消痔散联合艾盐包预防吻合器痔上黏膜切除术后尿潴留的回顾性研究

潘建丹; 陈春丽; 胡阿丽; 蔡丹凤; 汪少艳; 郑阿芬; 郑晨果

doi:10.16766/j.cnki.issn.1674-4152.003322

消痔散联合艾盐包预防吻合器痔上黏膜切除术后尿潴留的回顾性研究

doi: 10.16766/j.cnki.issn.1674-4152.003322

温州医科大学附属第二医院育英儿童医院肛肠外科，浙江温州 325000

基金项目:

国家自然科学基金项目 81704076

浙江省温州市科技局项目 Y20220671

详细信息

通讯作者:
潘建丹，E-mail: pjd969696@163.com

中图分类号: R657.18
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- 被引次数: 0
出版历程
- 收稿日期: 2023-09-11
- 网络出版日期: 2024-03-09

Retrospective study of Xiaozhi Powder combined with moxa salt bag to prevent urinary retention after procedure for prolapse and hemorrhoids

Colorectal Surgery Wenzhou Medical University Affiliated Second Hospital, Yuying Children' s Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的回顾性研究中医治疗技术在预防吻合器痔上黏膜切除术(PPH)后尿潴留中的作用。方法选择2020年1月—2022年1月温州医科大学附属第二医院育英儿童医院收治的100例行PPH治疗的混合痔患者，按照治疗方式不同分为对照组(50例)和观察组(50例)。对照组术后给予常规西医治疗，观察组术后给予消痔散联合艾盐包治疗，比较2组治疗后中医证候积分、排尿情况、视觉模拟评分法(VAS)、尿动力学指标变化情况，统计2组治疗总有效率，评价治疗安全性。结果 2组治疗后各项中医证候积分、术后8 h膀胱残余尿量均低于治疗前(P＜0.05)，且观察组治疗后均低于对照组(P＜0.05)；2组治疗后最大尿流量、充盈期逼尿肌压力、最大膀胱容量均高于治疗前(P＜0.05)，且观察组均高于对照组(P＜0.05)；观察组术后首次排尿时间、小腹膨满感消失时间及术后8 h尿潴留发生率均短于或低于对照组(P＜0.05)，首次排尿量多于对照组(P＜0.05)；观察组术后36 h的VAS评分低于对照组(P＜0.05)；观察组治疗的总有效率(92.0%，46/50)高于对照组(72.0%，36/50，χ²=6.775，P=0.009)；2组均未出现明显药物不良反应。结论消痔散联合艾盐包能够有效调节PPH术后患者尿动力学指标，缓解腹胀、腹痛等不适症状，促进术后排尿，降低术后尿潴留的发生风险。
- 吻合器痔上黏膜环切术 /
- 混合痔 /
- 尿潴留 /
- 消痔散 /
- 艾盐包 /
- 尿动力学
Abstract: Objective To retrospectively investigate the role of traditional Chinese medicine (TCM) treatment technique in preventing urinary retention after procedure for prolapse and hemorrhoids (PPH) surgery. Methods A total of 100 patients with mixed hemorrhoids treated with PPH from the Second Affiliated Hospital of Wenzhou Medical University, Yuying Children' s Hospital from January 2020 to January 2022, were divided into two groups according to different treatment methods. The control group was treated with routine western medicine after surgery, while the observation group was treated with Xiaozhi Powder combined with moxa salt bag after surgery, compare the traditional Chinese medicine syndrome scores, urinary status, visual analogue scale (VAS) and changes in urodynamic indicators between the two groups after treatment, calculate the overall efficacy rate of two treatment groups and evaluate the safety of treatment. Results The scores of various traditional Chinese medicine syndromes in both groups showed that the residual urine volume in the bladder at 8 hours after surgery was lower than before treatment (P < 0.05), and the observation group was lower than the control group after treatment (P < 0.05); After treatment, the maximum urine flow, detrusor pressure during filling, and maximum bladder volume in both groups were higher than before treatment (P < 0.05), and the observation group was higher than the control group (P < 0.05); The time of first urination, the time of disappearance of abdominal sensation and the incidence of urinary retention at 8 hours after surgery in the observation group were shorter or lower than those in the control group (P < 0.05), and the amount of first urination was more than that in the control group (P < 0.05); The VAS scores of the observation group at 36 hours after surgery were lower than those of the control group (P < 0.05); The overall treatment efficacy rate in the observation group (92.0%, 46/50) was higher than that in the control group (72.0%, 36/50, χ²=6.775, P=0.009); No significant adverse drug reactions were observed in either group. Conclusion Xiaozhi Powder in combination with moxa salt bag can effectively adjust the urodynamic indicators of patients after PPH, alleviate abdominal distension, abdominal pain and other uncomfortable symptoms, promote postoperative urination, reduce the risk of postoperative urinary retention, and is worthy of clinical promotion.
- Procedure for prolapse and hemorrhoids /
- Mixed hemorrhoids /
- Urinary retention /
- Xiaozhi Powder /
- Moxa salt bag /
- Urodynamics

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表 1 2组PPH术后患者中医证候积分比较(x±s，分)

Table 1. Comparison of Traditional Chinese Medicine Syndrome Scores between Two Groups of Postoperative PPH Patients(x±s, points)

组别	例数	小便滴沥不畅		腹胀		腹痛		每日小便量少
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	50	2.33±0.39	0.87±0.15^a	2.29±0.37	0.83±0.13^a	2.18±0.41	0.78±0.09^a	2.11±0.39	0.73±0.10^a
对照组	50	2.31±0.40	1.28±0.31^a	2.25±0.43	1.25±0.28^a	2.16±0.39	1.22±0.25^a	2.08±0.37	1.18±0.23^a
t值		0.253	8.418	0.499	9.620	0.250	11.709	0.395	12.687
P值		0.801	＜0.001	0.619	＜0.001	0.803	＜0.001	0.694	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 2 2组PPH术后患者基本临床指标比较

Table 2. Comparison of basic clinical indicators between two groups of PPH postoperative patients

组别	例数	术后首次排尿时间(x±s，h)	首次排尿量(x±s，mL)	小腹膨满感消失时间(x±s，h)	术后8 h尿潴留发生[例(%)]
对照组	50	4.95±0.61	189.92±27.71	4.31±0.45	11(22.0)
观察组	50	2.45±0.35	243.55±30.08	2.98±0.50	2(4.0)
统计量		25.136^a	9.272^a	13.987^a	7.162^b
P值		＜0.001	＜0.001	＜0.001	0.007
注: ^a为t值，^b为χ²值。

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表 3 2组PPH术后患者VAS评分比较(x±s，分)

Table 3. Comparison of VAS scores between two groups of PPH postoperative patients(x±s, points)

组别	例数	术后6 h	术后36 h
对照组	50	6.52±0.55	2.05±0.31^a
观察组	50	6.55±0.57	0.82±0.19^a
t值		0.335	21.149
P值		0.739	＜0.001
注：与同组术后6 h比较，^aP＜0.001。

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表 4 2组PPH术后患者尿动力学指标比较(x±s)

Table 4. Comparison of urodynamic indicators between two groups of PPH postoperative patients(x±s)

组别	例数	最大尿流量(mL/s)		充盈期逼尿肌压力(mmH₂O)		最大膀胱容量(mL)		术后8 h膀胱残余尿量(mL)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	50	6.52±1.30	13.67±1.56^a	9.95±1.25	28.91±1.58^a	230.81±26.45	455.65±30.71^a	251.62±35.76	68.83±8.41^a
对照组	50	6.54±1.25	8.99±1.33^a	9.93±1.22	17.79±1.38^a	227.57±25.07	335.62±28.81^a	247.71±34.41	125.56±19.91^a
t值		0.078	16.143	0.081	37.482	0.629	20.156	0.557	18.560
P值		0.938	＜0.001	0.936	＜0.001	0.531	＜0.001	0.579	＜0.001
注：与同组治疗前比较，^aP＜0.05；1 mmH₂O=0.009 8 kPa。

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表 5 2组PPH术后患者临床疗效比较[例(%)]

Table 5. Comparison of clinical efficacy between two groups of PPH postoperative patients[cases (%)]

组别	例数	临床控制	显效	有效	无效	总有效
对照组	50	12(24.0)	11(22.0)	13(26.0)	14(28.0)	36(72.0)
观察组	50	17(34.0)	17(34.0)	12(24.0)	4(8.0)	46(92.0)
注: 2组疗效比较，Z=-2.317，P=0.021。2组总有效率比较，χ²=6.775，P=0.009。

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参考文献(20)

[1]	桂阳, 刘丹峰. 吻合器痔上黏膜环切术与传统外剥内扎术治疗痔的疗效和安全性对比[J]. 皖南医学院学报, 2019, 38(5): 451-454. doi: 10.3969/j.issn.1002-0217.2019.05.012 GUI Y, LIU D F. Comparing the efficacy and safety of procedure for prolapse and hemorrhoids and conventional Milligan-Morgan hemorrhoidectomy[J]. Acta Academiae Medicinae Wannan, 2019, 38(5): 451-454. doi: 10.3969/j.issn.1002-0217.2019.05.012
[2]	DE ROBLES M S, YOUNG C J. Surgical technique is the main predictor of recurrence in the management of haemorrhoids[J]. ANZ J Surg, 2021, 91(9): 1854-1858. doi: 10.1111/ans.16738
[3]	章志霞, 李静, 潘兰兰, 等. 循经中药熨烫结合自我按摩预防混合痔术后尿潴留的临床观察[J]. 中国民间疗法, 2019, 27(7): 20-22. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMJL201907012.htm ZHANG Z X, LI J, PAN L L, et al. Clinical Observation on the Prevention of Urinary Retention after Operation of Mixed Hemorrhoids by Traditional Chinese Medicine Pressing along Meridians and Self massage[J]. China's Naturopathy, 2019, 27(7): 20-22. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMJL201907012.htm
[4]	周喜, 熊燕萍, 谭伟能. 中药热罨包外敷神阙穴联合腹部按摩对预防混合痔PPH术后尿潴留的干预价值[J]. 内蒙古中医药, 2021, 40(1): 133-134. https://www.cnki.com.cn/Article/CJFDTOTAL-NZYY202101080.htm ZHOU X, XIONG Y P, TAN W N. Interventional value of external application of traditional Chinese medicine hot pouches on Shenque point combined with abdominal massage in preventing urinary retention after PPH for mixed hemorrhoids[J]. Nei Mongol Journal of Traditional Chinese Medicine, 2021, 40(1): 133-134. https://www.cnki.com.cn/Article/CJFDTOTAL-NZYY202101080.htm
[5]	段文英. 腹腔镜胆囊切除术后女性患者发生尿潴留的危险因素分析[J]. 中国医学创新, 2020, 17(32): 151-155. doi: 10.3969/j.issn.1674-4985.2020.32.039 DUAN W Y. Risk Factors of Urinary Retention in Female Patients after Laparoscopic Cholecystectomy[J]. Chinese Medical Innovation, 2020, 17(32): 151-155. doi: 10.3969/j.issn.1674-4985.2020.32.039
[6]	陈婕妤, 盛莉莉, 陈俭, 等. 中药热熨联合中药灌肠治疗慢性盆腔炎(气滞血瘀型)的临床价值及对患者情绪的影响[J]. 山西医药杂志, 2023, 52(4): 243-246. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202304001.htm CHEN J Y, SHENG L L, CHEN J, et al. Evaluation of the clinical efficacy of Chinese herbal hot pressing and Chinese herbal enema for the treatment of chronic inflammatory diseases of the pelvis(Types of Qi stagnation and congestion)and its effect on patients'mood[J]. Shanxi Medical Journal, 2023, 52(4): 243-246. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202304001.htm
[7]	中国中西医结合学会大肠肛门病专业委员会. 中国痔病诊疗指南(2020)[J]. 结直肠肛门外科, 2020, 26(5): 519-533. https://www.cnki.com.cn/Article/CJFDTOTAL-DCGM202204020.htm The Professional Committee of Colorectal and Anorectal Diseases of the Chinese Society of Integrated Traditional and Western Medicine. Chinese Guidelines for the Diagnosis and Treatment of Hemorrhoids (2020)[J]. Colorectal and anal surgery, 2020, 26(5): 519-533. https://www.cnki.com.cn/Article/CJFDTOTAL-DCGM202204020.htm
[8]	郑筱萸. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 90-105. ZHENG X Y. Guiding Principles for Clinical Research of New Traditional Chinese Medicine (Trial)[M]. Beijing: China Medical Science and Technology Press, 2002: 90-105.
[9]	孙壮, 杨宇慎, 宫爱民. 肠镜下长城式切开环切法治疗吻合器痔上黏膜环切术术后重度吻合口狭窄的临床疗效[J]. 实用医学杂志, 2020, 36(4): 475-478. doi: 10.3969/j.issn.1006-5725.2020.04.011 SUN Z, YANG Y S, GONG A M. Clinical efficacy analysis of colonoscopic assisted Great Wall type incision and ring-cut method for severe anastomotic stenosis after PPH[J]. The Journal of Practical Medicine, 2020, 36(4): 475-478. doi: 10.3969/j.issn.1006-5725.2020.04.011
[10]	鲁振锋, 张秀峰, 沈忠, 等. 外剥内扎术联合荷包缝合术治疗Ⅲ、Ⅳ度混合痔的临床效果分析[J]. 中华全科医学, 2019, 17(4): 574-576, 604. doi: 10.16766/j.cnki.issn.1674-4152.000738 LU Z F, ZHANG X F, SHEN Z, et al. Clinical effects of Milligan-Morgan hemorrhoidectomy combined with purse-string suture for grades Ⅲ-Ⅳ mixed hemorrhoid[J]. Chinese Journal of General Practice, 2019, 17(4): 574-576, 604. doi: 10.16766/j.cnki.issn.1674-4152.000738
[11]	邵继华, 黄英, 陈芳. 吻合器痔上黏膜环切术治疗环状脱垂痔的疗效及术后发生尿潴留的影响因素[J]. 实用医学杂志, 2022, 38(23): 2986-2990. doi: 10.3969/j.issn.1006-5725.2022.23.017 SHAO J H, HUANG Y, CHEN F. Efficacy of PPH in the treatment of circumferential prolapsed hemorrhoids and the influencing factors of postoperative urinary retention[J]. The Journal of Practical Medicine, 2022, 38(23): 2986-2990. doi: 10.3969/j.issn.1006-5725.2022.23.017
[12]	刘泽洋, 白国民, 李彤, 等. 揿针联合全息刮痧防治混合痔吻合器痔上黏膜环切术后尿潴留临床观察[J]. 河北中医, 2023, 45(4): 613-616. https://www.cnki.com.cn/Article/CJFDTOTAL-HBZY202304020.htm LIU Z Y, BAI G M, LI T, et al. Curative effect of press-needle combined with holographic scraping on postoperative urinary retention in mixed hemorrhoid patients underwent procedure for prolapse and hemorrhoids[J]. Hebei Journal of Traditional Chinese Medicine, 2023, 45(4): 613-616. https://www.cnki.com.cn/Article/CJFDTOTAL-HBZY202304020.htm
[13]	刘聪聪, 刘剑, 于航, 等. 肛肠病术后尿潴留的防治研究进展[J]. 中国肛肠病杂志, 2020, 40(12): 76-78. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202012037.htm LIU C C, LIU J, YU H, et al. Research progression on preventing&treating uroschesis following surgery for coloproctological diseases[J]. Chinese Journal of Coloproctology, 2020, 40(12): 76-78. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202012037.htm
[14]	李荣华, 蔡靓羽, 蒋晨浩, 等. 吻合器痔上黏膜环切术前揿针埋针对患者术后尿潴留发生的影响[J]. 山东医药, 2020, 60(20): 70-72. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202020019.htm LI R H, CAI J Y, JIANG C H, et al. The effect of pressing needle embedding before stapler hemorrhoidectomy on postoperative urinary retention[J]. Shandong Medical Journal, 2020, 60(20): 70-72. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202020019.htm
[15]	HIRAKI M, TANAKA T, SADASHIMA E, et al. The risk factors of acute urinary retention after laparoscopic colorectal cancer surgery in elderly patients receiving epidural analgesia[J]. Int J Colorectal Dis, 2021, 36(9): 1853-1859.
[16]	PATEL P M, SERIGERT S E, NELSON M, et al. Disparities in benign prostatic hyperplasia progression: predictors of presentation to the emergency department in urinary retention[J]. J Urol, 2020, 204(2): 332-335.
[17]	FRENDL D M, CHEN Y W, CHANG D C, et al. A claims based assessment of reoperation and acute urinary retention after ambulatory transurethral surgery for benign prostatic hyperplasia[J]. J Urol, 2021, 205(2): 532-538.
[18]	陈文鹏, 卢健棋, 庞延, 等. 仙鹤草化学成分、药理作用及临床应用研究进展[J]. 辽宁中医药大学学报, 2022, 24(6): 118-122. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202206026.htm CHEN W P, LU J Q, PANG Y, et al. Research Progress on Chemical Constituents Pharmacological Action and Clinical Application of Xianhecao (Agrimoniae Herba)[J]. Journal of Liaoning University of Traditional Chinese Medicine, 2022, 24(6): 118-122. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202206026.htm
[19]	刘琳, 程伟. 槐花化学成分及现代药理研究新进展[J]. 中医药信息, 2019, 36(4): 125-128. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN201904035.htm LIU L, CHENG W. Research Progress in Chemical Constituents and Modern Pharmacology of Sophora japonica[J]. Information on Traditional Chinese Medicine, 2019, 36(4): 125-128. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN201904035.htm
[20]	董庆海, 吴福林, 王涵, 等. 延胡索药学研究进展[J]. 中国野生植物资源, 2019, 38(1): 48-53, 79. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYSZ201901013.htm DONG Q H, WU F L, WANG H, et al. Advances in Pharmaceutical Research of Corydalis Yanhusuo[J]. Chinese Wild Plant Resources, 2019, 38(1): 48-53, 79. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYSZ201901013.htm