切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 605 -612. doi: 10.3877/cma.j.issn.2095-3224.2021.06.007

论著

针刺疗法促进结直肠癌患者术后肠道功能恢复的疗效研究
刘雪妍1, 黄剑2, 姚昊1, 杨艳蓉1, 郑入文2,()   
  1. 1. 100078 北京中医药大学第二临床医学院
    2. 100078 北京中医药大学东方医院针灸科
  • 收稿日期:2021-06-22 出版日期:2021-12-25
  • 通信作者: 郑入文
  • 基金资助:
    国家自然科学基金项目(81904287); 北京中医药大学东方医院1166人才培养项目(030903010301); 北京中医药大学青年教师基金项目(2017-JYB-JS-112)

Effect of acupuncture on postoperative intestinal function recovery in patients with colorectal cancer

Xueyan Liu1, Jian Huang2, Hao Yao1, Yanrong Yang1, Ruwen Zheng2,()   

  1. 1. The Second Clinical Medical College of Beijing University of Traditional Chinese Medicine, Beijing 100078, China
    2. Department of Acupuncture, Dongfang Hospital, Beijing University of Traditional Chinese Medicine, Beijing 100078, China
  • Received:2021-06-22 Published:2021-12-25
  • Corresponding author: Ruwen Zheng
引用本文:

刘雪妍, 黄剑, 姚昊, 杨艳蓉, 郑入文. 针刺疗法促进结直肠癌患者术后肠道功能恢复的疗效研究[J/OL]. 中华结直肠疾病电子杂志, 2021, 10(06): 605-612.

Xueyan Liu, Jian Huang, Hao Yao, Yanrong Yang, Ruwen Zheng. Effect of acupuncture on postoperative intestinal function recovery in patients with colorectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(06): 605-612.

目的

观察针刺疗法对结直肠癌患者术后肠道功能恢复的作用。

方法

将68例结直肠癌术后患者随机分为针刺组33例,对照组35例。针刺组在快速康复外科(ERAS)方案基础上,予针刺双侧足三里、上巨虚、合谷、内关穴,术后第1天开始每天治疗1次,共治疗4天;对照组无针刺治疗。比较两组术后肠鸣音恢复、首次排气、排便时间、进食流质时间、下床活动时间、术后住院天数等术后恢复情况,术后疼痛评分,术后并发症与不良事件等指标的变化。

结果

针刺组与对照组在术后肠鸣音恢复时间、首次排气时间、首次排便时间、首次进食流质时间、首次下床活动时间、术后住院天数的差异无统计学意义(均P>0.05);针刺组直肠癌患者的术后首次排气时间(t=2.250,P<0.05)、排便时间(t=3.350,P<0.05)、进食流质饮食时间(t=2.643,P<0.05)明显短于结肠癌患者;两组患者术后第一天VAS 评分差异有统计学意义(t=-2.212,P<0.05);术后第二天(t=-1.826,P>0.05)、术后第三天(t=-1.170,P>0.05)VAS评分差异无统计学意义;术后第四天,差异有统计学意义(t=2.015,P<0.05),两组在术后第一天到第四天的疼痛评分下降值差异有统计学意义(t=-2.813,P<0.01);两组在术后并发症及不良事件的发生情况上差异无统计学意义(均P>0.05)。

结论

在本次研究中,针刺改善术后即时疼痛疗效显著,但在术后肠道功能恢复上未显现出明确的疗效,后续需要进一步大样本的研究来提供更充分的数据支持。

Objective

To observe the effect of acupuncture on the recovery of intestinal function in patients with colorectal cancer after operation.

Methods

Sixty-eight patients with colorectal cancer were randomly divided into acupuncture group (33 cases) and control group (35 cases). The acupuncture group was given acupuncture at Zusanli, Shangjuxu, Hegu and Neiguan on both sides on the basis of eras scheme, once a day from the first day after operation, for 4 days; There was no acupuncture treatment in the control group. The recovery of bowel sounds, first exhaust, defecation time, fluid intake time, ambulation time, postoperative hospital stay,postoperative pain score, postoperative complications and adverse events were compared between the two groups.

Results

There was no significant difference between the acupuncture group and the control group in postoperative bowel sound recovery time, first exhaust time, first defecation time, first fluid intake time, first ambulation time and postoperative hospital stay (P>0.05); The first postoperative exhaust time (t=2.250, P<0.05), defecation time (t=3.350, P<0.05) and liquid diet time (t=2.643, P<0.05) of rectal cancer patients in acupuncture group were significantly shorter than those in colon cancer patients; There was significant difference in VAS score between the two groups on the first day after operation (t=-2.212, P<0.05); There was no significant difference in VAS score on the second day (t=-1.826, P>0.05) and the third day (t=-1.170, P>0.05); On the fourth day after operation, the difference was significant (t=2.015, P<0.05). There was significant difference in the decrease of pain score between the two groups from the first day to the fourth day after operation (t=-2.813, P<0.01); There was no significant difference in the incidence of postoperative complications and adverse events between the two groups (P>0.05).

Conclusion

In this study, acupuncture has a significant effect on improving immediate postoperative pain, but it does not show a clear effect on the recovery of postoperative intestinal function. Further large sample research is needed to provide more sufficient data support.

表1 两组结直肠癌术后患者一般资料比较
表2 两组术后恢复情况比较(
xˉ
±s
表3 针刺对结肠癌与直肠癌术后恢复情况比较(
xˉ
±s
表4 两组术后疼痛评分比较(
xˉ
±s
图1 术后疼痛评分
表5 术后并发症与不良事件[例(%)]
[1]
刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-14.
[2]
Nfonsam VN, Jecius H, Chen D, et al. Increasing incidence of colon cancer in the young: assessing the tumor biology [J]. J Am Coll Surg, 2019, 229(1): 79-90.
[3]
张育葵, 许成. 腹腔镜微创手术治疗结直肠癌的进展[J]. 医学综述, 2021, 27(3): 582-585+591.
[4]
黄安振, 吴浩源, 刘毅. 快速康复外科理念在结直肠癌手术中的临床效果研究[J]. 中外医学研究, 2021, 19(7): 157-159.
[5]
Bagnall NM, Malietzis G, Kennedy RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients [J]. Colorectal Dis, 2014, 16(12): 947-956.
[6]
吴国豪, 谈善军. 胃肠外科病人围手术期全程营养管理中国专家共识(2021版)[J].中国实用外科杂志, 2021, 41(10): 1111-1125.
[7]
陈松耀, 陈创奇. 加速康复外科对胃肠手术后胃肠功能的影响[J]. 消化肿瘤杂志(电子版), 2017, 9(2): 86-91.
[8]
Cao LX, Chen ZQ, Jiang Z, et al. Rapid rehabilitation technique with integrated traditional Chinese and Western medicine promotes postoperative gastrointestinal function recovery [J]. World J Gastroenterol, 2020, 26(23): 3271-3282.
[9]
韩旭, 任逸东, 李庚, 等. 针灸治疗术后胃肠功能紊乱的研究进展[J].中医临床研究, 2018, 10(11): 138-141.
[10]
中华人民共和国国家卫生健康委员会医政医管局, 中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2020年版)[J].中国实用外科杂志, 2020, 40(6): 601-625.
[11]
Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain [J]. J Pain, 2003, 4(7): 407-414.
[12]
Pei KY, Asuzu DT, Davis KA. Laparoscopic colectomy reduces complications and hospital length of stay in colon cancer patients with liver disease and ascites [J]. Surg Endosc, 2018, 32(3): 1286-1292.
[13]
侯雅泉, 屠建锋, 金美林, 等. 针刺治疗术后肠麻痹的选穴规律分析[J].吉林中医药, 2019, 39(1): 118-121.
[14]
郑春丽, 王健, 王世军, 等. 针灸治疗胃肠功能紊乱用穴规律浅析[J]. 针灸临床杂志, 2015, 31(9): 52-55.
[15]
Lu MJ, Yu Z, He Y, et al. Electroacupuncture at ST36 modulates gastric motility via vagovagal and sympathetic reflexes in rats [J]. World J Gastroenterol, 2019, 25(19): 2315-2326.
[16]
罗容, 石文英, 邝涛, 等. 基于r-fMRI技术观察电针曲池、上巨虚对功能性肠病患者大脑的即刻效应[J].上海针灸杂志, 2018, 37(1): 92-96.
[17]
Murakami H, Li S, Foreman R, et al. Ameliorating effects of electroacupuncture on dysmotility, inflammation, and pain mediated via the autonomic mechanism in a rat model of postoperative ileus [J]. J Neurogastroenterol Motil, 2019, 25(2): 286-299.
[18]
吴艳英, 任晓暄, 郭孟玮, 等. 电针足三里、合谷穴对IBS模型大鼠肠道痛敏及动力异常治疗效应的比较研究[J]. 北京中医药大学学报, 2017, 40(6): 514-521.
[19]
黄展明, 李丽君, 张子敬, 等. 宣肺利气法针刺治疗促进胃肠癌术后肠道功能恢复的临床观察[J]. 广州中医药大学学报, 2019, 36(10): 1584-1587.
[20]
邓晶晶, 袁青.针刺促进结直肠癌术后胃肠动力恢复的miRNA相关机制探讨[J]. 广州中医药大学学报, 2018, 35(1): 74-79.
[21]
王一, 李统虎. 电针远近取穴促进直肠癌术后胃肠功能恢复研究[J].针灸临床杂志, 2019, 35(4): 26-28.
[22]
王天渊, 孟尽海, 麦思聪. 不同时点电针处理复合静脉麻醉对结直肠癌根治术患者术后肠功能的影响[J]. 针刺研究, 2018, 43(12): 797-800.
[23]
韩晶, 王贵英, 张难, 等. 肿瘤部位及临床病理特征对不同TNM分期行结直肠癌根治性切除术患者预后的影响研究[J].中国全科医学, 2020, 23(18): 2275-2283.
[24]
缪娴. 不同部位结直肠癌的血清肿瘤指标及中医分型[J]. 中国继续医学教育, 2020, 12(18): 155-157.
[25]
Sanger GJ, Tuladhar BR. The role of endogenous opioids in the control of gastrointestinal motility: predictions from in vitro modelling [J]. Neuro-gastroenterol Motil, 2004, 16(Suppl. 2): 38e45.
[26]
Chen T, Zhang WW, Chu YX, et al. Acupuncture for pain management: molecular mechanisms of action [J]. Am J Chin Med, 2020, 48(4): 793-811.
[27]
麦思聪, 孟尽海, 王文娟, 等. 电针预处理对结直肠癌手术患者全麻用药及恢复质量的影响[J]. 宁夏医科大学学报, 2017, 39(1): 42-45.
[28]
朱伟坚, 王茵萍, 高岑, 等. 电针治疗对结肠癌术后康复的影响[J]. 上海针灸杂志, 2021, 40(4): 416-420.
[1] 罗青杉, 梅海涛, 郝家领, 蔡锦锋, 周润楷, 温玉刚. 连接蛋白43通过调控细胞周期抑制结直肠癌的增殖机制研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 344-349.
[2] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[3] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[4] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[5] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[6] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[7] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[8] 张蔚林, 王哲学, 白峻阁, 黄忠诚, 肖志刚. 利用TCGA数据库构建基于miRNA的结直肠癌列线图预后模型[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 381-388.
[9] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[10] 任佳琪, 刁德昌, 何自衍, 张雪阳, 唐新, 李文娟, 李洪明, 卢新泉, 易小江. 网膜融合线导向的脾曲游离技术在左半结肠癌根治术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 362-367.
[11] 张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
[12] 杭丽, 张耀辉, 孙文恺. 参菝抗瘤液对结直肠腺瘤性息肉术后肠道功能、炎症指标及复发情况的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 413-416.
[13] 邱岭, 朱旭丽, 浦坚, 邢苗苗, 吴佳玲. 糖尿病肾病患者肠道菌群生态特点与胃肠道功能障碍的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 453-458.
[14] 蔡雨玲, 王刚, 江志伟. 针刺应用于术后肠麻痹的研究进展[J/OL]. 中华针灸电子杂志, 2024, 13(04): 164-168.
[15] 刘涛, 谢海波, 张雪竹. 针刺治疗节段性带状疱疹肌麻痹案[J/OL]. 中华针灸电子杂志, 2024, 13(04): 169-170.
阅读次数
全文


摘要