本文選題：直腸前突 + 手術(shù)��； 參考：《河北醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：便秘嚴(yán)重影響著患者的生活質(zhì)量，極大地危害著患者的身心健康，因此對本病的研究日益受到人們的重視。臨床醫(yī)生提出了多種手術(shù)方式來糾正異常的解剖結(jié)構(gòu)，各有特色，但近遠(yuǎn)期療效不穩(wěn)定，易復(fù)發(fā)，，尤其對于重度直腸前突合并直腸內(nèi)脫垂的出口梗阻型便秘。排便過程是人體中一系列復(fù)雜而協(xié)調(diào)的生理反射活動，人的全身功能狀態(tài)和高級神經(jīng)活動對其有很大的影響。因此中醫(yī)的辯證論治、整體觀念，能對重度直腸前突合并直腸內(nèi)脫垂的出口梗阻型便秘起到標(biāo)本兼治的作用。此論文旨在探討“STARR術(shù)+消痔靈柱狀注射+溫腎運(yùn)腸湯口服”聯(lián)合治療重度直腸前突合并直腸內(nèi)脫垂所致出口梗阻型便秘的近遠(yuǎn)期療效。 方法:臨床選擇河北醫(yī)科大學(xué)中醫(yī)院肛腸科住院病人中經(jīng)癥狀、體征、排糞造影示為重度直腸前突合并直腸內(nèi)脫垂型便秘患者80例，采用“STARR術(shù)+消痔靈柱狀注射+溫腎運(yùn)腸湯口服”，即先行STARR+消痔靈柱狀注射術(shù)，術(shù)后將科室自擬中藥方溫腎運(yùn)腸方制成袋裝湯劑200ml每日兩次，共服10天。觀察治療前后排便頻率、排便時間、便不盡感、肛門下墜感、應(yīng)用緩瀉劑、排糞造影示前突深度等指標(biāo)的改變情況。全部數(shù)據(jù)采用SPSS13.0軟件統(tǒng)計包進(jìn)行統(tǒng)計學(xué)處理，全部計量資料以平均值加減標(biāo)準(zhǔn)差（x士S）表示，符合正態(tài)分布采用配對t檢驗(yàn)，不符合正態(tài)分布采用配對秩和檢驗(yàn)。P0.05為顯著性差異的標(biāo)準(zhǔn)。通過統(tǒng)計學(xué)原理分析統(tǒng)計來判定近遠(yuǎn)期療效。 結(jié)果：80例患者經(jīng)治療后,治愈60例（75%），顯效14例（17.5%），好轉(zhuǎn)6例（7.5%），總有效率為100%。 1、患者治療前后排便頻率積分?jǐn)?shù)據(jù)經(jīng)配對秩和檢驗(yàn)得出P0.05，具有顯著性差異。治療后患者的排便頻率比治療前明顯增多。 2、患者治療前后排便時間積分?jǐn)?shù)據(jù)經(jīng)配對秩和檢驗(yàn)得出P0.05，具有顯著性差異。治療后患者的排便時間比治療前明顯縮短。 3、患者治療前后肛門下墜感積分?jǐn)?shù)據(jù)經(jīng)配對秩和檢驗(yàn)得出P0.05具有顯著性差異。治療后患者的肛門下墜感比治療前明顯減輕。 4、患者治療前后便不盡感積分?jǐn)?shù)據(jù)經(jīng)配對秩和檢驗(yàn)得出P0.05，具有顯著性差異。治療后患者的便不盡感比治療前明顯減輕。 5、患者治療前后應(yīng)用緩瀉劑積分?jǐn)?shù)據(jù)經(jīng)配對秩和檢驗(yàn)得出P0.05具有顯著性差異。治療后患者應(yīng)用緩瀉劑比治療前明顯減少。 6、患者治療前后前突深度數(shù)據(jù)經(jīng)配對t檢驗(yàn)得出P0.05，具有顯著性差異。治療后患者的前突深度比治療前明顯縮小。 結(jié)論：該治療方案消除了直腸前突的囊袋樣松弛粘膜，重構(gòu)了直腸中下段的直腸內(nèi)解剖結(jié)構(gòu)，加強(qiáng)了直腸陰道隔。同時配合中藥口服，補(bǔ)腎溫陽、益氣養(yǎng)血、潤腸通便，改善了患者體質(zhì)，增強(qiáng)了包括排便能力在內(nèi)的內(nèi)臟機(jī)能。充分發(fā)揮了中西醫(yī)結(jié)合的優(yōu)勢，標(biāo)本皆治，治療效果顯著，近遠(yuǎn)期療效好。
[Abstract]:Objective: constipation seriously affects the quality of life of patients and greatly endangers the physical and mental health of patients, so people pay more and more attention to the study of this disease. A variety of surgical methods have been proposed to correct the abnormal anatomical structure, each of which has its own characteristics, but the short-term and long-term results are unstable and easy to recur, especially for the outlet obstructive constipation with severe prolapse of the rectum and prolapse of the rectum. Defecation is a series of complex and coordinated physiological reflex activities in human body. Therefore, the dialectical treatment and the whole concept of TCM can play a role in treating the outlet obstruction constipation of severe protrusion of rectum with prolapse of rectum. The purpose of this study was to investigate the short and long-term effect of combined treatment of severe prolapse of rectum combined with outlet obstruction constipation caused by rectum prolapse by columnar injection of Wenshenyunchang decoction (WYT). Methods: 80 patients with severe prolapse of rectum associated with rectum prolapse constipation were selected clinically in the anorectal department of the Hospital of traditional Chinese Medicine, Hebei Medical University, with symptoms, signs, defecography and defecography. The columnar injection of Wenshenyunchang decoction for Ruozhouxiaoling was used, that is, the columnar injection of Starr and Xiaozhiling. After the operation, 200ml was made into a bag decoction twice a day, taking it for 10 days. The changes of defecation frequency, defecation time, anus falling feeling and the depth of protrusion were observed before and after treatment. All the data were processed by SPSS 13.0 software statistical package, all the measurement data were expressed as the average value plus or minus the standard deviation (S), and the normal distribution was matched t test. Nonconformance normal distribution using pairing rank sum test. P05 as the standard of significant difference. To judge the short-and long-term curative effect by analyzing the statistics principle. Results after treatment, 60 cases were cured, 14 cases were significantly effective, 6 cases were improved, the total effective rate was 100.1. The data of defecation frequency integral before and after treatment were obtained by pairing rank sum test (P0.05), with significant difference. The defecation frequency of patients after treatment was significantly higher than that before treatment. 2. The score data of defecation time before and after treatment showed significant difference by pairing rank sum test (P0.05). After treatment, the defecation time of the patients was significantly shorter than that before treatment. 3. The anus drop score data before and after treatment were significantly different by pairing rank sum test (P0.05). After treatment, the anus drop feeling of the patients was significantly less than that before and after treatment. 4. Before and after treatment, the scores of insensitive scores of the patients were found to be significantly different by pairing rank sum test (P0.05). After treatment, the feces of the patients were significantly reduced than before treatment. 5, patients before and after treatment with laxative integration data by pairing rank sum test showed that P0.05 has significant difference. After treatment, the number of patients treated with laxative was significantly lower than that before treatment. 6. The depth of protrusion before and after treatment was significantly different from that before and after treatment by paired t test (P0.05). The protrusion depth of patients after treatment was significantly smaller than that before treatment. Conclusion: this treatment scheme eliminates the saccular sachelike mucous membrane of anterior rectal protrusion, reconstructs the internal anatomy of the middle and lower rectum, and strengthens the rectovaginal septum. At the same time, combined with oral Chinese medicine, tonifying kidney and warming yang, tonifying qi and nourishing blood, moistening intestines and defecating, improving patients' physique and enhancing visceral function including defecation ability. Give full play to the advantages of integrated Chinese and western medicine, all specimens are treated, the treatment effect is remarkable, the short-and long-term effect is good.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R657.1

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本文編號：2018998