本文選題：直腸脫垂　切入點(diǎn)：消痔靈　出處：《中國(guó)中醫(yī)科學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的觀察消痔靈直腸周圍間隙八步注射法,對(duì)于治療完全性直腸脫垂的臨床療效,并探索完全性直腸脫垂的發(fā)病機(jī)制,及消痔靈直腸周圍間隙八步注射術(shù)治療完全性直腸脫垂的可行性研究。方法本研究共收集2011.2--2015.10期間的63例病例,均為經(jīng)中國(guó)中醫(yī)科學(xué)院廣安門醫(yī)院肛腸科診斷為完全性直腸脫垂的住院患者。采用消痔靈直腸周圍間隙八步注射法治療全部病例,完善術(shù)前準(zhǔn)備,術(shù)后禁食3-5天,予抗生素及腸外營(yíng)養(yǎng),控制排便3-5天。觀察記錄患者年齡、性別等基本資料,對(duì)術(shù)前術(shù)后的相關(guān)癥狀、體征進(jìn)行評(píng)分,并于術(shù)前1天、術(shù)后15天進(jìn)行核磁共振成像及雙重造影檢查,對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。隨訪并記錄患者復(fù)發(fā)情況。結(jié)果1.全部63例患者,治愈51例(80.95%),好轉(zhuǎn)10例(15.87%),無效(完全復(fù)發(fā))者2例(3.18%),總有效率96.82%。在治療期間,患者脫垂情況達(dá)到完全改善,對(duì)于其余癥狀包括肛周分泌物、便秘、疼痛等,治療前后亦有不同程度的改善,尤其是術(shù)前及術(shù)后近期的療效評(píng)分存在明顯差異。手術(shù)前后患者血常規(guī)指標(biāo)及生化指標(biāo)未見嚴(yán)重異常。2.術(shù)后隨訪半年至5年,隨訪63例,主訴肛門口少許粘膜脫出者10例,訴有分泌物者12例,肛內(nèi)墜脹不適者6例,直腸脫垂完全復(fù)發(fā)者2例,行經(jīng)腹結(jié)直腸懸吊手術(shù)治療。隨訪63例患者中,出現(xiàn)粘膜脫垂及完全復(fù)發(fā)者共12例,連續(xù)不復(fù)發(fā)時(shí)間中,3個(gè)月不復(fù)發(fā)比例為95.23%,1年連續(xù)不復(fù)發(fā)達(dá)到87.30%,2年連續(xù)不復(fù)發(fā)率達(dá)到80.95%。所有復(fù)發(fā)患者均于2年內(nèi)復(fù)發(fā)。其中0-3個(gè)月復(fù)發(fā)比率最高,達(dá)到25%,4-6個(gè)月、7-9個(gè)月、9-12個(gè)月復(fù)發(fā)比率依次為16.7%、8.3%,16.7%,總計(jì)0-12個(gè)月復(fù)發(fā)例數(shù)可占總復(fù)發(fā)例數(shù)的66.7%。結(jié)論1.消痔靈直腸周圍間隙八步注射法治療完全性直腸脫垂療效肯定,創(chuàng)傷小,經(jīng)濟(jì),安全,大劑量注射亦未出現(xiàn)肝腎等功能的損害,局部感染和壞死率低,復(fù)發(fā)率低,而且易于操作,適合在各級(jí)醫(yī)院開展,患者接受度較高,便于臨床推廣。所以,可作為所有完全性直腸脫垂的首選治療方法。2.根據(jù)入組患者一般情況分析,完全性直腸脫垂一般病程較長(zhǎng),患病年齡范圍較大,性別間差異不大,發(fā)病誘因不明確,無明確職業(yè)相關(guān)性。但仍需更大樣本量進(jìn)行統(tǒng)計(jì)分析。3.盆腔核磁共振成像及雙重造影在觀察評(píng)估盆底解剖結(jié)構(gòu)中具有較大的優(yōu)勢(shì),能很好地了解肛管直腸周圍器官、組織的功能、解剖和狀態(tài),有助于探索直腸脫垂的發(fā)病機(jī)制,提高對(duì)直腸脫垂的診斷價(jià)值,應(yīng)作為直腸脫垂的常規(guī)檢查手段。
[Abstract]:Objective to observe the clinical effect of 8-step injection of Xiaozhiling perirectal space in the treatment of complete rectal prolapse and to explore the pathogenesis of complete rectal prolapse. And the feasibility study of 8-step injection of Xiaozhiling perirectal space for the treatment of complete rectal prolapse. Methods 63 cases of rectal prolapse between January 2 and May 10, 2011 were collected in this study. All the inpatients were diagnosed as complete rectal prolapse by the anorectal department of Guang'an Men Hospital, Chinese Academy of traditional Chinese Medicine. All the patients were treated with 8-step injection of Xiaozhiling perirectal space to improve preoperative preparation and fasting for 3-5 days after operation. Antibiotics and parenteral nutrition were given to control defecation for 3 to 5 days. The patients' age, sex and other basic data were observed, and the symptoms and signs were evaluated before and after operation, and 1 day before operation. Magnetic resonance imaging and double contrast examination were performed 15 days after operation. The results were statistically analyzed. The patients were followed up and their recurrence was recorded. 1. All the 63 patients, 51 cases were cured, 10 cases improved 15.87%, 2 cases were ineffective (completely relapsed), the total effective rate was 96.82%. During the treatment period, the prolapse of the patients reached a complete improvement, for other symptoms including perianal secretion, constipation, pain, etc. Before and after treatment, there were significant differences in the scores of curative effect before and after operation, and there was no serious abnormality in blood routine and biochemical indexes before and after operation. The follow-up period was 6 months to 5 years, and 63 cases were followed up. There were 10 cases of anal mucosal prolapse, 12 cases of secretion, 6 cases of anal distension and discomfort, 2 cases of complete recurrence of rectal prolapse. There were 12 cases of mucosal prolapse and complete recurrence. In the continuous non-recurrence time, the proportion of non-recurrence in 3 months was 95.23, 87.30 in one year, and 80.95in 2 years. All the recurrence patients were recurred within 2 years. The recurrence rate of 0-3 months was the highest. The recurrence rate of 254-6 months, 7-9 months and 9-12 months was 16.7and 16.7in turn, and the total number of recurrence cases from 0-12 months to 12 months could account for 66.7% of the total recurrence cases. Conclusion 1.The effect of 8-step injection of Xiaozhiling perirectal space in the treatment of complete rectal prolapse is certain, the trauma is small, and it is economical. Safety, high dose injection, no damage to liver and kidney function, low local infection and necrosis rate, low recurrence rate, and easy to operate, suitable to be carried out in hospitals at all levels, with high patient acceptance and easy to be popularized. According to the general situation of the patients, the general course of complete rectal prolapse is longer, the age range of the disease is larger, the difference between sex is not obvious, and the cause of the disease is not clear. There is no definite occupational correlation. However, a larger sample size is still needed for statistical analysis .3. pelvic magnetic resonance imaging and double contrast imaging have great advantages in observing and evaluating the anatomical structure of the pelvic floor, and can better understand the perianal organs. The function, anatomy and state of tissue are helpful to explore the pathogenesis of rectal prolapse and to improve the diagnostic value of rectal prolapse. It should be used as a routine examination method for rectal prolapse.
【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R266

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