挂线疗法联合白竭散治疗高位肛瘘疗效及对术后创面新血管生成、VEGF和VEGFR-2表达的影响

Effect of Seton therapy combined with Baijie powder on treatment of high anal fistula and its effect on postoperative wound angiogenesis, VEGF and VEGFR-2 expression

目的:观察挂线疗法联合白竭散治疗高位肛瘘的疗效及对VEGF和VEGFR-2表达水平影响。方法:120例符合高位肛瘘诊断标准患者,随机分为两组,对照组患者采取挂线疗法治疗,术后第1 d开始换药,观察组患者在对照组患者治疗的基础上联合白竭散外用,比较两组患者的疗效,并于术后7 d、14 d取新鲜肉芽组织测定毛细血管数,采取免疫组化法测定VEGF和VEGFR-2表达水平。结果:两组患者的疗效比较,差异无统计学意义(P>0.05);术后第14 d观察组患者创面肉芽颜色评分为(0.9±0.1)分,低于对照组的(1.1±0.2)分(P<0.05);观察组患者术后7 d、术后14 d创面愈合率高于对照组(P<0.05);观察组患者术后7 d、术后14 d创面毛细血管含量高于对照组(P<0.05);观察组术后7 d、14 d创面VEGF和VEGFR-2表达水平高于对照组(P<0.05)。结论:挂线疗法联合白竭散治疗高位肛瘘疗效较好,创面愈合速度更快,VEGF和VEGFR-2表达水平升高,可能为促进愈合的机制之一。

Objective:To observe curative effect of Seton therapy combined with Baijie powder in the treatment of high anal fistula and its effect on postoperative wound angiogenesis,VEGF and VEGFR-2 expression.Methods:120 cases which accorded with high anal fistula diagnosis standard were enrolled in the study,and according to random number table they were divided into two groups with 60 cases in each group.Patients in the control group were treated with Seton therapy,and the dressing was changed at the first day after surgery.Patients in the observation group were treated on the basis of the treatment in the control group and combined with external topical use of Baijie powder.The efficacy of the two groups was compared,and the number of capillaries was measured in fresh granulation tissue 7 days and 14 days after surgery,and the expression levels of VEGF and vegfr-2 were determined by immunohistochemistry.Results:There was no significant difference in the efficacy of the two groups(P>0.05).On the 14th day after surgery,the color score of wound granulation in the observation group was(0.9±0.1),which was lower than(1.1±0.2)in the control group(P<0.05).The wound healing rate of the observation group was higher than that of the control group 7 days and 14 days after surgery(P<0.05).The content of capillaries on wound surface of the observation group was higher than that of the control group 7 days and 14 days after surgery(P<0.05).VEGF and VEGFR-2 expression levels of wound 7 d and 14 d after surgery in the observation group were higher than those in the control group(P<0.05).Conclusion:The curative effect of Seton therapy combined with Baijie powder in the treatment of high anal fistula is better,wound healing faster,VEGF and VEGFR-2 expression level increased,which may be one of the mechanisms to promote healing.