透脓托毒饮配合西医手术疗法对肛周坏死性筋膜炎患者预后的影响

Effect of Spleen and Toxic Decoction Combined with Western Medicine on the Prognosis of Patients with Perianal Necrotizing Fasciitis

目的:探究透脓托毒饮配合西医手术疗法对肛周坏死性筋膜炎(Perianal necrotizing fasciitis,PNF)患者预后的影响。方法:选择西安市中医医院肛肠科于2013年10月-2018年10月收治的肛周坏死性筋膜炎患者60例,根据其入院顺序经随机数字表法分为两组,每组各30例。其中,对照组行PNF清创术,研究组在对照组基础上辅助透脓托毒饮进行治疗,对比两组的治疗总有效率、外周血炎症因子水平、住院时间、创面愈合时间、疼痛积分、腐肉脱落时间、复发率和死亡率。结果:治疗后,研究组的总有效率显著高于对照组(93.3%vs.73.3%,P<0.05);两组血清肿瘤坏死因子-α(Tumor necrosis factor-alpha,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-10(IL-10)水平均较治疗前显著降低,且研究组以上指标均明显低于对照组(P<0.05)。研究组的住院时间、创面愈合时间、疼痛积分、腐肉脱落时间均显著短于(低于)对照组(P<0.05)。随访3个月,两组的术后复发率和死亡率比较均无显著差异(P>0.05)。结论:透脓托毒饮配合清创术治疗PNF的效果显著优于单用清创术,其可有效改善患者的临床症状和预后,可能与其显著降低血清炎症因子水平有关。

Objective:To investigate the effect of spleen and toxic decoction combined with western medicine on the prognosis of patients with perianal necrotizing(PNF)fasciitis.Methods:Sixty patients with perianal necrotizing fasciitis admitted to the Department of Anorectal Surgery,Xi’an Hospital of Traditional Chinese Medicine from October 2013 to October 2018 were selected.According to the order of admission,they were divided into two groups by random number table method,30 patients in each group.The control group underwent PNF debridement,and the study group was treated with the spleen toxic decoction on the basis of the control group.The total effective rate of treatment,peripheral blood inflammatory factor levels,hospitalization time,wound healing time,pain score,time of carrion shedding,recurrence rate,and mortality were compared between the two groups.Results:After treatment,the total effective rate of the study group was significantly higher than that of the control group(93.3%vs.73.3%,P>0.05).The two groups were serum tumor necrosis factor-alpha(TNF-α),interleukin The levels of-6(Interleukin-6,IL-6)and interleukin-10(IL-10)were significantly lower than those before treatment,and the above indexes of the study group were significantly lower than the control group(P<0.05).The hospitalization time,wound healing time,pain score,and carrion shedding time of the study group were significantly shorter than(less than)the control group(P<0.05).There was no significant difference in postoperative recurrence rate and mortality between the two groups(P>0.05).After 3 months of follow-up,there was no significant difference in postoperative recurrence rate and mortality between the two groups(P>0.05).Conclusion:Spleen and toxic decoction combined with debridement is more effective for PNF than debridement alone,it can effectively improve the clinical symptoms and prognosis of patients,which may be related to the significant reduction of serum inflammatory factors.