四君子汤合四磨汤加减治疗出口梗阻型便秘吻合器经肛门直肠切除术后的临床疗效

Clinical Effect Addition and Subtraction Therapy of Si Junzitang Combined with Simotang to Outlet Obstructive Constipation After Stapled Trans-anal Rectal Resection

目的:观察四君子汤合四磨汤加减治疗出口梗阻型便秘(OOC)吻合器经肛门直肠切除术后(STARR)的临床疗效。方法:124例患者随机按数字表法分为对照组和观察组各62例。对照组术后给予芪蓉润肠口服液,20 mL/次/,3次/d;观察组术后给予四君子汤合四磨汤加减内服,1剂/d。两组疗程均连续治疗4周,并进行8周随访。分别于手术前、治疗后2周,4周、随访8周进行便秘主要症状评分和Longo ODS评分;于手术前和治疗后4周,进行超氧化物歧化酶(SOD),丙二醛(MDA)和便秘患者生存质量自评量表(PAC-QOL)评价,并进行肛门直肠测压,记录肛管静息压(ARP),肛管最大收缩压(MSP),直肠排便压力(RSP),初始感觉阈值(FSV),排便感觉阈值(CRS)和最大耐受容量(MTV)等指标;随访记录并发症发生率、复发率和排便正常率;术后4周进行满意度评价和安全性评价。结果:治疗后4周,观察组患者临床疗效优于对照组(Z=2.096,P<0.05);治疗后2周,4周和随访8周,观察组便秘主要症状积分和Longo ODS评分均低于对照组(P<0.01);观察组患者ARP,FSV,FSV,CRS均低于对照组(P<0.01),MSP和RSP均高于对照组(P<0.01);观察组并发症发生率、复发率分别为20.97%(13/62)和4.84%(3/62),分别低于对照组的39.71%(24/62)和16.13%(10/62)(P<0.05);观察组排便正常率为91.94%(57/62),高于对照组的80.65%(50/62),组间差异无统计学意义;观察组PAC-QOL总分和各因子评分均低于对照组(P<0.01);观察组SOD水平高于对照组,MDA水平低于对照组(P<0.01);未发现干预中药相关不良反应。结论:四君子汤合四磨汤加减用于出口梗阻型便秘STARR术后患者,可进一步减轻便秘症状和病情程度,提高生活质量,降低术后并发症发生率和复发率,并可改善肛门直肠动力学指标和氧化应激指标,提高临床疗效。

Objective: To observe clinical effect of addition and subtraction therapy of Si Junzitang combined with Simotang to outlet obstructive constipation(OOC)after stapled trans-anal rectal resection(STARR). Method: One hundred and twenty-four patients were randomly divided into control group(62 cases)and observation group(62 cases)by random number table. Patients in control group got Qirong Ruichang oral liquid,20 mL/time,3 times/day. After operation,patients in observation group got addition and subtraction therapy of Si Junzitang combined with Simotang,1 dose/day. And courses of treatment in two groups were4 weeks,and 8 weeks’ follow-up was recorded. Before the operation and at the second and fourth week after treatment,and the eighth week of follow-up,scores of main symptoms of constipation and Longo ODS were graded. Before the operation and at the fourth week after treatment,levels of superoxide dismutase(SOD),malondialdehyde(MDA),constipation patients quality of life self-assessment scale(PAC-QOL),anorectal pressure,anal resting pressure(ARP),maximum anal systolic pressure(MSP),rectal defecation pressure(RSP),FSV,CRS and MTV were recorded. And incidence,recurrence,normal defecation,satisfaction at the fourth week after the operation and safety were evaluated. Result: The clinical rate in observation group was better than that in control group(Z=2.096,P<0.05). At the second,fourth after treatment and eigh weeks’ for follow-up,score of main symptoms of constipation and Longo ODS were both lower than those in control group(P<0.01). Levels of ARP,FSV,FSV,CRS and MDA were lower than those in control group(P<0.01),levels of MSP,RSP and SOD were higher than those in control group(P<0.01). Incidence and recurrence rate in observation group were 20.97%(13/62)and 4.84%(3/62)were all lower than 39.71%(24/62)and 16.13%(10/62)in control group(P<0.05). Normal defecation rate in observation group was 91.94%(57/62)higher than80.65%(50/62)in control group,but there was no statistical significance in two groups. And total score of PACQOL and scores of each factor were all lower than those in control group(P<0.01). Then there was no adverse reaction related to the traditional Chinese medicine. Conclusion: Addition and subtraction therapy of Si Junzitang combined with Simotang can reduce constipation symptoms and the degree of illness,improve the quality of life,reduce the incidence of postoperative complications and recurrence rate,and improve anorectal dynamic indicators and oxidative stress indicators,improve the clinical efficacy.