复方黄柏液熏洗配合括约肌间入路治疗肛周脓肿的疗效及安全性研究

Efficacy and safety of fumigation with Compound Phellodendron Amurense Liquid combined with inter-sphincteric approach in the treatment of perianal abscesses

目的探究复方黄柏液熏洗配合括约肌间入路治疗肛周脓肿的疗效及安全性。方法选取2019年6月至2022年6月河南科技大学第一附属医院收治的60例肛周脓肿患者纳入研究,按随机数表法分为对照组和观察组各30例。两组患者均给予括约肌间入路手术治疗,术后对照组予以康复新液熏洗,观察组予以复方黄柏液熏洗,直至创面愈合。4周后比较两组患者的临床疗效,术后7 d、14 d及21 d的肛门疼痛程度、肉芽生长情况、创面愈合率、创面组织形态和术前、术后7 d、14 d及21 d的免疫炎性因子水平[白介素(IL)-6、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]以及术后4周、6周及8周的肛门功能评分;同时比较两组患者术后并发症发生情况。结果观察组患者的治疗总有效率为96.67%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);观察组患者术后7 d、14 d及21 d的创面肉芽生长情况评分分别为(1.22±0.57)分、(0.62±0.27)分、(0.25±0.04)分,明显低于对照组的(1.83±0.85)分、(1.32±0.48)分、(0.67±0.32)分,肛门疼痛程度分别为(2.15±0.53)分、(1.25±0.22)分、(1.07±0.13)分,明显低于对照组的(4.64±1.34)分、(3.57±1.08)分、(1.85±0.59)分,创面愈合率分别为(15.82±1.56)%、(72.37±3.85)%、(95.83±4.37)%,明显高于对照组的(10.37±1.31)%、(55.69±3.29)%、(77.52±3.57)%,差异均有统计学意义(P<0.05);观察组患者术后7 d、14 d及21 d的巨噬细胞比例、新生毛细血管数、成纤维细胞数明显高于对照组,血清IL-6、CRP、TNF-α水平明显低于对照组,差异均有统计学意义(P<0.05);观察组患者术后4周、6周及8周的肛门功能评分明显低于对照组,差异均有统计学意义(P<0.05);观察组患者的术后并发症发生率为6.67%,明显低于对照组的30.00%,差异有统计学意义(P<0.05)。结论复方黄柏液熏洗配合括约肌间入路治疗肛周脓肿能有效减轻患者的肛门疼痛程度,降低免疫炎性反应和术后并发症发生率,有助于术后创面愈合,临床治疗效果较好。

Objective To explore the efficacy and safety of fumigation with Compound Phellodendron Amurense Liquid(Fufang Huangbai Ye)combined with inter-sphincteric approach in the treatment of perianal abscess.Methods Sixty patients with perianal abscess were selected from June 2019 to June 2022 in the First Affiliated Hospital of Henan University of Science and Technology and divided into control group(n=30)and observation group(n=30)according to the random number table.All the patients were given surgical treatment via inter-sphincteric approach.After surgery,the control group was fumigated with Kangfuxin Liquid,and the observation group was fumigated with Compound Phellodendron Amurense Liquid until wound healing.After 4 weeks,the clinical efficacy of the patients were compared between the two groups,as well as the degree of anal pain,granulation growth,wound healing rate,and wound tissue morphology at 7 d,14 d and 21 d after surgery,the immuno-inflammatory factors[interleukin(IL)-6,tumour necrosis factor-α(TNF-α),C-reactive protein(CRP)]before surgery and at 7 d,14 d and 21 d after surgery,anal function scores at 4 weeks,6 weeks,and 8 weeks postoperatively,and postoperative complications.Results The total effective rate of treatment for patients in the observation group was 96.67%,which was significantly higher than 73.33% in the control group(P<0.05).The wound granulation growth scores of the observation group at 7 d,14 d and 21 d after surgery were(1.22±0.57)points,(0.62±0.27)points,(0.25±0.04)points,respectively,significantly lower than(1.83±0.85)points,(1.32±0.48)points,(0.67±0.32)points in the control group;the degree of anal pain were(2.15±0.53)points,(1.25±0.22)points,(1.07±0.13)points,respectively,significantly lower than(4.64±1.34)points,(3.57±1.08)points,(1.85±0.59)points in the control group;wound healing rates were(15.82±1.56)%,(72.37±3.85)%,(95.83±4.37)%,respectively,significantly higher than(10.37±1.31)%,(55.69±3.29)%,(77.52±3.57)% in the control group;the differences were statistically significant(P<0.05).The proportion of macrophages,number of new capillaries,number of fibroblasts at 7 d,14 d and 21 d after surgery were significantly higher than those in the control group(P<0.05);the serum levels of IL-6,CRP,and TNF-α in the observation group were significantly lower(P<0.05).The anal function scores in the observation group were significantly lower than those in the control group at 4 weeks,6 weeks,and 8 weeks after surgery(P<0.05).Conclusion Fumigation with Compound Phellodendron Amurense Liquid combined with inter-sphincteric approach in the treatment of perianal abscess has significant curative effect,which can effectively reduce the degree of anal pain,reduce immune inflammatory response,reduce postoperative complications,and contribute to postoperative wound healing.