结肠次全切联合中医药序贯治疗慢传输型便秘临床研究
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摘要
目的分析研究慢传输型便秘(STC)患者在经结肠次全切术后采用中医药序贯治疗方案治疗后的临床疗效。方法以2014年6月-2016年6月在河南中医药大学第三附属医院手术治疗资料完整且能回访到的20例STC患者为研究对象,患者术后联合中药(第1个月以补中益气、健脾止泻为原则,方用补中益气汤合参苓白术散加减;第2个月以活血化瘀、益气健脾为原则,方用血府逐瘀汤合四君子汤加减)治疗,统计分析患者治疗后1个月、2个月、6个月、12个月的排便次数,粪便性状,腹部症状积分情况及治疗后6个月和12个月的治疗有效率。结果患者手术治疗后排便次数普遍较多,便质较稀,腹痛症状较为普遍,中药干预治疗后,患者症状改善较为明显,且第2个月改善情况优于第1个月(P <0. 05);患者第12个月的症状积分达到治愈的患者较6个月有所增加(P <0. 05),同时整体有效率增加,差异具有统计学意义。结论 STC患者在结肠次全切术后预防性的给予中医药序贯治疗措施,能减少患者术后腹痛,粪便质稀,排便次数过多等并发症,具有较高的临床价值。
Objective To analyze the clinical therapeutic effects of the sequential treatment with Chinese herbal decoction on slow transit constipation( STC) after colon subtotal excistion. Methods From June 2014 to June 2016,20 cases of STC with complete operation data were collected as the subjects in the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine. After operation,Chinese herbal decoction was combined. In the 1 stmonth,the treating principle was to tonify qi in the middle jiao,strengthen the sleep and stop diarrhea,the modified formula of buzhong yiqi tang and shenling baizhu san was used. In the 2 ndmonth,the treating principle was to benefit qi and strengthen the spleen,the modified formula of xuefu zhuyu tang and sijunzi tang was used. The defecation frequency,the stool condition and abdominal symptom score in 1,2,6 and 12 months after treatment and the effective rate in 6 and 12 months after treatment were analyzed statistically in the patients. Results In the statistical analysis,after operation,the defecation frequency was high,the stool was loose and abdominal pain was common. After intervention with Chinese herbal decoction,the symptoms were relieved obviously. The improvements in the 2 nd month were better than that in the 1 st month,indicating the significant difference( P < 0. 05). The case number with the symptom score near to the curative level in the 12 thmonth was increased as compared with that in the 6 th month after treatment and the total effective rate was increased,indicating the significant differences( P < 0. 05). Conclusion For STC patients after colon subtotal excision,the sequential preventive treatment with Chinese herbal decoction alleviates the post-operative abdominal pain,loose stool and excessive defecation. This treatment is highly valuable in clinical application.
Objective To analyze the clinical therapeutic effects of the sequential treatment with Chinese herbal decoction on slow transit constipation( STC) after colon subtotal excistion. Methods From June 2014 to June 2016,20 cases of STC with complete operation data were collected as the subjects in the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine. After operation,Chinese herbal decoction was combined. In the 1 stmonth,the treating principle was to tonify qi in the middle jiao,strengthen the sleep and stop diarrhea,the modified formula of buzhong yiqi tang and shenling baizhu san was used. In the 2 ndmonth,the treating principle was to benefit qi and strengthen the spleen,the modified formula of xuefu zhuyu tang and sijunzi tang was used. The defecation frequency,the stool condition and abdominal symptom score in 1,2,6 and 12 months after treatment and the effective rate in 6 and 12 months after treatment were analyzed statistically in the patients. Results In the statistical analysis,after operation,the defecation frequency was high,the stool was loose and abdominal pain was common. After intervention with Chinese herbal decoction,the symptoms were relieved obviously. The improvements in the 2 nd month were better than that in the 1 st month,indicating the significant difference( P < 0. 05). The case number with the symptom score near to the curative level in the 12 thmonth was increased as compared with that in the 6 th month after treatment and the total effective rate was increased,indicating the significant differences( P < 0. 05). Conclusion For STC patients after colon subtotal excision,the sequential preventive treatment with Chinese herbal decoction alleviates the post-operative abdominal pain,loose stool and excessive defecation. This treatment is highly valuable in clinical application.
引文
[1]刘宝华,魏东,杨向东,等.不同术式对慢传输型便秘患者的疗效、营养和健康状况的影响[J].第三军医大学学报,2013,35(21):2265-2269.
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[9]颜帅,王晓鹏,吴本升,等.中药干预慢传输型便秘鼠的结肠动力信号通路的研究进展[J].中华中医药学刊,2016,34(10):2339-2343.
[10]王永兵,孙万驹,张根福,等.GI-pill检测支持的腹腔镜下结肠次全切除旋转盲肠与直肠吻合治疗慢传输型便秘的疗效分析[J].结直肠肛门外科,2017,23(5):570-573.
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[15]刘凯,王本军,马恒,等.补中益气汤对胃癌术后气虚血瘀证胃肠功能恢复和营养状况的影响[J].中国实验方剂学杂志,2015,21(24):152-156.
[16]孙娟,王键,胡建鹏,等.参苓白术散对脾虚湿困证溃疡性结肠炎大鼠结肠菌群的影响[J].云南中医学院学报,2013,36(4):1-4.
[17]吴青,李敏.血府逐瘀汤合大承气汤加减治疗术后肠粘连性腹痛75例临床观察[J].浙江中医杂志,2014,49(12):900-901.
[18]崔钰珠,于慧会,崔巧妍,等.四君子汤加减改善大肠癌患者生存质量研究进展[J].辽宁中医药大学学报,2017,19(2):74-76.
[19]贺百林.综合诊疗方案治疗中重度慢传输型便秘的临床研究[D].成都:成都中医药大学,2013.
[2]王文航,魏东,张剑锋,等.直肠保留长度对腹腔镜结肠全切除回直肠吻合术治疗慢传输型便秘疗效的影响[J].临床外科杂志,2017,25(4):269-271.
[3]吴勉华.中医内科学[M].北京:中国中医药出版社,2012.
[4]Drossman DA.The functional gastrointestinal disorders and the RomeⅢprocess[J].Gastroenterology,2006,130(5):1377-1390.
[5]傅传刚.便秘的手术指征和手术方式的选择∥中华中医药学会肛肠分会换届会议暨便秘专题研讨会论文专刊[C].北京:中华中医药学会,2007:2.
[6]国家中医药管理局.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:383-384.
[7]Menees SB,Kim HM,Wren P,et al.Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in averagerisk screening colonoscopy[J].Gastrointest Endosc,2014,79(5):811-820.
[8]第18次中国中西医结合学会大肠肛门病专业委员会学术会议纪要[J].中国中西医结合杂志,2016,36(1):115.
[9]颜帅,王晓鹏,吴本升,等.中药干预慢传输型便秘鼠的结肠动力信号通路的研究进展[J].中华中医药学刊,2016,34(10):2339-2343.
[10]王永兵,孙万驹,张根福,等.GI-pill检测支持的腹腔镜下结肠次全切除旋转盲肠与直肠吻合治疗慢传输型便秘的疗效分析[J].结直肠肛门外科,2017,23(5):570-573.
[11]黄福斌,黄河,张阳,等.便秘通膏治疗慢传输型便秘50例[J].陕西中医,2011,32(9):1179-1181.
[12]Sohn G,Yu CS,Kim CW,et al.Surgical outcomes after total colectomy with ileorectal anastomosis in patients with medically intractable slow transit constipation[J].J Korean Soc Coloproctol,2011,27(4):180-187.
[13]田代华.黄帝内经[M].北京:人民卫生出版社,2005.
[14]查勤芳,闫伟,陈洪林,等.便秘的原因及治疗进展[J].辽宁中医药大学学报,2013,15(11):117-119.
[15]刘凯,王本军,马恒,等.补中益气汤对胃癌术后气虚血瘀证胃肠功能恢复和营养状况的影响[J].中国实验方剂学杂志,2015,21(24):152-156.
[16]孙娟,王键,胡建鹏,等.参苓白术散对脾虚湿困证溃疡性结肠炎大鼠结肠菌群的影响[J].云南中医学院学报,2013,36(4):1-4.
[17]吴青,李敏.血府逐瘀汤合大承气汤加减治疗术后肠粘连性腹痛75例临床观察[J].浙江中医杂志,2014,49(12):900-901.
[18]崔钰珠,于慧会,崔巧妍,等.四君子汤加减改善大肠癌患者生存质量研究进展[J].辽宁中医药大学学报,2017,19(2):74-76.
[19]贺百林.综合诊疗方案治疗中重度慢传输型便秘的临床研究[D].成都:成都中医药大学,2013.