中医综合治疗干预应用于Ⅲ期肛裂患者术后的临床疗效观察

Postoperative treatment of patients with stage Ⅲ anal fissure:a comprehensive intervention based on traditional Chinese medicine

目的观察中医综合治疗干预应用于Ⅲ期肛裂患者术后的临床疗效。方法采用信封进行方案隐藏(按1:1分组),根据干预方案的不同分为治疗组与对照组,纳入2018年1月至2019年9月在上海市金山区中西医结合医院肛肠科和云南省普洱市景东彝族自治县中医医院外科住院手术的90例Ⅲ期肛裂患者进行研究。对照组予以常规术后护理,治疗组在对照组常规护理的基础上再给予中医综合治疗干预。观察记录两组临床疗效、创面愈合情况、术后主要并发症(肛门疼痛、肛缘水肿、便血)及排便情况。结果术后1个月,两组疗效比较差异无统计学意义(P>0.05)。治疗组创面愈合时间短于对照组,愈合后瘢痕面积小于对照组(均P<0.05)。术后第1、2、3天,治疗组换药后半小时肛门疼痛程度轻于对照组(均P<0.05);术后第7天,两组换药后半小时肛门疼痛程度比较,差异无统计学意义(P>0.05)。术后第1天及第2天,两组肛缘水肿及便血程度比较,差异均无统计学意义(均P>0.05);术后第3天及术后第7天,治疗组肛缘水肿程度及便血程度轻于对照组(均P<0.05)。治疗组术后3天内首次排便比例与对照组比较,差异无统计学意义(P>0.05),治疗组排便费力、粪便质硬、肛门堵塞感发生率低于对照组(均P<0.05)。结论在Ⅲ期肛裂患者术后常规护理基础上加用中医综合治疗干预,有助于缓解早期肛门疼痛、改善早期排便情况,也可促进创面愈合,对于改善肛缘水肿及便血情况也有一定的作用。

Objectives To investigate the effect of comprehensive intervention based on traditional Chinese medicine in postoper?ative treatment of patients with stageⅢanal fissure.Methods Ninety patients with stageⅢanal fissure treated at Department of Anorectal Diseases,Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai,and Depart?ment of Surgery,Traditional Chinese Medicine Hospital of Jingdong Yi Autonomous County,Jingdong County,Pu’er City,Yun?nan,between January 2018 and September 2019 were recruited.Patients were assigned into the treatment group and control group using‘sealed envelope’with a 1:1 ratio.Patients in the control group received routine postoperative nursing,and those in the treatment group received additional comprehensive intervention based on traditional Chinese medicine.Clinical effective?ness,wound healing,major complications(anal pain,anal margin edema,and hematochezia),and bowel movement were recorded.Results Effectiveness at one month after surgery was comparable between groups(P>0.05).Time to wound healing was signifi?cantly shorter,and scar area was significantly smaller in the treatment group than in the control group(P<0.05).Anal pain scores at 30 min after dressing at postoperative day 1,2,and 3 was significantly lower in the treatment group than in the con?trol group(P<0.05),but such difference was absent at postoperative day 7(P>0.05).Anal margin edema and hematochezia at postoperative day 1 and 2 did not differ between groups(P>0.05),but they were significantly less severe in the treatment group at postoperative day 3 and 7(P<0.05).Bowel movement within 3 days after surgery did not differ significantly between groups(P>0.05),but laborious defecation,hard stool,and anal blockage occurred significantly less in the treatment group(P<0.05).Conclusion Comprehensive intervention based on traditional Chinese medicine in addition to routine postoperative nursing could alle?viate early anal pain,improve bowel movement,and promote wound healing.It was also beneficial for improving anal margin ede?ma and hematochezia.