复方黄柏液坐浴辅助内口封闭联合负压封闭引流技术治疗高位肛周脓肿的疗效

Efficacy of sitz bath with Compound Huangbai Lotion assisted closure of internal orifice combined with vacuum sealing drainage technique in the treatment of patients with high perianal abscess

目的探讨复方黄柏液坐浴辅助内口封闭联合负压封闭引流技术(vacuum sealing drainage,VSD)治疗高位肛周脓肿的效果。方法选取128例高位肛周脓肿患者,采用随机数字表法分为2组,各64例。2组均给予内口封闭联合VSD治疗,对照组术后给予高锰酸钾坐浴治疗,观察组术后给予复方黄柏液坐浴治疗。比较2组疗效、创面恢复情况、炎症因子[C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]、疼痛因子[五羟色胺(5-hydroxytryptamine,5-HT)、P物质(substance P,SP)和去甲肾上腺素(norepinephrine,NE)]、血清转化生长因子β(transforming growth factor beta,TGF-β)、表皮细胞生长因子(epidermal growth factor,EGF)和血管内皮细胞生长因子(vascular endothelial cell growth factor,VEGF)水平,并随访1年内创面感染、脓肿复发和功能障碍发生情况。结果观察组总有效率(90.63%)高于对照组(76.56%),P<0.05;观察组创面渗液评分、创面水肿评分、创面疼痛视觉模拟(visual analogue scale,VAS)评分和创面愈合时间均低(短)于对照组(P<0.05);治疗后,2组血清CRP、IL-6、TNF-α、5-HT、SP和NE水平均降低,且观察组均低于对照组(P<0.05);治疗后,2组血清TGF-β、EGF和VEGF水平均升高,且观察组均高于对照组(P<0.05);观察组创面感染、脓肿复发和功能障碍发生率均低于对照组(P<0.05)。结论复方黄柏液坐浴辅助内口封闭联合VSD治疗高位肛周脓肿效果确切,可减轻患者术后创面水肿、渗出和疼痛等症状,促进创面愈合,抑制炎症因子与疼痛因子表达,促进TGF-β、EGF和VEGF表达,并可降低创面感染、脓肿复发和功能障碍的发生。

Objective To explore the effect of sitz bath with Compound Huangbai(Phellodendron chinense Schneid)Lotion assisted closure of internal orifice combined with vacuum sealing drainage(VSD)technique in the treatment of patients with high perianal abscess.Methods 128 patients with high perianal abscess were selected and divided into 2 groups by using a random number table method,with 64 cases in each group.The both groups were treated with closure of internal orifice combined with VSD,the control group were given potassium permanganate sitz bath after the operation,and the observation group were given the Compound Huangbai Lotion sitz bath after the operation.The efficacy,wound recovery,inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)],pain factors[5-hydroxytryptamine(5-HT),substance P(SP),and norepinephrine(NE)],serum transforming growth factor beta(TGF-β),epidermal growth factor(EGF),and vascular endothelial cell growth factor(VEGF)levels were compared,and the wound infection,abscess recurrence,and dysfunction were followed up within 1 year.Results The total effective rate of the observation group was 90.63%,higher than that of the control group(76.56%),P<0.05.The wound exudation score,wound edema score,wound visual analogue scale(VAS)score,and wound healing time of the observation group were less(shorter)than those of the control group(P<0.05).After treatment,the levels of serum CRP,IL-6,TNF-α,5-HT,SP and NE in the 2 groups decreased,and the observation group were lower than the control group(P<0.05).After treatment,the levels of serum TGF-β,EGF and VEGF increased in the 2 groups,and the observation group were higher than the control group(P<0.05).The incidence of wound infection,abscess recurrence,and dysfunction in the observation group were lower than those in the control group(P<0.05).Conclusion The sitz bath with Compound Huangbai Lotion assisted closure of internal orifice combined with VSD is effective in the treatment of high perianal abscess.It can reduce postoperative wound edema,exudation and pain,promote wound healing,inhibit the expression of inflammatory factors and pain factors,and promote the expression of TGF-β,EGF and VEGF,It can also reduce the wound infection,abscess recurrence,and dysfunction.