王慧娟，馮曉蘭，楊　軍，王常生

(1.張家口市第五醫(yī)院，河北 張家口 075000；2.張家口市傳染病醫(yī)院，河北 張家口 075000)

?

中藥灌洗聯(lián)合經(jīng)陰道瘺皮瓣修補(bǔ)術(shù)對(duì)直腸陰道瘺患者生活質(zhì)量的影響

王慧娟1，馮曉蘭2，楊軍1，王常生1

(1.張家口市第五醫(yī)院，河北 張家口 075000；2.張家口市傳染病醫(yī)院，河北 張家口 075000)

摘要：目的觀察中藥灌洗聯(lián)合經(jīng)陰道瘺皮瓣修補(bǔ)術(shù)對(duì)直腸陰道瘺(RVF)患者生活質(zhì)量的影響。方法取我院收治的直腸陰道瘺患者50例，依據(jù)治療方案不同分為治療組與對(duì)照組，各25例，2組均采用經(jīng)陰道瘺皮瓣修補(bǔ)術(shù)治療，術(shù)前常規(guī)陰道、直腸準(zhǔn)備;治療組于術(shù)前5 d給予本院自擬中藥灌洗方(苦參、蛇床子、白鮮皮等)，1次/d；2組術(shù)后均給予常規(guī)處置，對(duì)比2組1次手術(shù)修補(bǔ)成功率，并采用諾丁漢健康調(diào)查問(wèn)卷 (NHP )評(píng)價(jià)患者術(shù)后生活質(zhì)量改善情況。結(jié)果術(shù)后NHP評(píng)分治療組患者生活質(zhì)量改善優(yōu)于對(duì)照組(P<0.05)。結(jié)論中藥灌洗聯(lián)合經(jīng)陰道瘺皮瓣修補(bǔ)術(shù)可有效提高RVF患者術(shù)后生活質(zhì)量。

關(guān)鍵詞：中藥；陰道灌洗；直腸陰道瘺；生活質(zhì)量

目前,手術(shù)仍是治療直腸陰道瘺(RVF)最為有效的手段，但因病變部位特殊，患者術(shù)后多易發(fā)生感染、紅腫等并發(fā)癥，對(duì)患者術(shù)后康復(fù)影響極大[1-2]。本研究觀察中藥灌洗聯(lián)合經(jīng)陰道瘺皮瓣修補(bǔ)術(shù)對(duì)RVF患者術(shù)后康復(fù)及生活質(zhì)量的影響?，F(xiàn)報(bào)道如下。

1資料與方法

1.1一般資料選取我院收治的直腸陰道瘺患者50例，均符合《婦產(chǎn)科學(xué)》[3]中相關(guān)描述,亞甲藍(lán)注射試驗(yàn)陽(yáng)性，B超檢查顯示瘺管區(qū)呈低回聲區(qū)，X線鋇劑灌腸造影檢查可見(jiàn)鋇劑在瘺管內(nèi)顯影；患者臨床表現(xiàn)為主訴陰道有少量糞便溢出或排氣，可合并陰部疼痛或低熱；肛門(mén)陰道指診可觸及明顯竇道。年齡20～55歲，平均(30.2±2.3)歲；產(chǎn)傷32例，婦科手術(shù)引起8例，直腸癌術(shù)后5例，肛周感染5例；中位瘺29例，低位瘺21例。依據(jù)治療方案不同分為治療組及對(duì)照組，各25例。

1.2治療方法2組手術(shù)均避開(kāi)月經(jīng)期，并確認(rèn)陰道及腸道無(wú)感染，術(shù)前3 d口服甲硝唑片及慶大霉素，常規(guī)腸道及陰道準(zhǔn)備，進(jìn)無(wú)渣飲食，每晚用稀釋強(qiáng)力碘紗布陰道擦洗，術(shù)前晚及術(shù)晨清潔灌腸后用甲硝唑保留灌腸。治療組于術(shù)前5 d即給予自制中藥沖洗方進(jìn)行陰道灌洗，藥物組成：苦參、蛇床子、白鮮皮、土茯芩、黃柏各15 g，花椒6 g，每劑加500 mL水，煎30 min成300 mL，1次/d。手術(shù)方法：2組均在腰麻下完成手術(shù)，麻醉后取膀胱截石位，常規(guī)直腸、陰道、會(huì)陰消毒，鋪巾，牽開(kāi)陰道探查瘺口大小后，在瘺口周?chē)⑷?∶20 000腎上腺素鹽水，于瘺口0.3～0.5 cm處將正常陰道黏膜切開(kāi)，在黏膜下用組織鉗做潛狀分離陰道直腸間隙3～4 cm，然后將瘺口邊緣及疤痕組織完全切除，徹底止血后，將直腸創(chuàng)口做定點(diǎn)、橫行、間斷一層式外翻縫合;然后以同法縫合陰道黏膜。2組術(shù)后常規(guī)處置，治療組在常規(guī)處置基礎(chǔ)上聯(lián)合自制中藥沖洗方進(jìn)行陰道灌洗，1次/d。

2結(jié)果

2.12組術(shù)后生活質(zhì)量評(píng)價(jià)見(jiàn)表1。

表1　2組術(shù)后生活質(zhì)量評(píng)價(jià)

注：與術(shù)前比較，#P<0.05；與對(duì)照組比較，△P<0.05

2.22組1次修補(bǔ)成功率比較治療組成功22例(88.0%)，對(duì)照組成功21例(84.0%)，2組比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。

3小結(jié)

本研究采用經(jīng)陰道瘺皮瓣修補(bǔ)術(shù)對(duì)直腸陰道瘺患者進(jìn)行治療，術(shù)后1次性修補(bǔ)成功率均達(dá)80%以上，證實(shí)經(jīng)陰道瘺皮瓣修補(bǔ)術(shù)治療直腸陰道瘺療效確切[4-6]。自制中藥灌洗方可有效促進(jìn)患者康復(fù)，提高患者生活質(zhì)量。中醫(yī)學(xué)認(rèn)為，濁陰出下竅；傷于濕者，下先受之；而腎開(kāi)竅于前后二陰，而司二便；足厥陰肝經(jīng)繞陰器；脾主濕，濕性趨下，本病治療當(dāng)從肝脾腎入手。本研究中外洗煎劑，以蛇床子、苦參、黃柏、土茯苓、白鮮皮燥濕止癢，且白鮮皮又能祛風(fēng)解毒，蛇床子性溫助陽(yáng)，花椒性熱溫通止痛，又能防止苦參、黃柏、土茯苓等苦寒太過(guò)，合方燥濕祛穢，寒溫并用，先熏后洗，可直達(dá)病灶，利于促進(jìn)患者康復(fù)[7-8]。

參考文獻(xiàn)：

[1]劉佰純,宋瑩,白東梅.結(jié)腸鏡下鈦夾治療直腸陰道瘺4例臨床分析[J].中國(guó)婦產(chǎn)科臨床雜志,2014,16(2):158-159.

[2]汝琨,趙曉霞.陰道直腸瘺圍手術(shù)期的護(hù)理體會(huì)[J].齊齊哈爾醫(yī)學(xué)院學(xué)報(bào),2013,34(11):1696-1697.

[3]謝幸,茍文麗.婦產(chǎn)科學(xué)[M].8版.北京:人民衛(wèi)生出版社,2013:327-328.

[4]黃華麗,孟祥鴻,黃曉東.PPH及其改良術(shù)治療混合痔合并排便障礙型便秘療效觀察[J].長(zhǎng)春中醫(yī)藥大學(xué)學(xué)報(bào),2012,28(3):495-496.

[5]唐華,王真權(quán).PPH術(shù)配合穴位注射治療直腸前突型便秘30例[J].中醫(yī)外治雜志,2013,22(3):6-7.

[6]徐波,張成貴,周青華.三種沖洗液用于產(chǎn)婦會(huì)陰沖洗效果的研究[J].護(hù)理學(xué)雜志,2012,27(8):27-28.

[7]高小山,劉棟才,段金元,等.7 例直腸陰道瘺患者圍手術(shù)期的護(hù)理[J].當(dāng)代護(hù)士(學(xué)術(shù)版),2014(2):47-48.

[8]梁明娟,馬雪霞,林瑞燕.1例直腸陰道瘺病人會(huì)陰部皮膚護(hù)理體會(huì)[J].嶺南現(xiàn)代臨床外科,2010,10(4):312-313.

Chinese medicine lavage in combined with transvaginal fistula flap repair on the living qualities in patients with rectovaginal fistula

WANG Huijuan1,FENG Xiaolan2,YANG Jun1,WANG Changsheng1

(1.The Fifth Hospital of Zhangjiakou City in Hebei Province,Zhangjiakou 075000,Hebei Province,China;2.The Infectious Hospital of Zhangjiakou City,Zhangjiakou 075000,Hebei Province,China)

Abstract：ObjectiveTo observe the effect traditional Chinese medicine lavage in combined with transvaginal fistula flap repair on the living qualities in patients with rectovaginal fistula (RVF).MethodsA total of 50 patients with RVF who were admitted in our hospital were included in the study and divided into the traditional Chinese medicine group and the control group according to different treatment protocols with 25 cases in each group.The patients in the two groups were given the transvaginal fistula flap repair.Conventional vaginal and bowel preparations before operation were performed.The patients in the observation group were given self-made traditional Chinese medicine lavage (sophora flavescens,fructus cnidii,cotex dictamni,rhizome smilacis glabrae,phellodendron amurense,each 15g;capsicum annuum,6g,decoction),one vaginal lavage each day.The patients in the two groups were given conventional treatments after operation.The therapeutic effect in the two groups was compared.NHP was used to evaluate the improvement of living qualities after operation.ResultsNHP scores showed that the improvement of living qualities in the traditional Chinese medicine group was significantly superior to that in the control group (P<0.05).ConclusionTraditional Chinese medicine lavage in combined with transvaginal fistula flap repair can effectively enhance the postoperative living qualities in patients with RVF.

Keywords：traditional Chinese medicine;lavage;RVF;living quality

(收稿日期:2015-11-20)

文章編號(hào)：2095-6258(2016)02-0363-02

中圖分類(lèi)號(hào)：R269

文獻(xiàn)標(biāo)志碼：A

作者簡(jiǎn)介：王慧娟(1981-)，女，大學(xué)本科，主治醫(yī)師，主要從事婦產(chǎn)科疾病研究。

基金項(xiàng)目：河北省張家口市科技計(jì)劃外科研項(xiàng)目(2016033)。

DOI:10.13463/j.cnki.cczyy.2016.02.051