摘要
目的观察铜离子电化学疗法治疗老年非环形痔的安全性及有效性。方法纳入2018年9月至2019年12月中国中医科学院西苑医院肛肠外科收治的144例老年非环形痔患者为研究对象,按照随机数字表法随机分为治疗组(n=48,采用铜离子电化学疗法)、对照1组(n=48,采用弹力线套扎术)和对照2组(n=48,采用外剥内扎术)。比较三组患者的临床疗效、术后疼痛、镇痛药使用种类及频率、术后并发症发生情况(术后24 h尿潴留、肛门狭窄、切口延迟愈合和肛门水肿)和肛门失禁Wexner评分等指标。结果术后2周和3周,治疗组的效果均优于对照2组(均P<0.05);术后4周,治疗组的效果均优于对照1组和对照2组(均P<0.05)。治疗组术后第一次排便时的疼痛评分较对照2组低,对照1组的疼痛评分较对照2组低(均P<0.05)。术后第3天,治疗组和对照1组术后镇痛药种类均较对照2组少(均P<0.05);术后第7天,治疗组术后镇痛药种类及使用频率均较对照2组少,对照1组术后镇痛药使用频率较对照2组少(均P<0.05);术后第14天,治疗组术后镇痛药种类较对照1组少,治疗组和对照1组术后镇痛药种类及使用频率均较对照2组少(均P<0.05)。治疗组的切口延迟愈合发生率低于对照2组(P<0.017)。术后第3天、第7天,治疗组肛门水肿发生情况均优于对照2组(均P<0.05);术后第14天,治疗组肛门水肿发生情况优于对照1组和对照2组(均P<0.05)。术后4周及术后8周,治疗组肛门失禁Wexner评分均较对照1组和对照2组低,对照1组的肛门失禁Wexner评分均较对照2组低(均P<0.05)。结论应用铜离子电化学疗法治疗老年非环形痔患者,可以有效控制术后疼痛,减少术后并发症,加速康复,而且手术操作简单易行,该术式值得进一步进行临床推广和应用。
Objectives To investigate the safety and efficacy of electro-chemical therapy by cupric ion for non-circumferential hemorrhoids in older patients.Methods One hundred and forty-four older patients with non-circumferential hemorrhoids treated at the Department of Anorectal Surgery,Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine,between Sep⁃tember 2018 and December 2019 were recruited.They were randomly assigned to treatment group(n=48,received electro-chemi⁃cal therapy by cupric ion),control-1 group(n=48,received rubber band ligation),and control-2 group(n=48,received Milligan-Morgan hemorrhoidectomy).Clinical efficacy,postoperative pain,type and frequency of analgesics,postoperative complications(uri⁃nary retention within 24 hours after surgery,anal stricture,delayed wound healing,and anal edema),and Wexner incontinence score were compared among the three groups.Results The efficacy at 2 and 3 weeks after surgery was significantly better in the treatment group than in the control-2 group(P<0.05),and the efficacy at 4 weeks after surgery was significantly better in the treatment group than in the control-1 and control-2 groups(P<0.05).The score of pain at the first defecation after surgery was significantly lower in the treatment group than in the control-2 group,and it was significantly lower in the control-1 group than in the control-2 group(P<0.05).The types of analgesics at 3 days after surgery were significantly fewer in the treatment and control-1 groups than in the control-2 group(P<0.05).The types of analgesics at 7 days after surgery were significantly fewer,and the frequency was significantly less in the treatment group than in the control-2 group(P<0.05).The frequency of analge⁃sics at 7 days after surgery was significantly less in the control-1 group than in the control-2 group(P<0.05).The types of anal⁃gesics at 14 days after surgery were significantly fewer in the treatment group than in the control-1 group.Types of analgesic at 14 days after surgery were significantly fewer and frequency significantly less in the treatment group and control-1 group than in the control-2 group(P<0.05).The incidence of delayed wound healing was significantly lower in the treatment group than in the control-2 group(P<0.017).Anal edema at 3 and 7 days after surgery was significantly less in the treatment group than in the control-2 group(P<0.05),and anal edema at 14 days after surgery was significantly less in the treatment group than in the con⁃trol-1 and control-2 groups.Wexner incontinence scores at 4 and 8 weeks after surgery were significantly lower in the treatment group than in the control-1 and control-2 groups.They were significantly lower in the control-1 group than in the control-2 group(P<0.05).Conclusion In older patients with non-circumferential hemorrhoids,efficacy of electro-chemical therapy by cu⁃pric ion can effectively control postoperative pain,reduce postoperative complications,and facilitate recovery.It is a simple proce⁃dure and has the potential for broader use in clinical practice.
作者
谢振年
安晓静
李东冰
张艳娜
贾小强
赵卫兵
权隆芳
曹威巍
Xie Zhennian;An Xiaojing;Li Dongbing;Zhang Yanna;Jia Xiaoqiang;Zhao Weibing;Quan Longfang;Cao Weiwei(Department of Anorectal Surgery,Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine,Beijing 100091,China;Department of Pathology,Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine,Beijing 100091,China;Department of Medical Records,Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine,Beijing 100091,China)
出处
《结直肠肛门外科》
2020年第4期469-474,478,共7页
Journal of Colorectal & Anal Surgery
基金
中国中医科学院西苑医院苗圃课题(2019XYMP-38)
北京肛肠学会科研专项(2018ABCP-002)。
关键词
非环形痔
老年患者
铜离子电化学疗法
临床效果
non-circumferential hemorrhoids
older patients
electro-chemical therapy by cupric ion
clinical efficacy
作者简介
通信作者:安晓静,E-mail:ajlb@163.com。
