基于巨噬细胞极化探讨“煨脓长肉”法促进肛瘘术后创面愈合作用机制

Investigate the Mechanism of“Simmering Pus and Forming Flesh”Method Promoting Wound Healing After Anal Fistula Surgery Study Based on Macrophage Polarization

肛瘘是结直肠肛门外科的常见疾病之一。巨噬细胞参与了肛瘘术后创面愈合的全过程。巨噬细胞极化是创面修复的关键步骤,从创面愈合过程的炎症期到修复期,巨噬细胞的表型发生了由经典激活M1型向替代激活M2型的转变,M1型巨噬细胞具有促炎和介导组织损伤的作用,M2型巨噬细胞在抗炎的同时促进组织修复。因此,针对肛瘘术后创面愈合迟缓,调节巨噬细胞极化无疑成为治疗的重要手段之一。在中医学中,肛瘘术后创面属于“疮疡”的范畴。气血瘀滞,正气虚损是肛瘘术后创面愈合迟缓的病机,“煨脓长肉”法是促进创面愈合的中医外治法,常用生肌玉红膏、回阳生肌膏等。生肌玉红膏、回阳生肌膏可以通过调节巨噬细胞表型转化而促进创面愈合。因此,运用“煨脓长肉”法指导中药调节巨噬细胞极化是促进肛瘘术后创面愈合的有效方法。

Anal fistula is one of the common diseases in colorectal and anal surgery.Macrophages are involved in the whole process of wound healing after anal fistula surgery.Macrophage polarization is a key step in wound repair.From the inflammatory phase of the wound healing process to the repair phase,the phenotype of macrophages changes from classical activated M1 macrophage to alternative activated M2 macrophage:M1 macrophages are specialized at proinflammatory and mediating tissue damage,and M2 macrophages promote tissue repair while working with anti-inflammation.Therefore,regulating macrophage polarization is undoubtedly one of the important therapeutic methods for the chronic wound healing after anal fistula.In traditional Chinese medicine,the wound after anal fistula surgery belongs to the category of“sore”.Qi stagnation and blood stasis,deficiency of vital Qi is the pathogenesis of chronic wound healing after anal fistula surgery,“simmering pus and forming flesh”method is the traditional Chinese medicine external treatment method to promote wound healing,commonly used Shengji Yuhong Ointment(生肌玉红膏),Huiyang Shengji Ointment(回阳生肌膏),etc.Shengji Yuhong Ointment and Huiyang Shengji Ointment can promote wound healing by regulating macrophage phenotype inversion.Therefore,using the method of“simmering pus and forming flesh”to guide traditional Chinese medicine to regulate macrophage polarization is an effective method to promote the wound healing after anal fistula.