生肌促愈汤对湿热下注型环状混合痔术后患者的影响及相关机制研究

Effect of Shengji Cuyu Decoction(生肌促愈汤)on Postoperative Circular Mixed Hemorrhoids of Damp Heat Pouring Down Syndrome and Related Mechanisms

目的:观察生肌促愈汤对湿热下注型环状混合痔术后患者的影响,并探讨相关作用机制。方法:共纳入湿热下注型环状混合痔患者126例,以随机数字表法分为观察组和对照组各63例。两组患者均予以混合痔外剥内扎术,术后对照组予抗感染、换药等常规治疗,以痔瘘洗剂熏洗,观察组在常规治疗的基础上联合生肌促愈汤外洗。比较两组患者各时间点肛门疼痛评分、肛门水肿评分,肛管最大收缩压(MSP)、高压区长度(HPZ)、直肠静息压(RRP)、直肠最大耐受容量(MTV)、直肠肛管抑制反射阈值(AIRT)、肛管最大收缩压(AMC)等肛肠动力学指标水平,血管内皮生长因子(VEGF)、血小板源性生长因子(PDGF)、碱性成纤维细胞生长因子(b FGF)等新生血管形成指标水平,以及血清表皮生长因子(EGF)、转化生长因子-β(TGF-β)、Ⅰ型胶原蛋白(COL-Ⅰ)水平。结果:术后7 d,两组患者肛门疼痛评分和肛门水肿评分均较术后1 d降低(P<0.05),且观察组低于照组(P<0.05)。术后14 d,两组患者MSP、HPZ、MTV、AMC水平均较术前降低(P<0.05),且观察组低于对照组(P<0.05);RRP、AIRT水平较术前升高(P<0.05),且观察组高于对照组(P<0.05)。术后14 d,两组患者血清VEGF、PDGF、bFGF水平及创面毛细血管含量均较术后1 d升高(P<0.05),且观察组高于对照组(P<0.05)。术后7 d,两组患者血清EGF、TGF-β、COL-Ⅰ水平均较术后1 d升高(P<0.05),且观察组高于对照组(P<0.05)。结论:生肌促愈汤加减对湿热下注型环状混合痔患者术后肛门疼痛、水肿改善效果明显,并对肛门功能恢复、创面愈合具有积极作用,其机制与提高血管形成因子水平,促进新生血管形成有关。

Objective:To observe the effect of Shengji Cuyu Decoction(生肌促愈汤)on postoperative circular mixed hemorrhoids of damp heat pouring down type,and to explore the related mechanisms.Methods:One hundred and twenty six patients with circular mixed hemorrhoids of damp heat pouring down type were divided into observation group and control group using a random number table,63 patients in each group.Both groups were treated with Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids,and after operation,the control group was given routine treatment including anti-infection and dress changing,and also treated with fumigation and washing with Zhilou Lotion(痔瘘洗剂),while the observation group was further treated with Shengji Cuyu Decoction besides the routine treatment.At each time point,anal pain score,anal edema score,and anal canal maximum systolic pressure(MSP),high pressure zone length(HPZ),rectal static pressure(RRP),rectum maximum tolerable volume(MTV),anorectal inhibitory reflex threshold(AIRT),anal canal maximum systolic pressure(AMC)and other anorectal dynamics index levels,and angiogenesis indexes like vascular endothelial growth factor(VEGF),platelet-derived growth factor(PDGF),basic fibroblast growth factor(bFGF),as well as serum levels of epidermal growth factor(EGF),transforming growth factor-β(TGF-β),and typeⅠcollagen(COL-Ⅰ)were compared between both groups.Results:At 7 days postoperatively,the anal pain score and anal edema score of both groups were lower than those on the first day after surgery(P<0.05),and in the observation group were lower than those in the control group(P<0.05).On the 14th day after operation,the levels of MSP,HPZ,MTV,and AMC in the two groups were lower than those before the operation(P<0.05),and in the observation group were lower than those in the control group(P<0.05),while the levels of RRP and AIRT were higher than those before the operation(P<0.05),and in the observation group were higher than those in the control group(P<0.05).On the 14th day after operation,the serum levels of VEGF,PDGF,bFGF and wound capillary content in both groups were higher than those on the 1st day after operation(P<0.05),and in the observation group were higher than those in the control group(P<0.05).On the 7th day after operation,the serum levels of EGF,TGF-β,and COL-Ⅰlevels of both groups were higher than those on the 1st day after operation(P<0.05),and in the observation group were higher than those in the control group(P<0.05).Conclusion:Shengji Cuyu Decoction with modification could significantly relieve postoperative anal pain and anal edema in patients with circular mixed hemorrhoids of damp heat pouring down type,and could promote recovery of anal function and wound healing effectively.The underlying mechanism might be related to improving levels of angiogenic factor and promote angiogenesis.