不同手术时机联合顾氏熏洗、贴敷法治疗嵌顿痔的临床研究

Clinical study on treatment of incarcerated hemorrhoids with Gu’s fumigating, washing and plastering methods at different operation timing

目的观察不同手术时机联合顾氏熏洗、贴敷法治疗嵌顿痔的临床疗效。方法将70例嵌顿痔患者随机分为急诊手术组(35例)和择期手术组(35例)。急诊手术组患者在入院当天或次日行吻合器痔上黏膜环切术联合外痔剥离术,术后予顾氏外科丹卿方熏洗、消痔膏贴敷21 d;择期手术组予顾氏外科丹卿方熏洗、消痔膏贴敷3~7 d后行手术治疗,术后继续予顾氏外科熏洗、贴敷法治疗21 d。观察住院时间、创面愈合时间,比较两组术后主要症状和体征(疼痛、水肿、渗出、出血)、生活质量评分的变化情况。结果①试验期间,两组各脱落1例、剔除1例,最终完成试验者66例,每组33例。②术后1 d、3 d、7 d组间比较,择期手术组VAS疼痛评分低于急诊手术组(P<0.05),水肿程度轻于急诊手术组(P<0.05);术后3 d组间比较,择期手术组出血量少于急诊手术组(P<0.05)。③择期手术组住院时间长于急诊手术组(P<0.05);两组术后渗出量、生活质量评分、创面愈合时间比较,差异无统计学意义(P>0.05)。④试验期间,两组均无明显不良反应发生。结论为减少术后初期的相关并发症(疼痛、出血、水肿),宜选取择期手术治疗嵌顿痔。

Objective To evaluate and observe the clinical effect on the treatment of incarcerated hemorrhoids combined with Gu’s fumigating, washing and plastering methods at different operation timing. Methods Seventy patients with incarcerated hemorrhoids were randomly divided into the emergency operation group(35 cases) and selective operation group(35 cases). Patients in the emergency operation group underwent PPH combined with external hemorrhoid dissection on the day of admission or the next day, and were treated with Gu’s fumigating, washing and plastering methods for 21 days after operation. The selective operation group was first treated with Gu’s fumigating washing and plastering methods for 3 to 7 days before operation, and continued to be treated with Gu’s fumigating, washing and plastering methods for 21 days after operation. The hospitalization days and wound healing time were observed, and the changes of main symptoms and signs(pain, edema, exudation, hemorrhage) and quality of life scores between the two groups were compared. Results ①During the experiment, one case dropped out and one case was eliminated in both groups. There were 66 cases finally completed the experiment with 33 cases in each group. ②On day 1, 3 and 7 after operation, the VAS pain score in the elective operation group was lower than that in the emergency operation group(P < 0.05), and the degree of edema was milder than that in the emergency operation group(P < 0.05);On day 3 after operation, the bleeding amount in the elective operation group was less than that in the emergency operation group(P < 0.05). ③The hospitalization time of the selective operation group was longer than that of the emergency operation group.(P< 0.05).There was no significant difference in postoperative exudation,quality of life score and wound healing time between the two groups( P > 0. 05).(4) During the trial,no obvious adverse reactions occurred in both groups. Conclusion To reduce the related postoperation complications( pain,hemorrhage and edema) at the initial stage,selective operation should be considered in the first place for patients with incarcerated hemorrhoids.