掛線療法治療高位肛瘺的臨床療效評(píng)價(jià)
發(fā)布時(shí)間：2019-02-18 14:20
【摘要】：目的:通過觀察對(duì)比高位肛瘺患者低位切開高位掛線治療與低位切開高位曠置術(shù)后的疼痛、愈合時(shí)間、肛門控便能力、肛門壓力測定、術(shù)后復(fù)發(fā)率等數(shù)據(jù),形成一套治愈率高、術(shù)后痛苦小、住院時(shí)間短,而且能最大限度維護(hù)肛門功能的療法,從而達(dá)到使用規(guī)范掛線療法治療高位肛瘺的目的。材料與方法:采納自2012年3月至2014年1月期間的200例高位肛瘺病例(均為沈陽市肛腸醫(yī)院住院患者),隨機(jī)分為兩個(gè)觀察組,分別為治療組與對(duì)照組,兩組對(duì)照觀察,隨訪半年。作為觀察研究的數(shù)據(jù)的有:術(shù)后的VAS疼痛評(píng)分(術(shù)后72、168小時(shí)疼痛評(píng)分)、術(shù)后療效評(píng)價(jià)、術(shù)后7天創(chuàng)面分泌物情況、手術(shù)前后的肛門直腸壓力測定(靜息壓、最大收縮壓)、手術(shù)前后肛門功能評(píng)價(jià)、wexner評(píng)分、術(shù)后復(fù)發(fā)率等。結(jié)果:經(jīng)隨訪觀察,兩組間療效評(píng)價(jià)比較P值0.05,無統(tǒng)計(jì)學(xué)意義;治愈時(shí)間比較,兩組間經(jīng)統(tǒng)計(jì)學(xué)軟件分析P0.05,不具有統(tǒng)計(jì)學(xué)意義,無明顯差異;術(shù)后疼痛以VAS評(píng)分為標(biāo)準(zhǔn),對(duì)比術(shù)后72小時(shí)及168小時(shí)疼痛評(píng)分經(jīng)統(tǒng)計(jì)學(xué)軟件分析兩組均可見P0.05,差異無統(tǒng)計(jì)學(xué)意義;術(shù)后7天創(chuàng)面分泌物情況兩組間對(duì)照經(jīng)統(tǒng)計(jì)學(xué)軟件分析P0.05,無統(tǒng)計(jì)學(xué)意義;兩組間手術(shù)前后功能評(píng)價(jià)及Wexner評(píng)分對(duì)比結(jié)果經(jīng)統(tǒng)計(jì)學(xué)軟件分析P0.05,差異無統(tǒng)計(jì)學(xué)意義;術(shù)前術(shù)后對(duì)比肛門直腸壓力測定P0.05,不具有統(tǒng)計(jì)學(xué)意義;跟蹤對(duì)比兩組間術(shù)后六個(gè)月復(fù)發(fā)率,經(jīng)統(tǒng)計(jì)學(xué)軟件分析,P0.05兩組間差異明顯,具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1、通過對(duì)患者對(duì)照分析后發(fā)現(xiàn),治療組低位切開高位掛線術(shù)用于治療高位肛瘺與對(duì)照組低位切開高位曠置的治療方式相比在臨床療效、術(shù)后7天創(chuàng)面分泌物情況以及術(shù)后Wexner評(píng)分等方面并未優(yōu)于對(duì)照組;2、術(shù)后疼痛VAS評(píng)分方面,治療組低位切開高位掛線沒有明顯優(yōu)于對(duì)照組低位切開高位曠置術(shù);而在術(shù)后治愈時(shí)間的對(duì)比中,治療組低位切開高位掛線術(shù)沒有明顯的優(yōu)于對(duì)照組低位切開高位曠置術(shù),在病程的縮短上沒有體現(xiàn)出明顯的優(yōu)勢。3、在術(shù)后六個(gè)月隨訪觀察中發(fā)現(xiàn),復(fù)發(fā)率方面兩者的差異較明顯,治療組低位切開高位曠置明顯的優(yōu)于對(duì)照組低位切開高位曠置術(shù)。作為臨床中較為常用的治療高位肛瘺的術(shù)式,低位切開高位掛線用以橡皮筋起到慢性切割、異物刺激的作用,在對(duì)括約肌慢性切割的同時(shí)保證了組織愈合的同步性,避免了施治肛瘺處的括約肌出現(xiàn)突然大面積的損傷,能夠保證肛直角的完整,避免或盡量減少肛管直腸環(huán)的損傷從而保證了對(duì)肛門擴(kuò)約功能的保護(hù)。低位切開高位掛線術(shù)在繼承了上述掛線療法的優(yōu)點(diǎn)的基礎(chǔ)上,通過掛松線的方式避免了緊線對(duì)瘺管處括約肌的強(qiáng)烈刺激,明顯減輕了掛線過程中對(duì)患者造成的疼痛。這也與現(xiàn)代外科學(xué)的微創(chuàng)理念不謀而合,在盡量減少組織損傷和減輕患者痛苦的前提下,收獲同樣的治療預(yù)期。而在控制復(fù)發(fā)率方面,由于掛線方法與低位切開高位曠置術(shù)相對(duì)比對(duì)疾病治療更加徹底,對(duì)形成假腔控制的更為理想,所以在臨床中具有推廣使用的價(jià)值。
[Abstract]:Objective: To establish a set of data such as pain, healing time, anal-control, anal pressure and postoperative recurrence rate after the low-position high-position hanging-line treatment and low-position high-position hanging-line treatment in the high-order anorectal cancer patients, and to form a set of data with high cure rate, small postoperative pain and short hospital stay. but also can furthest maintain the treatment of the anus function, so as to achieve the purpose of using the standard wire-hanging therapy for treating the high-level anorectal cancer. Materials and Methods: 200 high-order anorectal cases (all of which were in-hospital patients in the hospital of anorectal hospital in Shenyang) from March 2012 to January 2014 were randomly divided into two groups: the treatment group and the control group, the two groups of control group and the follow-up half year. The data of the study were: VAS pain score (72, 168 hours post-operative pain score), postoperative efficacy evaluation, 7-day postoperative wound discharge, anal rectal pressure measurement before and after operation (resting pressure, maximum systolic pressure), and post-operative anal function evaluation. Wexer score, post-operative recurrence rate, etc. Results: The results of follow-up observation showed that the difference between the two groups was 0. 05, no statistical significance, no significant difference between the two groups, and no significant difference between the two groups. The postoperative pain was the standard of VAS. There was no significant difference between the two groups after the 72-hour and 168-hour pain scores compared with that of the two groups (P0.05). The preoperative and postoperative functional evaluation of the two groups and the comparison of the Wexer score were compared with that of the Wexer score (P0.05). The difference between the two groups was significant, and the difference between the two groups was statistically significant. Conclusion: 1. After the analysis of the patient's control, it is found that the low-position high-position hanging-line operation in the treatment group is used for the treatment of the high-position anal canal and the low-position high-position and high-position and high-position and high-position ligation of the control group in the clinical curative effect, The postoperative wound discharge and the postoperative Wexner score were not superior to those in the control group. In the aspect of postoperative pain VAS score, the low-position high-position hanging line of the treatment group was not significantly superior to that of the control group, while in the comparison of the postoperative cure time, in that follow-up observation of the six-month follow-up, it was found that the two difference in the recurrence rate was more obvious. The lower open high position of the treatment group was superior to that of the control group, which was superior to that of the control group. As a more commonly used technique for treating the high-position anal sphincter, the low-position high-position hanging wire is used for treating the rubber band to play a role of chronic cutting and foreign body stimulation, and the synchronicity of the tissue healing is ensured while the sphincter is chronic cutting, avoids the sudden large-area injury of the sphincter at the anus and the anus, can ensure the integrity of the right angle of the anus, avoid or minimize the damage of the anorectal ring, and ensure the protection of the function of the anus expansion. On the basis of inheritance of the advantages of the above-mentioned line-hanging therapy, the low-position-cut high-level hanging-line operation avoids the strong stimulation of the tight wire to the sphincter of the tube-hanging tube through the way of hanging the loose wire, and obviously reduces the pain caused to the patient during the process of the hanging line. This is also the combination of the minimally invasive idea of modern foreign science, and the same treatment is expected to be obtained on the premise of minimizing tissue damage and alleviating the patient's suffering. and in the aspect of controlling the recurrence rate, because the relative ratio of the hanging wire method and the low-position high-position high-position setting technique is more thorough than the treatment of the disease, the ideal for forming the pseudo-cavity control is achieved, and therefore, the method has the value of promoting the use in the clinic.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.16
本文編號(hào)：2425925
[Abstract]:Objective: To establish a set of data such as pain, healing time, anal-control, anal pressure and postoperative recurrence rate after the low-position high-position hanging-line treatment and low-position high-position hanging-line treatment in the high-order anorectal cancer patients, and to form a set of data with high cure rate, small postoperative pain and short hospital stay. but also can furthest maintain the treatment of the anus function, so as to achieve the purpose of using the standard wire-hanging therapy for treating the high-level anorectal cancer. Materials and Methods: 200 high-order anorectal cases (all of which were in-hospital patients in the hospital of anorectal hospital in Shenyang) from March 2012 to January 2014 were randomly divided into two groups: the treatment group and the control group, the two groups of control group and the follow-up half year. The data of the study were: VAS pain score (72, 168 hours post-operative pain score), postoperative efficacy evaluation, 7-day postoperative wound discharge, anal rectal pressure measurement before and after operation (resting pressure, maximum systolic pressure), and post-operative anal function evaluation. Wexer score, post-operative recurrence rate, etc. Results: The results of follow-up observation showed that the difference between the two groups was 0. 05, no statistical significance, no significant difference between the two groups, and no significant difference between the two groups. The postoperative pain was the standard of VAS. There was no significant difference between the two groups after the 72-hour and 168-hour pain scores compared with that of the two groups (P0.05). The preoperative and postoperative functional evaluation of the two groups and the comparison of the Wexer score were compared with that of the Wexer score (P0.05). The difference between the two groups was significant, and the difference between the two groups was statistically significant. Conclusion: 1. After the analysis of the patient's control, it is found that the low-position high-position hanging-line operation in the treatment group is used for the treatment of the high-position anal canal and the low-position high-position and high-position and high-position and high-position ligation of the control group in the clinical curative effect, The postoperative wound discharge and the postoperative Wexner score were not superior to those in the control group. In the aspect of postoperative pain VAS score, the low-position high-position hanging line of the treatment group was not significantly superior to that of the control group, while in the comparison of the postoperative cure time, in that follow-up observation of the six-month follow-up, it was found that the two difference in the recurrence rate was more obvious. The lower open high position of the treatment group was superior to that of the control group, which was superior to that of the control group. As a more commonly used technique for treating the high-position anal sphincter, the low-position high-position hanging wire is used for treating the rubber band to play a role of chronic cutting and foreign body stimulation, and the synchronicity of the tissue healing is ensured while the sphincter is chronic cutting, avoids the sudden large-area injury of the sphincter at the anus and the anus, can ensure the integrity of the right angle of the anus, avoid or minimize the damage of the anorectal ring, and ensure the protection of the function of the anus expansion. On the basis of inheritance of the advantages of the above-mentioned line-hanging therapy, the low-position-cut high-level hanging-line operation avoids the strong stimulation of the tight wire to the sphincter of the tube-hanging tube through the way of hanging the loose wire, and obviously reduces the pain caused to the patient during the process of the hanging line. This is also the combination of the minimally invasive idea of modern foreign science, and the same treatment is expected to be obtained on the premise of minimizing tissue damage and alleviating the patient's suffering. and in the aspect of controlling the recurrence rate, because the relative ratio of the hanging wire method and the low-position high-position high-position setting technique is more thorough than the treatment of the disease, the ideal for forming the pseudo-cavity control is achieved, and therefore, the method has the value of promoting the use in the clinic.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.16
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 蘇克寧;手術(shù)治療高位復(fù)雜性肛瘺30例體會(huì)[J];大腸肛門病外科雜志;1996年04期
，本文編號(hào)：2425925
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2425925.html
最近更新
教材專著
