切开疗法与拖线疗法治疗淋巴结核窦道的临床效果比较  

Comparative Study of Incision Operation Treatment and Thread-dragging Therapy on Tuberculous-Sinus

作　　者：靳汝辉[1] 黄子慧[1] 薛倩一[1] 朱永康[2] JIN Ru-hui;HUANG Zi-hui;XUE Qian-yi;ZHU Yong-kang(Department of Luoli,Nanjing Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing（210014）;Department of Surgery,Affiliated Hospital,Nanjing University of Chinese Medicine,Nanjing（210029)

机构地区：[1]南京中医药大学附属南京市中西医结合医院瘰疬科,南京210014 [2]南京中医药大学附属医院普外科,南京210029

出　　处：《中国中西医结合杂志》2018年第11期1332-1335,共4页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：江苏省中医药科技项目(No.YB2017042);南京市科技计划资金资助项目(No.201503051);江苏省"十二五"中医重点学科建设项目(No.苏中医政[2013]30号);南京市名中医工作室(夏公旭)(No.宁卫中医[2017]8号)

摘　　要：目的观察切开疗法与拖线疗法治疗淋巴结核窦道的临床疗效。方法采用随机数字表法将60例淋巴结核窦道患者随机分为切开组(30例)及拖线组(30例)。局部窦道疮面的处理,切开组用切开疗法治疗,拖线组采用拖线疗法治疗,隔日换药1次。治疗前,治疗后第14、28、42、56天分别记录分泌物(形质、色泽、量)、腐肉(量、腐脱程度)、肉芽(色泽、量)、上皮组织(量)、窦道长度及疮周情况(皮色、肿胀程度)等局部体征指标,按轻重程度计分,统计各时间点体征指标总积分,评判其改善情况;术后第56天进行临床疗效评价;随访至术后3个月,观察窦道愈合时间及复发情况。结果与治疗前比较,两组患者在术后第14、28、42、56天主要体征指标评分降低(P<0.05),且第42、56天切开组较拖线组降低更明显(P<0.05)。术后第56天切开组愈显率100%(30/30),高于拖线组[86.67%(26/30)],差异有统计学意义(χ~2=4.29,P<0.05)。随访3个月,切开组平均窦道愈合时间(35.20±15.44)天,少于拖线组[平均窦道愈合时间(46.77±15.90)天],差异有统计学意义(t=2.86,P<0.05)。切开组复发率6.67%(2/30)较拖线组[复发率36.67%(11/30)]明显减少(χ~2=7.95,P<0.05)。结论 在淋巴结核窦道的治疗中,切开疗法较拖线疗法具有愈合率高、愈合时间短、复发率少的优势。Objective To observe the efficacy of incision operation treatment and thread-dragging therapy on tuberculous-sinus. Methods Totally 60 tuberculous-sinus patients were assigned to incision operation therapy（lOT）group （30 cases） and thread-dragging therapy （TDT） group （30 cases） according to random digit table. As for local sinus wound, patients in the IOT group received lOT, while those in the TDT group received TDT. The dressing was changed every other day. Local physical signs including excretion （shape, quality, color, amount）,slough （amount and degree）, granulation （color and amount）, epithelium amount, length of sinus and tissues surrounding sinus （skin color, swelling degree） were observed and recorded before treatment, and at post-surgical 14, 28, 42, and 56 days. Scoring were counted by severity degrees. Total scores of physical signs were statistically calculated at each time point to assess the improvement. The overall efficacy evaluation was assessed at post-surgical 56 days. Patients were followed-up till the 3rd month after treatment. The sinus recovery time was observed and recurrence was statistically calculated. Results Compared with before treatment, scores of main physical signs decreased in all patients at post-surgical 14, 28, 42, and 56 days （P 〈0.05）. Besides,better effect was shown in the lOT group at day 42 and 56 （P 〈0.05）. The markedly effective rate was 100% （30/30） in the IOT group, higher than that of the TDT group [86.67% （26/30）; X2 =4.29, P 〈 0.05）. The average sinus recovery time was （35.20 ±15.44）days in the lOT group, lower than that of the TDT group [ （46.77 ±15.90） days; t =2.86, P 〈0.05]. The recurrent rate was 6.67% （2/30） in the lOT group, obviously lower than that of the TDT group [36.67 （11/30） ; X2 =7.95 ,P 〈0.05 ]. Conclusion IOT was superior to TDT in accelerating sinus healing, shortening healing time, and lessening recurrence of tuberculous-sinus patients.

关 键 词：切开疗法 拖线疗法 淋巴结核窦道 

分 类 号：R52[医药卫生—内科学]