痔术后首次排便时间与手术切口愈合关系的临床研究
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摘要
目的：本文通过观察成都肛肠专科医院行外剥内扎硬注术的患者,术后首次排便后肛周局部症状、体征及其伤口愈合时间等情况,分析痔术后首次排便时间对伤口的愈合的影响。探索痔术后排便合理的时间。
方法：选择成都肛肠专科医院2008年10月～2009年12月行外剥内扎硬注术患者共176例,按首次排便时间的不同分为4组,术后第一天排便的为A组,第二天、第三天分别为B组、C组,四天以后排便的为D组。比较各组之间术前年龄、性别、病程、切口数量,首次排便后疼痛、出血、水肿、坠胀、感染的程度和创面愈合时间。统计学分析使用统计软件SPSS17.0,P<0.05表示差异有统计学意义。
结果：通过对176例患者的数据分析,发现不同的首次排便时间,患者便后症状的发生率及程度有所区别。其中：出血率术后第一天排便最高,且出血量较大,常需要止血药帮助止血。手术四天以后排便的患者出血、疼痛、血栓、肛门坠胀等并发症较多。第二天和第三天排便情况、便后症状积分及创面愈合时间优于其余两组,差异具有统计学意义(P<0.05)。
结论：术后第二天和第三天是比较合理的排便时间,其排便后患者便血、疼痛、水肿、切口感染等并发症的发生率及程度上较其他时间段低,更有利于切口的愈合。
Objective:to analysis the influence of first defecation time for patients with hemorrhoid after operation on incision healing and explore reasonable time of defecation according to the observation on anal symptoms and syndromes after first defecation and healing time for patients with External Excision and Internal Ligation.
Methods:176 patients with External Excision and Internal Ligation were choosen in ChengDu Proctology hospital during 2008.10-2009.12.They were divided into 4 groups according to first defecation time.Patients,whose first defecation time is in the first day after operation were A group(the second day were B group).Then age,sex, illness course,number of incision and the degrees of pain,bleeding,edema, the sense of fall-swell and infection were compared between pre-post operative periods separately. SPSS17.0 was used, P<0.05stands for statistical difference.
Results:the first defecation time,the incidence and degree of symptoms after defecation were different among groups:the rate of hemorrage was highest and bleeding volume was bigger in A group which need Hemostatic Drug usually.The degrees of bleeding, pain, thrombus, the sense of fall-swell of patients in D group were higher.Those patients whose clinical situation in B ans C group were better than the other two groups (P<0.05).
Conclusion::the first defecation time which is the second and third day after operation is resonable. The incidence and degrees of bleeding,pain,edema,infection after defecation were lower than those patients whose first defecation time weren't the second arid third day after operation.And the second and third day after operation are beneficial to healing.
方法：选择成都肛肠专科医院2008年10月～2009年12月行外剥内扎硬注术患者共176例,按首次排便时间的不同分为4组,术后第一天排便的为A组,第二天、第三天分别为B组、C组,四天以后排便的为D组。比较各组之间术前年龄、性别、病程、切口数量,首次排便后疼痛、出血、水肿、坠胀、感染的程度和创面愈合时间。统计学分析使用统计软件SPSS17.0,P<0.05表示差异有统计学意义。
结果：通过对176例患者的数据分析,发现不同的首次排便时间,患者便后症状的发生率及程度有所区别。其中：出血率术后第一天排便最高,且出血量较大,常需要止血药帮助止血。手术四天以后排便的患者出血、疼痛、血栓、肛门坠胀等并发症较多。第二天和第三天排便情况、便后症状积分及创面愈合时间优于其余两组,差异具有统计学意义(P<0.05)。
结论：术后第二天和第三天是比较合理的排便时间,其排便后患者便血、疼痛、水肿、切口感染等并发症的发生率及程度上较其他时间段低,更有利于切口的愈合。
Objective:to analysis the influence of first defecation time for patients with hemorrhoid after operation on incision healing and explore reasonable time of defecation according to the observation on anal symptoms and syndromes after first defecation and healing time for patients with External Excision and Internal Ligation.
Methods:176 patients with External Excision and Internal Ligation were choosen in ChengDu Proctology hospital during 2008.10-2009.12.They were divided into 4 groups according to first defecation time.Patients,whose first defecation time is in the first day after operation were A group(the second day were B group).Then age,sex, illness course,number of incision and the degrees of pain,bleeding,edema, the sense of fall-swell and infection were compared between pre-post operative periods separately. SPSS17.0 was used, P<0.05stands for statistical difference.
Results:the first defecation time,the incidence and degree of symptoms after defecation were different among groups:the rate of hemorrage was highest and bleeding volume was bigger in A group which need Hemostatic Drug usually.The degrees of bleeding, pain, thrombus, the sense of fall-swell of patients in D group were higher.Those patients whose clinical situation in B ans C group were better than the other two groups (P<0.05).
Conclusion::the first defecation time which is the second and third day after operation is resonable. The incidence and degrees of bleeding,pain,edema,infection after defecation were lower than those patients whose first defecation time weren't the second arid third day after operation.And the second and third day after operation are beneficial to healing.
引文
1.黄乃健.中国肛肠病学.山东科技出版社.624
2.全国中西医结合防治肛肠疾病协作组：57297人肛门直肠疾病调查报告.中西医结合防治肛门直肠疾病,江苏科技出版社,1980；
3.冯学军.肛肠病人术后排便的护理体会.中华使用中西医杂.2006.19(2)：207
4.周仁郁.SPSS13.0软件设计.成都：西南交通大学出版社,2005：57-89
5.姚泰.生理学.人民卫生出版社.2003：188-190
6王晓琳,廖行忠,等。现代肛肠科学。成都中医药大学：37-38
7.李玉林.病理学.人民卫生出版社.2005：70-83
8.董郡.病理学.人民卫生出版社.1996：117-124
9.阳世伟, 孙其凤等.骨科择期术后患者进食时间的研究.护理学杂志2008,3.23(6)： 1
10.严艺.护理干预在痔疮术后患者重建排便习惯中的应用[J].山东医药.2008,48(35)：42
11.洪英,王家云.心理因素对术后疼痛的影响[J].国外医学：麻醉学与复苏分册,2000,21(3)：156—157.
12.张振勇,张霓.挑断部分内括约肌对改善环状混合痔剥扎术后肛缘水肿、疼痛的观察[J].安徽中医学报,1996,18(6)：43-44
13.梁健.肛肠病术后并发症的中西医结合治疗[J].右江医学,2008,28(1)：47-48.
14.董郡.病理学.人民卫生出版社.1996：62-64
1.易文.中医药促进肛肠疾病术后创面愈合的研究概况[J].中国肛肠病杂志,2005,25(9)： 50-51.
2.陈瑶.混合痔术后创面愈合的影响因素与对策[J.医学综述,2008,14(12)：1856.
3.董郡.病理学.人民卫生出版社.1996：62-64
4. Reed M J, Ferara NS, Vernon RBI mpaired migration, integrin function, and action eytoskeletal organization in dermal fbroblasts from a subsetr of aged human donors[J].biech Ageing Dev,2001,122(11):1203.
5. Swift ME. Bums AL, Gray KL, et a 1. Age-related alterations in the in flam matory response to dermal injury [J]. Invest Dermatol,2001,117(5):1027.
6. Wicke C, Wagner S, Trabold O, et al. Age-dependency of insulin-like growth factors, insulin - like growth factor-binding proteins, and acidlabile subunit in plasma and wounds of surgical patients [J]. Wound Repair Regen,2002,10(6):360.
7. Ashcroft GS, lills SJ, Lei K, et al. Estrogen modulates cutalleous wound healing by downregulating macrophage migration inhibitor factory [J]. Clin Invest,2003,111(9):1309.
8.刘飞,赵国红.老年患者切口愈合不良影响因素分析[J].吉林医学,2006,27(10)：1202
9.郑家伟,赵国臣.伤口愈合机制的现代认识.国外医学口腔医学分册.1992,19(J)： 19.
10.王丽姿.伤口愈合的相关营养因素及护理[J].实用护理杂志,2002,18(9)：55.
11.华斌,柏连松.影响伤口愈合的因素及促愈方法[J].中国中西医结合外科杂志,2001,7(Ⅰ)：63.
12.程义勇,陈星伟,王冬兰等.锌对太鼠胶原合成和创伤愈合的作用[J].营养学报.1992,14(1)：70.
13.付小兵.国外创伤修复研究的新进展.国外医学创伤与外科基问题分册,1994.15(3)：147.
14.李玉林.病理学.人民卫生出版社.2005：70-83
15. Yamunaka M, Ishikawa O. Hypoxic conditions decrease the mRNA ex-pression of proalphal I and coll agens and increase matrix metallop-roteinases of dermal fibroblasts in three- dimensional cultures[J]. Dermatol Sci,2000,24(2):99.
16.李萍,李光善,盛巡.糖尿病大鼠创面愈合过程中成纤维细胞增殖及Ⅰ型胶原合成减少[J].中国病理生理杂志,2005,21(9)：1807.
17.吴晓山,丁敏,张仁等.高血脂对家兔伤口愈合的影响[J].浙江医学1996,18(2)： 81.
18.洪英,王家云.心理因素对术后疼痛的影响[J].国外医学：麻醉学与复苏分册,2000,21(3)：156—157.
19. Mereado AM. Padgett DA, Sheridan JF, et al. Altered kinetics of Lle IL- 11 and KGF- 1 gene expression in early wounds of restrained lce[J]. Brain Behav Immun,2002,16(2):150.
20.李玉林.病理学.人民卫生出版社,2005：42
21.张继领,汪阳林等。肛周脓肿细菌感染菌群分布研究.华北煤炭医学报,2004,6(4)：425
22.姚正国,范秋莲,姚月球,等.外科手术切口感染的病原菌耐药性调查.中华医院感染学杂志,2004,14(5)：593-594.
23.刘丽华,魏全珍,张惠珍,等.腹部手术切口感染的调查与对策.中华医院感染学杂志,2008,8(8)：1091-1092
24.赵明红.普外科切口感染目标性监测研究.中华医院感染学杂志.2004,14(5)： 519.
25.严金燕,贾氢,罗书练,等.外科手术切口的影响因素分析.临床军医杂志,2002,30(4)：39-4.
26. jonssion K, Jensen JA, Goodson WH, et al. Tissue oxygenation. anemis and perfusion in relation to wound healing in surgical patients. Ann Surg,1991.214(5):605
27.张东铭.痔的分类与治疗学的现代概念[J].中国肛肠病杂志2001,21(5)：29.
28. Dan jo Y, Gipson 1K. Specific Transduetion of the Leading Edge Cells of Migrating Epithelia De monstrates That They are Replaced During Healing[J]. Exp Eye Res,2002,74(2):199.
29.张俐,刘波.疼痛评估及其处理[J].国外医学：护理学分册,1999,18(6)： 273—-274.
30.季小平.疼痛对切口愈合的影响及护理.家庭护士.2008,6(2)：505
31.王跃振,刘屹,刘异,等.混合痔术后肛缘水肿的防治[J].长春中医药大学学报,2008,24(1)：85—86.
32.史仁杰,杨关根.痔术后水肿的原因及防治[J].现代中西医结合杂志.2003,12(9)
33.张军.肛肠病手术后创面愈合不良原因分析[J].中国中西医结合外科杂志.2006,12(5)499.
34.樊敏.肛肠病手术后创面愈合不良原因分析与护理[J].护士进修杂志.2008,23(6)：553
35.宿迁,陈焰.女子月经对肛肠手术切口愈合的影响.大肠肛门病外科杂志.2005,11(3)：208
36.梅笑玲,连文学等.臀沟深浅对肛肠病术后创面愈合的影响.中国中西医结合外科杂志.1999,5(1)：52
37. Reed MJ, Ferara NS, Vernon RB. Impaired migration, integrin function, and action eytoskeletal organization in dermal broblasts roma subsetr of aged human donors[J]. biech Ageing Dev,2001,122(11):1203.
38. Swift ME. Bums AL, Gray KL, et al. Age- related alterations in the inflam-matory response to dermal injury [J]. Invest Dermatol,2001, 117(5):1027.
39. Wicke C, Wagner S, Trabold O, et al. Age-dependency of insulin-like growth factors, insulin-like growth factor-binding proteins, and acid labile subunit in plasma and wounds of surgical patients [J]. Wound Repair Regen,2002,10(6):360.
40. Ashcroft GS, lills SJ, Lei K, et al. Estrogen modulates cutalleous wound healing by down regulating macrophage migration inhibitory factory [J]. Clin Invest,2003,111(9):1309.
2.全国中西医结合防治肛肠疾病协作组：57297人肛门直肠疾病调查报告.中西医结合防治肛门直肠疾病,江苏科技出版社,1980；
3.冯学军.肛肠病人术后排便的护理体会.中华使用中西医杂.2006.19(2)：207
4.周仁郁.SPSS13.0软件设计.成都：西南交通大学出版社,2005：57-89
5.姚泰.生理学.人民卫生出版社.2003：188-190
6王晓琳,廖行忠,等。现代肛肠科学。成都中医药大学：37-38
7.李玉林.病理学.人民卫生出版社.2005：70-83
8.董郡.病理学.人民卫生出版社.1996：117-124
9.阳世伟, 孙其凤等.骨科择期术后患者进食时间的研究.护理学杂志2008,3.23(6)： 1
10.严艺.护理干预在痔疮术后患者重建排便习惯中的应用[J].山东医药.2008,48(35)：42
11.洪英,王家云.心理因素对术后疼痛的影响[J].国外医学：麻醉学与复苏分册,2000,21(3)：156—157.
12.张振勇,张霓.挑断部分内括约肌对改善环状混合痔剥扎术后肛缘水肿、疼痛的观察[J].安徽中医学报,1996,18(6)：43-44
13.梁健.肛肠病术后并发症的中西医结合治疗[J].右江医学,2008,28(1)：47-48.
14.董郡.病理学.人民卫生出版社.1996：62-64
1.易文.中医药促进肛肠疾病术后创面愈合的研究概况[J].中国肛肠病杂志,2005,25(9)： 50-51.
2.陈瑶.混合痔术后创面愈合的影响因素与对策[J.医学综述,2008,14(12)：1856.
3.董郡.病理学.人民卫生出版社.1996：62-64
4. Reed M J, Ferara NS, Vernon RBI mpaired migration, integrin function, and action eytoskeletal organization in dermal fbroblasts from a subsetr of aged human donors[J].biech Ageing Dev,2001,122(11):1203.
5. Swift ME. Bums AL, Gray KL, et a 1. Age-related alterations in the in flam matory response to dermal injury [J]. Invest Dermatol,2001,117(5):1027.
6. Wicke C, Wagner S, Trabold O, et al. Age-dependency of insulin-like growth factors, insulin - like growth factor-binding proteins, and acidlabile subunit in plasma and wounds of surgical patients [J]. Wound Repair Regen,2002,10(6):360.
7. Ashcroft GS, lills SJ, Lei K, et al. Estrogen modulates cutalleous wound healing by downregulating macrophage migration inhibitor factory [J]. Clin Invest,2003,111(9):1309.
8.刘飞,赵国红.老年患者切口愈合不良影响因素分析[J].吉林医学,2006,27(10)：1202
9.郑家伟,赵国臣.伤口愈合机制的现代认识.国外医学口腔医学分册.1992,19(J)： 19.
10.王丽姿.伤口愈合的相关营养因素及护理[J].实用护理杂志,2002,18(9)：55.
11.华斌,柏连松.影响伤口愈合的因素及促愈方法[J].中国中西医结合外科杂志,2001,7(Ⅰ)：63.
12.程义勇,陈星伟,王冬兰等.锌对太鼠胶原合成和创伤愈合的作用[J].营养学报.1992,14(1)：70.
13.付小兵.国外创伤修复研究的新进展.国外医学创伤与外科基问题分册,1994.15(3)：147.
14.李玉林.病理学.人民卫生出版社.2005：70-83
15. Yamunaka M, Ishikawa O. Hypoxic conditions decrease the mRNA ex-pression of proalphal I and coll agens and increase matrix metallop-roteinases of dermal fibroblasts in three- dimensional cultures[J]. Dermatol Sci,2000,24(2):99.
16.李萍,李光善,盛巡.糖尿病大鼠创面愈合过程中成纤维细胞增殖及Ⅰ型胶原合成减少[J].中国病理生理杂志,2005,21(9)：1807.
17.吴晓山,丁敏,张仁等.高血脂对家兔伤口愈合的影响[J].浙江医学1996,18(2)： 81.
18.洪英,王家云.心理因素对术后疼痛的影响[J].国外医学：麻醉学与复苏分册,2000,21(3)：156—157.
19. Mereado AM. Padgett DA, Sheridan JF, et al. Altered kinetics of Lle IL- 11 and KGF- 1 gene expression in early wounds of restrained lce[J]. Brain Behav Immun,2002,16(2):150.
20.李玉林.病理学.人民卫生出版社,2005：42
21.张继领,汪阳林等。肛周脓肿细菌感染菌群分布研究.华北煤炭医学报,2004,6(4)：425
22.姚正国,范秋莲,姚月球,等.外科手术切口感染的病原菌耐药性调查.中华医院感染学杂志,2004,14(5)：593-594.
23.刘丽华,魏全珍,张惠珍,等.腹部手术切口感染的调查与对策.中华医院感染学杂志,2008,8(8)：1091-1092
24.赵明红.普外科切口感染目标性监测研究.中华医院感染学杂志.2004,14(5)： 519.
25.严金燕,贾氢,罗书练,等.外科手术切口的影响因素分析.临床军医杂志,2002,30(4)：39-4.
26. jonssion K, Jensen JA, Goodson WH, et al. Tissue oxygenation. anemis and perfusion in relation to wound healing in surgical patients. Ann Surg,1991.214(5):605
27.张东铭.痔的分类与治疗学的现代概念[J].中国肛肠病杂志2001,21(5)：29.
28. Dan jo Y, Gipson 1K. Specific Transduetion of the Leading Edge Cells of Migrating Epithelia De monstrates That They are Replaced During Healing[J]. Exp Eye Res,2002,74(2):199.
29.张俐,刘波.疼痛评估及其处理[J].国外医学：护理学分册,1999,18(6)： 273—-274.
30.季小平.疼痛对切口愈合的影响及护理.家庭护士.2008,6(2)：505
31.王跃振,刘屹,刘异,等.混合痔术后肛缘水肿的防治[J].长春中医药大学学报,2008,24(1)：85—86.
32.史仁杰,杨关根.痔术后水肿的原因及防治[J].现代中西医结合杂志.2003,12(9)
33.张军.肛肠病手术后创面愈合不良原因分析[J].中国中西医结合外科杂志.2006,12(5)499.
34.樊敏.肛肠病手术后创面愈合不良原因分析与护理[J].护士进修杂志.2008,23(6)：553
35.宿迁,陈焰.女子月经对肛肠手术切口愈合的影响.大肠肛门病外科杂志.2005,11(3)：208
36.梅笑玲,连文学等.臀沟深浅对肛肠病术后创面愈合的影响.中国中西医结合外科杂志.1999,5(1)：52
37. Reed MJ, Ferara NS, Vernon RB. Impaired migration, integrin function, and action eytoskeletal organization in dermal broblasts roma subsetr of aged human donors[J]. biech Ageing Dev,2001,122(11):1203.
38. Swift ME. Bums AL, Gray KL, et al. Age- related alterations in the inflam-matory response to dermal injury [J]. Invest Dermatol,2001, 117(5):1027.
39. Wicke C, Wagner S, Trabold O, et al. Age-dependency of insulin-like growth factors, insulin-like growth factor-binding proteins, and acid labile subunit in plasma and wounds of surgical patients [J]. Wound Repair Regen,2002,10(6):360.
40. Ashcroft GS, lills SJ, Lei K, et al. Estrogen modulates cutalleous wound healing by down regulating macrophage migration inhibitory factory [J]. Clin Invest,2003,111(9):1309.