ABSTRACT
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 were 4 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 than 80.65% (50/62) in control group, but there was no statistical significance in two groups. And total score of PAC-QOL 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.
ABSTRACT
Objective To evaluate the clinical efficacy stapledtransanal in the treatment of severe rectal obstructive constipation. Methods Eighty patients with rectal obstructive constipation and hospitalized in Tangshan City Hospital of TCM were enrolled in the study and randomly divided into the treatment group and control group,40 cases in each group. The treatment group was treated with stapledtransanal and the control group was treated with transvaginal repair of longitudinally cut transverse suture operation. The clinical symptoms of two groups were observed and quantified. The operation time,intraoperative blood loss and wound healing time were recorded, Wexner constipation scores were collected at 1, 3, 6 and 12 months after the operation; Postoperative bleeding,pain,infection,anal distention,rectovaginal fistula and other complications were observed. The clinical efficacy of the two groups was compared. Results The total effective rate in the treatment group was 100% (40/ 40),which was significantly higher than that in the control group (90. 00%(36/ 40)) (χ2 = 0. 60,P= 0. 027). There were significant differences in the clinical symptom scores of the two groups at 7 days (treatment group(3. 58±1. 61) points,control group(4. 12±1. 52)points))and 3 months after treatment(treatment group (4. 23±2. 13)points,control group (5. 33±1. 12)points) compared with those before treatment (treatment group (13. 23±3. 08)points,control group (14. 45±3. 01) points ) (P<0. 05);There was a statistically significant difference in clinical symptom quantification score between the treatment group and the control group at 3 months after treatment (P<0. 01). In the treatment group,the operation time ((15. 65±1. 61) min),intraoperative bleeding ((10. 77±5. 23) ml) and wound healing time ((9. 28±1. 41)) d were better than those of the control group ((25. 89±3. 71) min,(43. 31±8. 11) ml,(14. 87±1. 92) d) (t = 15. 632,14. 266,15. 518,P<0. 01). The scores of Wexner in the two groups were lower than those of the same group at 1,3,6 and 12 months after operation. The scores of Wexner in the treatment group were lower than those of the control group at 1,3,6 and 12 months after operation (P<0. 05). In terms of postoperative complications,the pain and anal distention in the treatment group were better than those in the control group ( P < 0. 05) . Conclusion Stapledtransanal is effective for the treatment of outlet obstructive constipation.
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To explore the clinical efficacies of surgical procedures for prolapse and hemorrhoids (PPH) plus anterior rectal wall repair in the treatment of outlet obstructive constipation caused by rectocele with internal prolapse.Postoperative complications and treatment effects of 162 cases with outlet obstructive constipation caused by rectocele with internal prolapse undergoing PPH plus anterior rectal wall repair were observed.The cure rate was 100％ at week 2 post-operation.No rectocele or rectal mucosa prolapse signs were found within 41 months after defecography in 110 cases.The follow-up period was 17-41 months for 114 cases.Four cases recurred with mild clinical symptoms.The combined approach has high efficacies and low recurrence rates in the treatment of outlet obstructive constipation caused by rectocele accompanied with internal prolapse.
ABSTRACT
Objective To investigate the role of blood motilin and anorectal function in the pathogenesis of functional outlet obstructive constipation (OOC), and study if motilin and its receptor agonist are effective to treat OOC. [WTHZ]Methods Patients with OOC were selected according to colonic transit time and transit index. Twenty healthy subjects were also selected as control group. Anorectal manometry was performed, and blood motilin level was measured in patients with OOC and healthy subjects. Correlation between blood motilin level and anorectal function was analyzed. [WTHZ]Results Compared with healthy subjects, OOC patients had higher anal resting pressure, lower defecating pressure difference,larger minimum relaxation volume to elicit anorectal inhibitory reflex, and higher rectal sensation threshold. The plasma level of motilin was positively correlated with anal resting pressure, maximum squeeze pressure and anal defecating pressure, but was negatively correlated with defecating pressure difference between rectum and anal canal. Conclusion OOC patients had anal sphincter dysfunction in relaxtion, discoordination of annorectum during defecation, and Low sensitivity of rectum. OCC patients with the normal level of blood motilin may have more severe outlet obstructive tendency, and motilin and its receptor agonist are not suitable for treating OOC patients.