中药熏洗联合肛瘘切开肌层缝合内口引流术治疗低位肛瘘对创面愈合及并发症的影响  

The effect of TCM fumigating and washing combined with anal fistula incision,muscle layer suture,and internal drainage on wound healing and complications in the treatment of low anal fistula

作　　者：刘晓军 张晓婷 蔡丽丹 LIU Xiaojun;ZHANG Xiaoting;CAI Lidan(Department 3 of Proctology,Zhangjiakou Fifth Hospital,Zhangjiakou,Hebei 075000,China)

机构地区：[1]张家口市第五医院肛肠3科,河北张家口075000

出　　处：《安徽医药》2025年第4期772-776,共5页Anhui Medical and Pharmaceutical Journal

基　　金：张家口市重点研发计划项目(2121117D)。

摘　　要：目的探讨中药熏洗联合肛瘘切开肌层缝合内口引流术治疗低位肛瘘对创面愈合及并发症的影响。方法选取2020年6月至2021年1月于张家口市第五医院就诊的120例低位单纯性肛瘘病人,按随机数字表法分成观察组(60例)、对照组(60例),两组均行肛瘘切开肌层缝合内口引流术及术后予常规西医治疗,观察组术后另予中药熏洗治疗。比较两组术后不同时点创面疼痛[视觉模拟评分(VAS)]、水肿评分、渗出物评分。观察两组临床疗效、术后并发症、创面愈合时间及愈合面积情况。另比较两组治疗前后炎症因子[γ干扰素(IFN-γ)、转化生长因子-β(TGF-β)、白细胞介素-1β(IL-1β)]、血清中表皮生长因子(EGF)、血管内皮生长因子(VEGF)水平。结果观察组治疗总有效率(93.33%)较对照组(80.00%)高(P<0.05);两组术后3 d、7 d、14 d VAS、水肿评分、渗出物评分均较术后1 d低,观察组较对照组低(P<0.05);观察组术后创面愈合时间及愈合面积较对照组缩短或缩小(P<0.05);两组治疗后IFN-γ、IL-1β水平均较治疗前降低,观察组较对照组低(P<0.05);两组治疗后TGF-β、EGF、VEGF水平均较治疗前高,观察组较对照组高(P<0.05);观察组并发症发生率(5.00%)较对照组(16.67%)低(P<0.05)。结论中药熏洗联合肛瘘切开肌层缝合内口引流术治疗低位肛瘘疗效确切,能改善临床症状,减轻术后疼痛,缩小创面愈合面积,促进创面愈合,抑制炎症反应,且降低并发症发生率。Objective To explore the effect of TCM fumigating and washing combined with anal fistula incision,muscle layer suture,and internal drainage on wound healing and complications in the treatment of low anal fistula.Methods One hundred and twenty patients with low level simple anal fistula who visited Zhangjiakou Fifth Hospital from June 2020 to January 2021 were divided into an observation group(60 cases)and a control group(60 cases)using a random number table method.Both groups underwent anal fistula inci-sion,muscle layer suture and internal drainage surgery,and received routine western medicine treatment after surgery,while the obser-vation group was treated with TCM fumigating after operation.The wound pain[visual analogue score(VAS)],edema scores and exudate scores were compared between the two groups at different time points after operation.The clinical efficacy,postoperative complications,wound healing time,and healing area of two groups were observed.The levels of inflammatory factors[interferon-γ(IFN-γ),transform-ing growth factor-β(TGF-β),interleukin-1β(IL-1β)],serum epidermal growth factor(EGF),and vascular endothelial growth factor(VEGF)were compared between the two groups before or after treatment.Results The total effective rate of the observation group(93.33%)was higher than that of the control group(80.00%)(P<0.05).The VAS,edema scores and exudate scores of the two groups on the 3th,7th and 14th day after operation were lower than those on the 1st day after operation,and the observation group was lower than the control group(P<0.05).The postoperative wound healing time and area in the observation group were shorter and smaller than those in the control group(P<0.05).After treatment,the levels of IFN-γand IL-1βin both groups decreased compared to before treatment,and the observation group was lower than the control group(P<0.05).After treatment,the levels of TGF-β,EGF,and VEGF in both groups were higher than before treatment,and the observation group was higher than the control group(P<0.05).

关 键 词：直肠瘘 中药熏洗 肛瘘切开肌层缝合内口引流术 创面愈合 并发症 

分 类 号：R657.16[医药卫生—外科学]