63例病例,均为经中国中医科学院广安门医院肛肠科诊断为完全性直肠脱垂的住院患者。采用消痔灵直肠周围间隙八步注射法治疗全部病例,完善术前准备,术后禁食3-5天,予抗生素及肠外营养,控制排便3-5天。观察记录患者年龄、性别等基本资料,对术前术后的相关症状、体征进行评分,并于术前1天、术后15天进行核磁共振成像及双重造影检查,对结果进行统计学分析。随访并记录患者复发情况。结果1.全部63例患者,治愈51例(80.95%),好转10例(15.87%),无效(完全复发)者2例(3.18%),总有效率96.82%。在治疗期间,患者脱垂情况达到完全改善,对于其余症状包括肛周分泌物、便秘、疼痛等,治疗前后亦有不同程度的改善,尤其是术前及术后近期的疗效评分存在明显差异。手术前后患者血常规指标及生化指标未见严重异常。2.术后随访半年至5年,随访63例,主诉肛门口少许粘膜脱出者10例,诉有分泌物者12例,肛内坠胀不适者6例,直肠脱垂完全复发者2例,行经腹结直肠悬吊手术治疗。随访63例患者中,出现粘膜脱垂及完全复发者共12例,连续不复发时间中,3个月不复发比例为95.23%,1年连续不复发达到87.30%,2年连续不复发率达到80.95%。所有复发患者均于2年内复发。其中0-3个月复发比率最高,达到25%,4-6个月、7-9个月、9-12个月复发比率依次为16.7%、8.3%,16.7%,总计0-12个月复发例数可占总复发例数的66.7%。结论1.消痔灵直肠周围间隙八步注射法治疗完全性直肠脱垂疗效肯定,创伤小,经济,安全,大剂量注射亦未出现肝肾等功能的损害,局部感染和坏死率低,复发率低,而且易于操作,适合在各级医院开展,患者接受度较高,便于临床推广。所以,可作为所有完全性直肠脱垂的首选治疗方法。2.根据入组患者一般情况分析,完全性直肠脱垂一般病程较长,患病年龄范围较大,性别间差异不大,发病诱因不明确,无明确职业相关性。但仍需更大样本量进行统计分析。3.盆腔核磁共振成像及双重造影在观察评估盆底解剖结构中具有较大的优势,能很好地了解肛管直肠周围器官、组织的功能、解剖和状态,有助于探索直肠脱垂的发病机制,提高对直肠脱垂的诊断价值,应作为直肠脱垂的常规检查手段。
[Abstract]:Objective to observe the clinical effect of 8-step injection of Xiaozhiling perirectal space in the treatment of complete rectal prolapse and to explore the pathogenesis of complete rectal prolapse. And the feasibility study of 8-step injection of Xiaozhiling perirectal space for the treatment of complete rectal prolapse. Methods 63 cases of rectal prolapse between January 2 and May 10, 2011 were collected in this study. All the inpatients were diagnosed as complete rectal prolapse by the anorectal department of Guang'an Men Hospital, Chinese Academy of traditional Chinese Medicine. All the patients were treated with 8-step injection of Xiaozhiling perirectal space to improve preoperative preparation and fasting for 3-5 days after operation. Antibiotics and parenteral nutrition were given to control defecation for 3 to 5 days. The patients' age, sex and other basic data were observed, and the symptoms and signs were evaluated before and after operation, and 1 day before operation. Magnetic resonance imaging and double contrast examination were performed 15 days after operation. The results were statistically analyzed. The patients were followed up and their recurrence was recorded. 1. All the 63 patients, 51 cases were cured, 10 cases improved 15.87%, 2 cases were ineffective (completely relapsed), the total effective rate was 96.82%. During the treatment period, the prolapse of the patients reached a complete improvement, for other symptoms including perianal secretion, constipation, pain, etc. Before and after treatment, there were significant differences in the scores of curative effect before and after operation, and there was no serious abnormality in blood routine and biochemical indexes before and after operation. The follow-up period was 6 months to 5 years, and 63 cases were followed up. There were 10 cases of anal mucosal prolapse, 12 cases of secretion, 6 cases of anal distension and discomfort, 2 cases of complete recurrence of rectal prolapse. There were 12 cases of mucosal prolapse and complete recurrence. In the continuous non-recurrence time, the proportion of non-recurrence in 3 months was 95.23, 87.30 in one year, and 80.95in 2 years. All the recurrence patients were recurred within 2 years. The recurrence rate of 0-3 months was the highest. The recurrence rate of 254-6 months, 7-9 months and 9-12 months was 16.7and 16.7in turn, and the total number of recurrence cases from 0-12 months to 12 months could account for 66.7% of the total recurrence cases. Conclusion 1.The effect of 8-step injection of Xiaozhiling perirectal space in the treatment of complete rectal prolapse is certain, the trauma is small, and it is economical. Safety, high dose injection, no damage to liver and kidney function, low local infection and necrosis rate, low recurrence rate, and easy to operate, suitable to be carried out in hospitals at all levels, with high patient acceptance and easy to be popularized. According to the general situation of the patients, the general course of complete rectal prolapse is longer, the age range of the disease is larger, the difference between sex is not obvious, and the cause of the disease is not clear. There is no definite occupational correlation. However, a larger sample size is still needed for statistical analysis .3. pelvic magnetic resonance imaging and double contrast imaging have great advantages in observing and evaluating the anatomical structure of the pelvic floor, and can better understand the perianal organs. The function, anatomy and state of tissue are helpful to explore the pathogenesis of rectal prolapse and to improve the diagnostic value of rectal prolapse. It should be used as a routine examination method for rectal prolapse.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R266

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