摘要
目的观察低位肛瘘术后应用黄柏五倍子汤熏洗治疗的疗效及对肛门括约肌功能和炎症因子的影响。方法选择2019年1月至2020年12月在该院行肛瘘切除术的低位肛瘘患者86例为研究对象,根据随机数字表法将患者分为观察组和对照组,每组43例。对照组术后予以常规治疗,观察组术后在对照组的基础上使用黄柏五倍子汤熏洗。比较两组术后治疗的总有效率、持续疼痛时间、肿胀消失时间、创面愈合时间、排便恢复时间,以及两组治疗前后创面渗液评分、肉芽形态评分、创面愈合率、直肠静息压(RRP)、肛管静息压(ARP)、肛管最长收缩时间(ALCT)、肛管最大收缩压(AMCP)、可溶性髓样细胞触发受体1(sTREM-1)、趋化因子配体5(CCL-5)和可溶性细胞间黏附分子1(sICAM-1)水平的变化。结果观察组的总有效率为95.35%,对照组的总有效率为74.42%,观察组的总有效率明显优于对照组(χ2=5.800,P<0.01)。观察组的持续疼痛时间、肿胀消失时间、创面愈合时间和排便恢复时间明显少于对照组(P<0.01)。两组术后3 d创面渗液评分、肉芽形态评分、创面愈合率、RRP、ARP、ALCT、AMCP以及sTREM-1、CCL-5、sICAM-1水平比较,差异均无统计学意义(P>0.05)。术后10 d两组创面渗液评分、肉芽形态评分、RRP、ARP及sTREM-1、CCL-5、sICAM-1水平均较术后3 d明显降低(P<0.01),且观察组低于对照组(P<0.01);术后10 d两组创面愈合率、ALCT和AMCP均较术后3 d明显增高(P<0.01),观察组的创面愈合率较对照组明显升高(P<0.01);术后10 d两组ALCT和AMCP差异均无统计学意义(P>0.05)。结论低位肛瘘术后使用黄柏五倍子汤熏洗的疗效显著,有助于肛门括约肌功能的恢复和sTREM-1、CCL-5、sICAM-1水平的降低。
Objective To observe the therapeutic effect of fumigation with Huangbai Wubeizi Decoction after low anal fistula operation and its influence on anal sphincter function and inflammatory factors.Methods Eighty-six patients with low anal fistula treated by anal fistula resection in this hospital from January 2019 to December 2020 were selected as the study subjects and divided into the observation group and control group according to the random number table method,43 cases in each group.The control group was given the conventional treatment,and on this basis of the control group,the observation group was fumigated and washed with Huangbai Wubeizi Decoction after operation.The total effective rate,duration of pain,swelling disappearance time,wound healing time,defecation recovery time after treatment were compared between the two groups,and the wound exudate score,granulation morphology score,wound healing rate,rectal resting pressure(RRP),anal resting pressure(ARP),anal anal longest contraction time(ALCT),anal maximum contraction pressure(AMCP),soluble myeloid cell trigger receptor 1(sTREM-1),chemokine ligand 5(CCL-5)and soluble intercellular adhesion molecule 1(sICAM-1)levels after treatment were compared between the two groups.Results The total effective rate in the observation group was 95.35%,which in the control group was 74.42%,the total effective rate in the observation group was significantly better than that in the control group(χ2=5.800,P<0.01).The duration of pain,swelling disappearance time,wound healing time and defecation recovery time in the observation group were significantly shorter than those in the control group(P<0.01).There was no statistically significant difference in the wound exudation score,granulation morphology score,wound healing rate,RRP,ARP,ALCT,AMCP,sTREM-1,CCL-5 and sICAM-1 levels on postoperative 3 d between the two groups(P>0.05).The scores of wound exudation and granulation morphology,RRP,ARP,sTREM-1,CCL-5 and sICAM-1 on postoperative 10 d in the two groups were significantly decreased compared with those on postoperative 3 d(P<0.01),moreover the observation group was lower than the control group(P<0.01);the wound healing rate,ALCT and AMCP on postoperative 10 d were significantly increased compared with those on postoperative 3 d(P<0.01),the wound healing rate in the observation group was significantly increased compared with that in the control group(P<0.01),and there was no statistically significant difference in the ALCT and AMCP levels on postoperative 10 d between the two groups(P>0.05).Conclusion The fumigation with Huangbai Wubeizi Decoction in low anal fistula operation has obvious effect,and helps to restore the function of anal sphincter and reduce the levels of sTREM-1,CCL-5 and sICAM-1.
作者
张冬梅
张雅明
夏泽华
ZHANG Dongmei;ZHANG Yaming;XIA Zehua(Department of Bai′s Proctology,Affiliated Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)
出处
《检验医学与临床》
CAS
2022年第18期2515-2519,共5页
Laboratory Medicine and Clinic
关键词
黄柏五倍汤
低位肛瘘
直肠内压
炎症介质
中西医结合
Huangbai Wubeizi Decoction
low anal fistula
internal rectal pressure
inflammatory mediators
integrated traditional Chinese and western medicine
