地奥司明对肛瘘术后患者创面愈合及肛管动力学的影响

Effect of Diosmin on Wound Healing and Anorectal Dynamics in Treatment of Postoperative Anal Fistula Patients

目的 探讨地奥司明对肛瘘术后患者创面愈合及肛管动力学的影响。方法 选取2013年7月至2015年4月武汉市第五医院收治的行肛瘘手术患者82例,按照随机数字法分为联合组和对照组,各41例。术后两组患者均常规止血,抗菌药物预防感染,对照组从术后1 d祛腐生肌软膏、凡士林软膏换药,每次2~3 g,每日2次,联合组在对照组基础上给予地奥司明片,每次1片（0.5 g）,每日2次,连续用药1周。比较两组患者创面水肿情况、创面愈合时间、住院时间及术后肛门控便能力、排便时肛门疼痛指数;分别于手术前后检测两组患者肛管最大收缩压、肛管最长收缩时间、直肠静息压、肛管的静息压。结果 联合组总有效率显著高于对照组[100.0%（41/47）比90.3%（37/47）,P〈0.05];两组术后1、3、5、7 d创面水肿评分均呈下降趋势,联合组下降速度更快,两组在组间、时点间、组间·时点间交互作用差异有统计学意义（P〈0.01）。联合组创面愈合时间、住院时间显著短于对照组[（21.6±3.9）d比（27.3±6.5）d、（11.8±4.8）d比（14.7±3.3）d],术后肛门控便能力得分、肛门疼痛指数均显著低于对照组[（0.28±0.04）分比（0.31±0.07）分、（6.4±1.5）分比（8.1±2.3）分]（P〈0.01）。治疗后7 d联合组后直肠静息压、肛管的静息压显著高于对照组[（2.9±0.3）mm Hg（1 mm Hg=0.133 k Pa）比（2.1±0.2）mm Hg、（14.9±0.8）mm Hg比（13.2±0.7）mm Hg]（P〈0.01）。结论 地奥司明能够促进肛瘘术后创面愈合,降低肛缘水肿,改善肛管动力学,提高术后控便能力,值得临床推广。

Objective To explore effect of diosmin on the wound healing and anorectal dynamics in treatment of postoperative anal fistula patients. Methods A total of 82 anal fistula patients in Wuhan City Fifth Hospital for surgical treatment from Jul. 2013 to Apr. 2015 were included in the study and divided into a combined treatment group of 41 cases and a control group of 41 cases according to the random number method. Both groups were treated with routine hemostasis and antibacterial agents, and the control group was given Qufushengji and vaseline ointment from day 1 after surgery, 2-3 g/time, 2 times/d, while the combined treatment group based on the control group＇s regimen was added with diosmin tablets, 1 tablet （0. 5 mg）/time,2 times/d, for 1 week. The wound edema, wound healing time, hospitalization time and postoperative anal control ability, defecation anus pain index of the two groups were compared ; and anal canal pressure, anal longest contraction time, rectal resting pressure, anal tube resting pressure of the two groups before and after treatment were detected. Results The total effective rate of the combined treatment group was 100.0% （41/47） , of the control group was 90. 3% （37/47）, the difference was statistically significant （ P 〈 0. 05 ）. At postoperative 1,3, 5, 7 d, the wound edema scores decreased, and the combined treatment group decreased faster, the differences between groups, different time points, and interaction of groups time points were statistically significant（ P 〈 0. 01 ）. The wound healing time, hospitalization time of the combined treatment group were significantly less than the control group[ （21.6 ±3.9） d vs （27.3±6.5） d, （ 11.8 ± 4. 8 ） d vs （ 14. 7 ± 3.3 ） d], th postoperative anal control score, pain index of the combined treatment group were significantly lower than the control group [ （0. 28 ± 0. 04 ） vs （0. 31 ± 0. 07 ） , （6. 4 ±1. 5 ） vs （8. 1 ± 2. 3 ） ] （ P 〈 0. 05 ）. After treatment the rectal rest pressure, anal resting pressure of the combined treatment were significantly higher than the control group[ （ 2.9 ± 0. 3 ） mmHg vs （ 2. 1 ± 0. 2 ） mmHg, （ 14. 9 ± 0. 8 ） mmHg vs （ 13.2 ± 0. 7 ） mmHg ] （ P 〈 0. 01 ）. Condusion Diosmin can promote wound healing after anal fistula operation, reduce anal margin edema,improve anorectal dynamics and postoperative anal control, thus is worthy of the clinical promotion.