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| Effect of traditional Chinese medicine anal dilation and hormone injection combined with oral administration of traditional Chinese medicine in the treatment of puborectal muscle syndrome |
| JIA Fei1 ZHI Jianwen1 YANG Yi1 CHEN Xinyu2 WANG Song2 HONG Zifu1 |
1.Department of Anorectal, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China;
2.Department of Anorectal, Sanming Integrated Traditional Chinese and Western Medicine Hospital, Fujian Province, Sanming 365001, China
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Abstract Objective To investigate clinical effect of traditional Chinese medicine anal dilation and hormone injection combined with oral administration of traditional Chinese medicine in the treatment of puborectal muscle syndrome. Methods Sixty patients with puborectal muscle syndrome admitted to Department of Anorectal, Guanganmen Hospital, China Academy of Chinese Medical Sciences from March 2020 to June 2022 were selected and they were divided into observation group and control group according to the random number table method, with 30 patients in each group. Minimally invasive surgery was adopted in both groups. The observation group was treated with traditional Chinese medicine anal dilation and hormone injection, while control group was treated with partial resection of the puborectal muscle. Both groups were given Yangxue Runchang Granules orally for three months after surgery. Efficacy, intraoperative indicators, hospitalization day, Wexner constipation quantification score main symptom score, visual analogue scale score, defecography anorectal angulation degree, and postoperative complications of two groups were compared. Results There was no statistically significant difference in overall efficacy between two groups (P＞0.05). The intraoperative bleeding in observation group was less than that in control group, and the surgical duration and hospitalization day in observation group were shorter than those in control group, the differences were statistically significant (P＜0.05). Overall analysis found that there were statistically significant differences in the intergroup comparison, time point comparison, interaction differences of incomplete emptying sensation score and each defecation time score (P＜0.05). Further pairwise comparison, intra group comparison: the scores of incomplete emptying sensation and defecation time in both groups during postoperative and follow-up were lower than before surgery, the differences were statistically significant (P＜0.05). Comparison between groups: the scores of incomplete emptying sensation and defecation time in observation group during follow-up were lower than those in control group, the differences were statistically significant (P＜0.05). Overall analysis found that there were statistically significant differences in the intergroup comparison, time point comparison, interaction differences of visual analogue scale score (P＜0.05). Further pairwise comparison, intra group comparison: visual analogue scale scores of two groups on the third and seventh day after surgery were lower than those on the first day after surgery, visual analogue scale scores of two groups on the seventh day after surgery were lower than those on the third day after surgery, the differences were statistically significant (P＜0.05). Comparison between groups: visual analogue scale scores of observation group on the third and seventh day after surgery were lower than those of control group, the differences were statistically significant (P＜0.05). Before surgery, there were no statistically significant differences in anorectal angulation degree between two groups during rest and exertion (P＞0.05). During follow-up, there were no statistically significant differences in anorectal angulation degree between two groups during rest and exertion (P＞0.05). During follow-up, anorectal angulation degree in both groups during exertion was greater than before surgery, the difference was statistically significant (P＜0.05). There was no statistically significant difference in anorectal angulation degree between two groups at rest before surgery and during follow-up (P＞0.05). Both groups did not experience complications such as anal incontinence or anal stenosis. Conclusion Traditional Chinese medicine anal dilation and hormone injection combined with oral administration of traditional Chinese medicine can improve constipation symptoms caused by puborectal muscle syndrome, increase the anorectal angulation degree. Compared to partial resection of the puborectal muscle, it has less intraoperative bleeding, shorter surgical duration and hospitalization day, and less postoperative pain.
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