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陆文洪,李鑫磊,罗雯鹏,王真权.“切”“补”“套”“注”四联术治疗女性出口梗阻型便秘的临床疗效评价[J].湖南中医药大学学报,2021,41(10):1635-1639[点击复制] |
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| “切”“补”“套”“注”四联术治疗女性出口梗阻型便秘的临床疗效评价 |
| 陆文洪,李鑫磊,罗雯鹏,王真权 |
| (湖南中医药大学第二附属医院, 湖南 长沙 410005;湖南中医药大学, 湖南 长沙 410208) |
| 摘要: |
| 目的 探讨“切”“补”“套”“注”四联术治疗女性出口梗阻型便秘患者的临床疗效。方法 选取2018年1月至2020年12月湖南中医药大学第二附属医院肛肠二科拟行手术治疗的女性出口梗阻型便秘患者103例，按随机数字表分为试验组（n=35）、对照Ⅰ组（n=32）、对照Ⅱ组（n=36）。试验组行“切”—选择性痔上黏膜切除吻合术（tissue selection therapy，TST）、“补”—直肠黏膜修补术、“套”—自动痔疮套扎术（Ruiyun procedure for hemorrhoids，RPH）、“注”—消痔灵注射术；对照Ⅰ组行TST联合RPH；对照Ⅱ组行TST联合直肠黏膜修补术、RPH。术后1、3个月对比3组治疗有效率；术前、术后1、3个月对比3组Longo-排便梗阻综合症（obstruction defecation syndrome，ODS）评分；术后第3天采用视觉模拟评分法（visual analogue scale，VAS）对比3组伤口疼痛情况；并对比术后3个月内3组并发症发生率。结果 术后1个月，试验组有效率高于对照Ⅰ组、对照Ⅱ组，但3组差异无统计学意义（P>0.05）；术后3个月试验组有效率明显高于对照Ⅰ组、对照Ⅱ组（P<0.05）。术后1、3个月3组Longo-ODS评分均较术前降低（P<0.05）；术后1、3个月，试验组Longo-ODS评分均低于对照Ⅰ组、对照Ⅱ组（P<0.05）。试验组术后第3天VAS评分低于对照Ⅰ组、对照Ⅱ组（P<0.05）。术后3个月内试验组并发症发生率低于对照Ⅰ组、对照Ⅱ组（P<0.05）。结论 “切”“补”“套”“注”四联术能有效提高女性出口梗阻型便秘患者术后1、3个月有效率，降低术后Longo-ODS评分、VAS评分及并发症总发生率。从而改善患者症状，减少术后并发症，提高治疗效果，获得较满意的远期疗效。 |
| 关键词: 出口梗阻型便秘 选择性痔上黏膜切除吻合术 直肠黏膜修补术 自动痔疮套扎术 消痔灵注射术 Longo-ODS评分 |
| DOI：10.3969/j.issn.1674-070X.2021.10.029 |
| 投稿时间：2021-03-22 |
| 基金项目:湖南省教育厅科研课题一般项目（20C1425）；湖南中医药防治肛肠疾病重点研究室（湘中医药函〔2020〕51号）。 |
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| Evaluation of Clinical Efficacy of “Cut”, “Supplement”, “Set” and “Injection” Four-step Associated Operation of Female Outlet Obstructive Constipation |
| LU Wenhong,LI Xinlei,LUO Wenpeng,WANG Zhenquan |
| (The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410005, China;Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| Objective To explore the clinical efficacy of "cut", "supplement", "set" and "injection" four-step associated operation of female outlet obstructive constipation patients. Methods 103 cases of female outlet obstructive constipation patients who were treated by surgery in The Second Affiliated Hospital of Hunan University of Chinese Medicine from January 2018 to December 2020 were selected, and divided into experimental group (n=35), control Ⅰ group (n=32), and control Ⅱ group (n=36) according to random number tables. The experimental group underwent "cut"-tissue-selecting therapy stapler (TST), "supplement"-rectal mucosa repair, "set"-Ruiyun procedure for hemorrhoids (RPH), "injection"-Xiaozhiling injection; the control Ⅰ group underwent TST combined with RPH; the control Ⅱ group underwent TST combined with rectal mucosa repair and RPH. The effective rate of three groups was compared one and three months after operation. Before operation, one month and three months after operation, Longo-obstruction defecation syndrome (ODS) score of the three groups was compared. Three days after surgery, visual analogue scale (VAS) was used to compare the wound pain in the three groups. The incidence of complications in three groups was compared within three months after operation. Results One month after surgery, the effective rate of the experimental group was higher than that of the control Ⅰ group and control Ⅱ group, but the differences of three groups were not statistically significant (P>0.05). Three months after operation, the effective rate of experimental group was significantly higher than that of control Ⅰ group and control Ⅱ group (P<0.05). After one and three months after operation, the Longo-ODS score of three groups was lower than before operation (P<0.05). The Longo-ODS score of the experimental group was lower than that of the control Ⅰ group and control Ⅱ group at one and three months after operation (P<0.05). On the 3rd day after operation, the VAS score of experimental group was lower than that of the control Ⅰ group and the control Ⅱ group (P<0.05). The incidence of complications in the experimental group was lower than the control Ⅰ group and the control Ⅱ group (P<0.05) within three months after surgery. Conclusion The four-step associated operation of "cut", "supplement", "set" and "injection" can effectively improve the effective rate of female patients with outlet obstructive constipation at one and three months after operation, and reduce the Longo-ODS score, VAS score and the total incidence of complications after operation. So as to improve patients' symptoms, reduce postoperative complications, improve the treatment effect and obtain satisfactory long-term curative effect. |
| Key words: outlet obstructive constipation tissue-selecting therapy stapler rectal mucosa repair Ruiyun procedure for hemorrhoids Xiaozhiling injection Longo-ODS score |
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