针灸促进腹腔镜下直肠癌腹会阴联合切除术后排尿功能恢复的临床研究
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摘要
[目的]研究针灸对腹腔镜下直肠癌腹会阴联合切除术后排尿功能恢复的影响。证明这种干预措施能促进直肠癌术后排尿功能恢复且是一种相对安全、疗效显著的方法。
[方法]本试验为前瞻性随机对照研究,将2010年6月至2011年03月间入住南京市中医院且行腹腔镜下直肠癌腹会阴联合切除术的符合纳入标准的患者30例,随机分入试验组15例和对照组15例。试验组及对照组均予术前宣教、术后夹闭尿管训练等留置导尿标准护理,试验组的患者术后第三日起予针灸治疗,每日一次,连续针灸治疗至术后第七日。对照组不予任何处理。观察两组在术后7日拔出尿管后膀胱残余尿、排尿功能等级、排尿积分、是否发生尿潴留、是否需要再次留置尿管等情况。两组间计量资料用均数±标准差描述,采用t检验,两组间计数资料比较采用卡方检验和秩和检验。检验水准取0.05,所有数据用SPSS17.0软件进行统计学分析。
[结果]两组患者年龄、性别构成、Dukes分期、手术时间均有可比性,在排尿积分、膀胱残余尿、术后排尿功能等级上试验组优于对照组(P<0.05),而拔管后尿潴留发生率及再次留置尿管的发生率两组未有明显差异(P>0.05)。
[结论]针灸能够较好地改善腹腔镜下直肠癌腹会阴联合切除术后患者的排尿情况,提高患者的生活质量,但本试验中未能降低其拔管后尿潴留的发生率。
[Objective] To observe the recovery of the urinary function after Laparoscopic Miles' operation by using acupuncture and moxibustion.And to extrapolate the effect that the acupuncture and moxibustion have obvious curative effects for the urinary function recovery.
[Method] This is a prospective randomized controlled study.30 patients suffered from rectal cancer who stay at Nanjing Chinese Medicine Hospital for Miles'operation between june 2010 and march 2011 were randomly divided into experimental group 15 cases and control group 15 cases. Both groups were treated with standard care about indwelling urinal catheter.Else,the experimental group patients were also treated with the acupuncture and moxibustion therapeutics.The treatment were taken from the third day after the operation,qd, until the seventh day.Pull out the catheter and to observe the residual urine volume in the bladder,the rank of cystic function,the grade of cystic function and have uroschesis or not.Measurement data between the two groups were described with a mean±standard deviation,and were compared by t test.Count data between the two groups were compared with chi-square test and rank test.Test level is 0.05, all data used SPSS 17.0 for statistical analysis.
[Results] The patients'age,sex,Dukes stages,operation time are comparable(P>0.05).There were significant difference in the residual urine volume in the bladder,the rank of cystic function and the grade of cystic function(P<0.05). There were not significant difference (P>0.05) between the groups on the incidence of uroschesis.
[Conclusion] Using the acupuncture and moxibustion can accelerate the urinary function recovery after Laparoscopic Miles' operation.And can to improve the quality of life of Patients. But can not avoid the happen of the uroschesis after pull out the catheter.
[方法]本试验为前瞻性随机对照研究,将2010年6月至2011年03月间入住南京市中医院且行腹腔镜下直肠癌腹会阴联合切除术的符合纳入标准的患者30例,随机分入试验组15例和对照组15例。试验组及对照组均予术前宣教、术后夹闭尿管训练等留置导尿标准护理,试验组的患者术后第三日起予针灸治疗,每日一次,连续针灸治疗至术后第七日。对照组不予任何处理。观察两组在术后7日拔出尿管后膀胱残余尿、排尿功能等级、排尿积分、是否发生尿潴留、是否需要再次留置尿管等情况。两组间计量资料用均数±标准差描述,采用t检验,两组间计数资料比较采用卡方检验和秩和检验。检验水准取0.05,所有数据用SPSS17.0软件进行统计学分析。
[结果]两组患者年龄、性别构成、Dukes分期、手术时间均有可比性,在排尿积分、膀胱残余尿、术后排尿功能等级上试验组优于对照组(P<0.05),而拔管后尿潴留发生率及再次留置尿管的发生率两组未有明显差异(P>0.05)。
[结论]针灸能够较好地改善腹腔镜下直肠癌腹会阴联合切除术后患者的排尿情况,提高患者的生活质量,但本试验中未能降低其拔管后尿潴留的发生率。
[Objective] To observe the recovery of the urinary function after Laparoscopic Miles' operation by using acupuncture and moxibustion.And to extrapolate the effect that the acupuncture and moxibustion have obvious curative effects for the urinary function recovery.
[Method] This is a prospective randomized controlled study.30 patients suffered from rectal cancer who stay at Nanjing Chinese Medicine Hospital for Miles'operation between june 2010 and march 2011 were randomly divided into experimental group 15 cases and control group 15 cases. Both groups were treated with standard care about indwelling urinal catheter.Else,the experimental group patients were also treated with the acupuncture and moxibustion therapeutics.The treatment were taken from the third day after the operation,qd, until the seventh day.Pull out the catheter and to observe the residual urine volume in the bladder,the rank of cystic function,the grade of cystic function and have uroschesis or not.Measurement data between the two groups were described with a mean±standard deviation,and were compared by t test.Count data between the two groups were compared with chi-square test and rank test.Test level is 0.05, all data used SPSS 17.0 for statistical analysis.
[Results] The patients'age,sex,Dukes stages,operation time are comparable(P>0.05).There were significant difference in the residual urine volume in the bladder,the rank of cystic function and the grade of cystic function(P<0.05). There were not significant difference (P>0.05) between the groups on the incidence of uroschesis.
[Conclusion] Using the acupuncture and moxibustion can accelerate the urinary function recovery after Laparoscopic Miles' operation.And can to improve the quality of life of Patients. But can not avoid the happen of the uroschesis after pull out the catheter.
引文
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2.李乾构,等.实用中医消化病学[M],人民卫生出版社,2001：618
3.刘静,张军,朱琦.中医药治疗大肠癌辨证用药分析[J].辽宁中医杂志,2006,33(9)：1166-1167
4.贾小强,杜永宏,张丽娟.中西医结合治疗大肠癌疗效分析[J].辽宁中医杂志,2005,32(7)：703-704
5.沈汉澄,朱娴如,等.长必安胶囊对大肠癌手术预后影响的临床研究[J].浙江中西医结合杂志,2003,13(10)：600-601
6.张有生,李春雨,实用肛肠外科学[M],2009：367
7. Smalley SR,Benedetti JK,Williamson SK,et al.Phase III trial offluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer[J].J Clin Oncol,2006,24:3542-3547
8.高橘孝.直腸癌根治術の变遷と最新の话题[J].消化器外科.1998,21(3)：271
9. Miles WE.Cancer of the rectum.Lettsomian lectures[M].London,1923
10. Clogg HS.Cancer of the colon.A study of 72 cases[J].The Lancet 1908,2:1007-1012
11.王平治等.带蒂臀大肌重建肠管括约肌用于肠管直肠下段癌手术[J].中华外科杂志,1986,7：385
12.徐忠法.球海绵体肌原位肛门直肠重建术[J].现代肛肠肿瘤,1993：254-255
13. Dixon CF.Surgical removal of lesions occurring in the sigmoid and rectosigmoid[J].Am J Surg,1939,46:12-17
14. Dixon CF.Anterior resection for malignant lesions of the upper part ofthe rectum and lower part of the sigmoid[J].Ann Surg,1948,128:425-442
15. Knight CD,Griffen FD.An improved technique for low anteriorresection of the rectum using EEA staper[J].Surgery,1980,88:710-714
16. Macfarlane JK,Ryall D,Heald RJ.Mesorectal excision for rectal cancer[J].The lancet,1993,341(8843):457
17.郁宝铭,蒋家骒等.949例直肠癌的外科治疗[J].中华独占鳌头杂志,1992,20：417-419
18. Jacobs M,Verdeja JC,Goldstein HS.Minimally invasive colon resection (laparoscopic colectomy)[J].Surg Laparosc Endosc,1991,1:144-150
19. Tete JT,Kwok S,Dawsen JW,et al.Prospective comparison of laparoscopic and conventional anterior resection[J].Br J Surg,1993,80:1396-1398
20. Moore JE,Bokey EL,Newland RC,et al.Lymphovascular clearance in laparoscopically assiste drigh themicol ectomy is similar to open surgery[J].Aust.N.Z.J.Surg,1999,66:605
21. Denlaney CP,Lynch AC,Senagore AJ,et al.Comparison of robotically performed and traditional laparoscopic colorectal surgery[J].Dis Colon Rectum,2003,46:1633-1639
22. Moriya Y,Sugihara K,Akasu T,et al.Importance of extended lympha-denectomy with lateral node dissection for advanced lower rectal cancer[J].World J Surg,1997,21(7):728
23. Yano H,Moran BJ.The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West[J].Br J Surg,2008,95:33-49
24. Hojo K,Sawada T,Moriya Y.An analysis of survival and voiding,sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum,compared with conventional lymphadenectomy[J].Dis Colon Rectum,1989,32:128-133
25. Havenga K, Enker WE, MacDermottk, et al. Male and female sexual and urinary function after total mesorectal excision for autonomic nerve preservation for carcinoma of the rectum[J].J Am Coll Surg,1996,182:495-502
26.曹伟新,等.外科护理学第3版[M].北京人民卫生出版社,2003：275
27. Jayne DG,Brown JM,Thorpe H,et al.Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique[J].Br J Surg,2005,92(9):1124-1132
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