祛毒二黄汤熏洗坐浴联合低位切开高位挂线法治疗湿热下注型高位复杂性肛瘘的临床疗效及对血清炎症指标和相关生长因子的影响

Clinical efficacy of Qudu Erhuang Decoction fumigation-washing combined with low cut high hang line method for high complex fistula of damp-heat type and how to impact on serum inflammation indicators and related growth factors

目的观察祛毒二黄汤熏洗坐浴联合低位切开高位挂线法治疗湿热下注型高位复杂性肛瘘的临床疗效及对血清炎症指标和相关生长因子的影响。方法将145例湿热下注型高位复杂性肛瘘患者按照随机数字表法分为2组,均予低位切开高位挂线术治疗,对照组71例同时予高锰酸钾溶液熏洗坐浴,治疗组74例在对照组治疗基础上联合祛毒二黄汤熏洗坐浴。2组均连续治疗2周。比较2组疗效;比较2组治疗前后临床症状评分变化;比较2组治疗前后血清炎症指标超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)和相关生长因子表皮生长因子(EGF)、成纤维细胞生长因子(bFGF)、转化生长因子β(TGF-β)变化。结果治疗组总有效率95.95%(71/74),对照组总有效率84.51%(60/71),治疗组疗效优于对照组(P<0.05)。2组治疗后创面疼痛、创面渗液、创面水肿、肉芽生长评分均较本组治疗前降低(P<0.05),且治疗组治疗后创面疼痛、创面渗液、创面水肿、肉芽生长评分均低于对照组(P<0.05)。2组治疗后血清hs-CRP、IL-6、TNF-α含量均较本组治疗前降低(P<0.05),且治疗组治疗后血清hs-CRP、IL-6、TNF-α含量均低于对照组(P<0.05)。2组治疗后血清EGF、bFGF、TGF-β含量均较本组治疗前升高(P<0.05),且治疗组治疗后血清EGF、bFGF、TGF-β含量均高于对照组(P<0.05)。结论祛毒二黄汤熏洗坐浴联合低位切开高位挂线法治疗湿热下注型高位复杂性肛瘘,能改善患者临床症状及体征,提高临床疗效,可能与拮抗炎性反应、调节相关生长因子等因素有关。

Objective To observe the clinical efficacy of Qudu Erhuang Decoction fumigation sitz bath combined with low cut high hang line method for high complex fistula(damp-heat type)and how to impact on serum inflammatory factor and related growth factors.Methods Totally 145 patients with high complex fistula(damp-heat type)were randomly divided into the treatment group(n=74)and the control group(n=71),in addition to low cut high hang line method,the control group received potassium permanganate solution fumigation-washing,and the treatment group received Qudu Erhuang Decoction fumigation-washing based on the control group.The treatment continued 2 weeks to compare clinical symptoms scores,serum inflammation indicators(high-sensitivity C-reactive protein[hs-CRP],interleukin-6[IL-6],tumor necrosis factor-α[TNF-α]),related growth factors(epidermal growth factor[EGF],basic fibroblast growth factor[bFGF],transforming growth factor-β[TGF-β]);the curative effect was assessed.Results The overall effective rate in treatment group was better than that in control group(95.95%[71/74]vs 84.51%[60/71],[P<0.05],respectively).After treatment,the scores of wound pain,wound effusion,wound edema,granulation growth in groups were decreased(P<0.05),which were lower in the treatment group than in the control group(P<0.05);hs-CRP,IL-6,TNF-αin groups were decreased(P<0.05),and the treatment group was more prevalent(P<0.05);EGF,bFGF,TGF-βin groups were increased(P<0.05),improvement of which in the treatment group were significantly better(P<0.05).Conclusion For patients with high complex fistula(damp-heat type),Qudu Erhuang Decoction fumigation-washing combined with low cut high hang line method can improve clinical symptoms and signs,and clinical efficacy by antagonizing inflammatory response and regulating related growth factors.