术前穴位埋线防治内痔PPH术后并发症疗效观察
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摘要
目的:观察术前穴位埋线防治内痔吻合器痔上黏膜环切术(PPH)术后并发症的临床疗效。方法:将符合纳入标准的Ⅲ度、Ⅳ度内痔患者144例随机分为2组,治疗组76例在术前给予经验穴埋线治疗后进行PPH手术,对照组68例常规进行PPH手术,不给予穴位埋线治疗;观察2组在术后6 h、24 h、7天时创面局部疼痛、水肿、肛门坠胀感、肛门潮湿感、出血、小腹胀痛、排尿情况等症状评分。结果:总有效率治疗组为97.36%,对照组为92.64%,2组比较,差异无统计学意义(P> 0.05)。术后6 h、12 h、7天,2组患者肛门水肿、肛门坠胀感、肛门潮湿感症状的评分值大致相当(P> 0.05)。术后6 h,治疗组小腹胀痛评分、排尿情况评分均低于对照组(P <0.05);术后24 h,治疗组肛门疼痛评分低于对照组(P <0.05);术后7天,治疗组肛门疼痛评分、出血评分、小腹胀痛评分均低于对照组(P <0.05,P <0.01);其他时间段2组肛门疼痛评分、出血评分、小腹胀痛评分、排尿情况评分比较,差异均无统计学意义(P> 0.05)。结论:术前穴位埋线联合PPH手术治疗内痔疗效肯定,并对患者术后肛门疼痛、小腹胀痛、排尿异常、出血等并发症疗效较好。
Objective:To observe the clinical curative effect of the preoperative point embedding therapy combined with procedure for prolapse and hemorrhoids(PPH) for the prevention and treatment of internal hemorrhoids and postoperative complications. Methods:Randomly divided 144 cases of patients with internal hemorrhoids of grade Ⅲ and Ⅳ who met the inclusion criteria into the treatment group and the control group, 76 and 68 cases in each group respectively. The treatment group underwent PPH after preoperative treatment with experiential point embedding therapy, while the control group was performed routine PPH without point embedding therapy. Observed the scores of local wound pain,edema,falling and swelling sensation of anus,damp sensation of anus,bleeding,abdominal distending pain,and urinary excretion in the two groups at the 6~(th) and 24~(th) hour and on the 7 ~(th) day after surgery. Results:The total effective rate was 97.36% in the treatment group and 92.64% in the control group,there being no significant difference(P > 0.05).At the 6~(th) and 12 ~(th) hour and on the 7~(th) day after surgery, the scores of anal edema, falling and swelling sensation of anus and damp sensation of anus in the two groups were similar(P > 0.05). At the 6~(th) hour after surgery,the scores of abdominal distending pain and urinary excretion in the treatment group were lower than those in the control group(P < 0.05). At the 24~(th) hour after surgery,the score of anal pain in the treatment group was lower than that in the control group(P < 0.05). On the 7~(th) day after surgery,the scores of anal pain,bleeding,abdominal distending pain and urinary excretion in the treatment group were lower than those in the control group(P < 0.05,P< 0.01). At other time,there was no significant difference between the two groups in the comparisons of the above scores(P > 0.05).Conclusion:The preoperative point embedding therapy combined with PPH has definite curative effect,and has good curative effect on postoperative complications such as anal pain,abdominal distending pain,abnormal urination and bleeding.
Objective:To observe the clinical curative effect of the preoperative point embedding therapy combined with procedure for prolapse and hemorrhoids(PPH) for the prevention and treatment of internal hemorrhoids and postoperative complications. Methods:Randomly divided 144 cases of patients with internal hemorrhoids of grade Ⅲ and Ⅳ who met the inclusion criteria into the treatment group and the control group, 76 and 68 cases in each group respectively. The treatment group underwent PPH after preoperative treatment with experiential point embedding therapy, while the control group was performed routine PPH without point embedding therapy. Observed the scores of local wound pain,edema,falling and swelling sensation of anus,damp sensation of anus,bleeding,abdominal distending pain,and urinary excretion in the two groups at the 6~(th) and 24~(th) hour and on the 7 ~(th) day after surgery. Results:The total effective rate was 97.36% in the treatment group and 92.64% in the control group,there being no significant difference(P > 0.05).At the 6~(th) and 12 ~(th) hour and on the 7~(th) day after surgery, the scores of anal edema, falling and swelling sensation of anus and damp sensation of anus in the two groups were similar(P > 0.05). At the 6~(th) hour after surgery,the scores of abdominal distending pain and urinary excretion in the treatment group were lower than those in the control group(P < 0.05). At the 24~(th) hour after surgery,the score of anal pain in the treatment group was lower than that in the control group(P < 0.05). On the 7~(th) day after surgery,the scores of anal pain,bleeding,abdominal distending pain and urinary excretion in the treatment group were lower than those in the control group(P < 0.05,P< 0.01). At other time,there was no significant difference between the two groups in the comparisons of the above scores(P > 0.05).Conclusion:The preoperative point embedding therapy combined with PPH has definite curative effect,and has good curative effect on postoperative complications such as anal pain,abdominal distending pain,abnormal urination and bleeding.
引文
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[10]邓影雪,许兵,李蕾蕾,等.艾灸曲骨穴治疗骨科术后尿潴留30例观察[J].浙江中医杂志,2014,49(11):819-820.
[11]吴蔷薇.按压承山穴缓解痔疮痛[J].中国民间疗法,2014,22(6):83.
[12]阮德锋,邹淑娥,周忠开,等.针刺双侧天枢穴治疗无痛结肠镜术后腹胀的临床研究[J].环球中医药,2014,7(12):953-955.
[13]洪媚,宋双临,仝进毅,等.穴位埋线预防宫颈癌术后尿潴留临床疗效观察[J].上海针灸杂志,2017,36(10):1229-1232.
[14]杨喜乐.传统痔切扎术与PPH术术后近远期并发症及相关病理临床研究[D].南京:南京中医药大学,2015.
[15]褚春华,汪凡,殷光磊,等.穴位埋线预处理镇痛对混合痔术后患者前列腺素E2的影响[J].浙江中西医结合杂志,2016,26(3):275-276.
[2]中华医学会外科分会结直肠外科组.痔临床诊治指南(2006)版[J].中华胃肠外科杂志,2006,9(5):461.
[3]国家中医药管理局.ZY/T001.1~001.9-94中医病证诊断疗效标准[S].南京:南京大学出版社,1994:132.
[4]唐小龙,马直勉,孙浩博,等.混合痔手术治疗技术新进展[J].现代生物医学进展,2015,15(28):5567-5570.
[5]肖东霖.改良PPH手术治疗重度痔临床价值初评[J].中外医学研究,2015,13(12):44-45.
[6]卢灿省,解伟华,石健,等.穴位埋线合并补中益气汤对肛肠术后肛门坠胀的预防性观察[J].安徽医药,2015,19(6):1179-1181.
[7]沈忠,邓群,杨关根,等.穴位埋线用于混合痔外剥内扎术后镇痛的疗效观察[J].上海针灸杂志,2014,33(12):1129-1131.
[8]黄梅,王峰,严晶,等.“八髎穴”文献考证及临床应用[J].中医药导报,2016,22(13):72-75.
[9]叶然,张爱霞,姜荣荣,等.艾灸治疗肾阳虚型女性性功能障碍的临床研究[J].时珍国医国药,2014,25(11):2700-2702.
[10]邓影雪,许兵,李蕾蕾,等.艾灸曲骨穴治疗骨科术后尿潴留30例观察[J].浙江中医杂志,2014,49(11):819-820.
[11]吴蔷薇.按压承山穴缓解痔疮痛[J].中国民间疗法,2014,22(6):83.
[12]阮德锋,邹淑娥,周忠开,等.针刺双侧天枢穴治疗无痛结肠镜术后腹胀的临床研究[J].环球中医药,2014,7(12):953-955.
[13]洪媚,宋双临,仝进毅,等.穴位埋线预防宫颈癌术后尿潴留临床疗效观察[J].上海针灸杂志,2017,36(10):1229-1232.
[14]杨喜乐.传统痔切扎术与PPH术术后近远期并发症及相关病理临床研究[D].南京:南京中医药大学,2015.
[15]褚春华,汪凡,殷光磊,等.穴位埋线预处理镇痛对混合痔术后患者前列腺素E2的影响[J].浙江中西医结合杂志,2016,26(3):275-276.