愈创汤对低位单纯性肛瘘术后创面促愈机理的临床研究

The Clinical Research on Mechanism of “Yu-chuang Decoction” Healing Postoperative Wound of Low Anal Fistula

目的:观察愈创汤治疗低位单纯性肛瘘患者术后创面愈合的临床疗效,探讨在创面愈合中的作用机制。方法:选择60例低位单纯性肛瘘患者,随机分成治疗组和对照组各30例,术后均常规处理,治疗组同时加服中药愈创汤;采用量化评分法观察患者创面组织修复的临床疗效,观察其创面愈合率、创面愈合时间、肉芽组织生长情况、血清EGF变化情况。采用肛管直肠测压法观察直肠肛门功能的恢复状况。结果:(1)治疗组患者创面愈合时间较对照组显著缩短(P<0.05);(2)治疗组患者术后第10 d、第14 d创面愈合率均大于对照组(P<0.05);(3)治疗组患者肉芽生长情况较对照组良好(P<0.05);(4)治疗前后组内比较,治疗组肛门功能各指标评分及总积分差异无统计学意义(P>0.05),对照组差异有统计学意义(P<0.05)。(5)治疗前后组内比较,治疗组肛管直肠压力各指标差异无统计学意义(P>0.05),对照组差异有统计学意义(P<0.05)。(6)术后第3 d,治疗组及对照组血清EGF值均较正常值显著下降(P<0.05),术后第7 d及第14 d,治疗组升高幅度显著高于对照组(P<0.05)。结论:愈创汤可缩短低位单纯性肛瘘术后患者创面愈合时间,不影响肛门功能。促愈机理可能与调节内源性EGF有关。

Objective： To observe the impact and mechanism of ＂Yu-chuang Decoction＂ on postoperative wound heahng of low simple anal fistula. Methods： 60 patients were randomly divided into treatment group and control group with 30 cases in each group. After conventional treatment, the treatment group and in combination with traditional Chinese medicine ＂Yu-chuang Decoc- tion＂. Quantitative grading methods were used to observe in patients with rate of wound healing, wound healing time, granulation tis- sue growth, EGF changes. Anorectal manometry was used to observed recovery status of anorectal physiological function . Results： （ 1 ） Wound healing time of the treatment group were shorter than the control group （ P 〈 0.05 ） ; （2） Wound healing rate of treatment group were better than the control group （ P 〈 0. 05 ） ; （3） Granulation growth of the treatment group were better than the control group （ P 〈 0. 05 ） ; （4） Before and after treatment , on anal function and anorectal dynamics index , the treatment group showed no significant difference （P 〉 0. 05）, which control group showed significant difference （ P 〈 0. 05 ） ; （5） EGF change of treatment group were better than the control group （ P 〈 O. 05 ） . Conclusion： ＂Yu-ehuang Decoction＂ has certain curative effect on wound re- pair of anal fistula operation. It can effectively shorten the wound healing time, and does not affect the function of anus. The healing of mechanism may related to endogenous EGF.