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
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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。P<0.05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P<0.05，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P<0.05，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P<0.05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P<0.05，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P<0.05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P<0.05，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。
Objective: Constipation seriously affect the patient's quality of life andendanger the patient's physical and mental health, so people pay moreattention on this disease. Clinicians proposed a variety of surgical procedureswhich have their own characteristics to correct the abnormal anatomicalstructure, but the short and long term efficacy is unstable and easy to recur,especially for the OOC of severe RC merger RRP. Systemic functional statusand higher nervous activity influence defecation process greatly which is aseries of complex and coordinated physiological reflex activity in human body.So Bianzheng Lunzhi and Zhengti Guannian of TCM has played the role ofboth the root causes of OOC of severe RC merger RRP.The purpose of thispaper is to explore the short and long term efficacy of OOC of severe RCmerger RRP with “STARR+Xiaozhiling columnar injection+WenshenYunpitang with oral”.
Methods: We select80cases from Anorectal in-patients of HebeiMedical University Hospital which showed OOC of severe RC merger RRPby means of symptoms, signs, defecography. We study by “STARR+Xiaozhiling columnar injection+Wenshen Yunpitang with oral”. We usesurgical treatment and boil Wenshen Yunpitang into decoction, which makedinto of200ml one bag, twice a day,10days is one treatment. Observating thechange in the situation of index for defecation frequency、defecation time、poor stool、anal sense of falling、application of laxatives、defecography beforeand after treatment. All the data use SPSS13.0software statistical package forstatistical analysis and all the measurement data use the average士standarddeviation（x士S）.If the line in normal distribution, we use paired t test, if not,we use the paired wilcoxon rank test. The standard of significant differencewas P <0.05. By statistical analysis of statistical principles to determine the short and long term efficacy.
Results:80patients after treatment,60cases (75%) were recovered,14cases (17.5%) were cured,6cases (7.5%)were improved, total effective ratewas100%.1Defecation frequency score data of patients before and after treatmentderived by the paired wilcoxon rank test showed P <0.05, with significantdifferences. Number of bowel movements after treatment than beforetreatment was significantly increased.
2Defecation time score data of patients before and after treatment derived bythe paired wilcoxon rank test showed P <0.05, with significant differences.Defecation time after treatment than before treatment was significantlyreduced.
3Poor stool score data of patients before and after treatment derived by thepaired wilcoxon rank test showed P<0.05, with significant differences. Poorstool after treatment than before treatment was significantly reduced.
4Anal sense of falling score data of patients before and after treatment derivedby the paired wilcoxon rank test showed P<0.05, with significant differences.Anal sense of falling after treatment than before treatment was significantlyreduced.
5Application of laxatives score data of patients before and after treatmentderived by the paired wilcoxon rank test showed P<0.05, with significantdifferences. Application of laxatives after treatment than before treatment wassignificantly reduced.
6The depth of Protrusion score data of patients before and after treatmentderived by the paired t test showed P<0.05, with significant differences. Thedepth of Protrusion after treatment than before treatment was significantlyreduced.
Conclusion: The treatment program eliminated the pouch-likerelaxation mucosa of the rectocele, reconstructed the anatomical structures ofthe middle and lower segments of the rectum and strengthened therectovaginal septum. In conjunction with oral of traditional Chinese medicine: Bushen Wenyang、 Yiqi Yangxue、 Runchang Tongbian, improved thephysique of patients and enhanced the function of internal organs, includingdefecation ability. It played the advantages of combining Chinese and Westernmedicine. The short and long term efficacy was significant.
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。P<0.05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P<0.05，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P<0.05，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P<0.05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P<0.05，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P<0.05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P<0.05，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。
Objective: Constipation seriously affect the patient's quality of life andendanger the patient's physical and mental health, so people pay moreattention on this disease. Clinicians proposed a variety of surgical procedureswhich have their own characteristics to correct the abnormal anatomicalstructure, but the short and long term efficacy is unstable and easy to recur,especially for the OOC of severe RC merger RRP. Systemic functional statusand higher nervous activity influence defecation process greatly which is aseries of complex and coordinated physiological reflex activity in human body.So Bianzheng Lunzhi and Zhengti Guannian of TCM has played the role ofboth the root causes of OOC of severe RC merger RRP.The purpose of thispaper is to explore the short and long term efficacy of OOC of severe RCmerger RRP with “STARR+Xiaozhiling columnar injection+WenshenYunpitang with oral”.
Methods: We select80cases from Anorectal in-patients of HebeiMedical University Hospital which showed OOC of severe RC merger RRPby means of symptoms, signs, defecography. We study by “STARR+Xiaozhiling columnar injection+Wenshen Yunpitang with oral”. We usesurgical treatment and boil Wenshen Yunpitang into decoction, which makedinto of200ml one bag, twice a day,10days is one treatment. Observating thechange in the situation of index for defecation frequency、defecation time、poor stool、anal sense of falling、application of laxatives、defecography beforeand after treatment. All the data use SPSS13.0software statistical package forstatistical analysis and all the measurement data use the average士standarddeviation（x士S）.If the line in normal distribution, we use paired t test, if not,we use the paired wilcoxon rank test. The standard of significant differencewas P <0.05. By statistical analysis of statistical principles to determine the short and long term efficacy.
Results:80patients after treatment,60cases (75%) were recovered,14cases (17.5%) were cured,6cases (7.5%)were improved, total effective ratewas100%.1Defecation frequency score data of patients before and after treatmentderived by the paired wilcoxon rank test showed P <0.05, with significantdifferences. Number of bowel movements after treatment than beforetreatment was significantly increased.
2Defecation time score data of patients before and after treatment derived bythe paired wilcoxon rank test showed P <0.05, with significant differences.Defecation time after treatment than before treatment was significantlyreduced.
3Poor stool score data of patients before and after treatment derived by thepaired wilcoxon rank test showed P<0.05, with significant differences. Poorstool after treatment than before treatment was significantly reduced.
4Anal sense of falling score data of patients before and after treatment derivedby the paired wilcoxon rank test showed P<0.05, with significant differences.Anal sense of falling after treatment than before treatment was significantlyreduced.
5Application of laxatives score data of patients before and after treatmentderived by the paired wilcoxon rank test showed P<0.05, with significantdifferences. Application of laxatives after treatment than before treatment wassignificantly reduced.
6The depth of Protrusion score data of patients before and after treatmentderived by the paired t test showed P<0.05, with significant differences. Thedepth of Protrusion after treatment than before treatment was significantlyreduced.
Conclusion: The treatment program eliminated the pouch-likerelaxation mucosa of the rectocele, reconstructed the anatomical structures ofthe middle and lower segments of the rectum and strengthened therectovaginal septum. In conjunction with oral of traditional Chinese medicine: Bushen Wenyang、 Yiqi Yangxue、 Runchang Tongbian, improved thephysique of patients and enhanced the function of internal organs, includingdefecation ability. It played the advantages of combining Chinese and Westernmedicine. The short and long term efficacy was significant.
引文
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6吴丹妮,范亚明,杨文治.STARR术结合中药辨证治疗直肠前突型便秘
20例.中国中西医结合外科杂志,2011,17(3):303-304
7周方.综述消痔灵注射液的应用现状.内蒙古中医药,2008,(6):62-63
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2张虹玺，李彦龙.预防肛肠病术后便秘的心理行为干预研究.中华中医药学刊,2007,25(5):109-111
3王章志.PPH并发症及分析.医学信息,2011,8
4王连生.PPH术后吻合口狭窄的原因、预防与处理.结直肠肛门外科，2009,15(6)：414-415
5王丽峰.STARR手术在直肠前突治疗中的应用.社区医学杂志,2010,8(13):33-34
6吴丹妮,范亚明,杨文治.STARR术结合中药辨证治疗直肠前突型便秘
20例.中国中西医结合外科杂志,2011,17(3):303-304
7周方.综述消痔灵注射液的应用现状.内蒙古中医药,2008,(6):62-63
1张竑晞，曾宇彤，陈双.改良Block手术在治疗直肠前突致便秘的应用.岭南现代临床外科,2010,6(3):181
2倪士昌,韩少良,宋华羽.肛门后方切开加改良Block修补术治疗直肠前突型便秘.中华普通外科杂志,2005,20(10):632-634
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