中西医结合加速康复理念在消化道穿孔中的临床应用

Treating gaslrointestinal perforation in the integrative medicine

目的:比较腹腔镜下修补术与开腹手术在消化道穿孔中的临床疗效,以及探索中医疗法在加速康复外科中的应用。方法:以2016年1月-2018年8月江苏省中医院普外科收治的64例消化道穿孔患者为研究对象,其中腹腔镜组34例,开腹组30例,比较两组的术后恢复各指标。随机数字表法将腹腔镜组分为干预组(17例)与对照组(17例)。干预组采用术前耳穴贴压和术后穴位贴敷的中医措施,比较两组术后排气时间、中医症状积分等指标。结果:开腹组和腹腔镜组平均手术时间,并发症和病死率比较差异无统计学意义;腹腔镜组排气时间、下床活动时间、拔胃管时间、进食时间均早于开腹组,术后视觉模拟评分法(Visual Analogue Scale,VAS)评分及炎症指标低于开腹组(P<0.05)。干预组的中医症状积分低于对照组(P<0.05)。结论:腹腔镜下穿孔修补术相较于传统开腹手术,利于术后快速恢复,且不增加并发症。围手术期应用中医治疗方法促进早期排气,改善中医症状积分。

Objective:To compare clinical efficacy between laparoscopic repair and open repair for gastrointestinal perforation,and to explore the application of TCM in Enhanced recovery surgery.Methods:According to their surgery procedures,64 patients were divided into the laparoscopic repair group(LR group,34 cases)and open repair group(OR group,34 cases).The indexes after the operation were compared between the groups.The patients in the LR group were divided into the TCM group and the control group,17 cases in each.The intervention group was given TCM medicine including auricular application before operation and acupoint application after operation.The time of exsufflation and TCM symptom score was comparod between the intervention group and the control group.Results:There was no significant difference in Average time of surgery,complications and mortality between the LR group and the OR group.The time of exsufflation,ambulation,pull the gastric tube and meal in the LR group were shorter than the OR group;the postoperative VAS score and inflammation index were lower than the OR group(P<0.05).The TCM symptom score in the intervention group was lower than the control group.Conclusion:The laparoscopic repair can quickly recover without increasing complications.TCM in perioperative period can promote early exhaust,improve TCM symptom score.