促愈熏洗方对湿热下注型复杂性肛瘘术后并发症及创面愈合的影响

Effect of Cuyu Xunxi Decoction on postoperative complications and wound healing of complex anal fistula with syndrome of dampness-heat diffusing downward

目的总结观察促愈熏洗方对湿热下注型复杂性肛瘘术后并发症及创面愈合的影响。方法选取2021年7月至2022年10月于上海中医药大学附属曙光医院住院手术的120例湿热下注型复杂性肛瘘患者为研究对象,按照随机数字表法将其分治疗组、对照组,每组60例。两组经肛瘘切除术后,治疗组给予促愈熏洗方,对照组给予高锰酸钾溶液,两组均治疗14 d。观察两组干预前后不同时间点的术后并发症积分、创面愈合面积、胃肠道生活质量评分,比较干预前后创面分泌物中血小板源性生长因子(PDGF)、血管内皮生长因子(VEGF)水平。结果治疗组术后第7、14天的疼痛、渗液评分低于本组手术当天及同期对照组;水肿评分高于本组手术当天,低于同期对照组;术后第14天的出血评分低于本组术后第7天,术后第7天的出血评分低于同期对照组(P<0.05)。对照组术后第14天的疼痛、渗液评分低于本组手术当天和术后第7天;术后第7、14天的水肿评分高于手术当天;术后第7天的出血评分高于手术当天,术后第14天的出血评分低于术后第7天(P<0.05)。术后第14、28天,两组创面面积小于手术当天,胃肠道生活质量指数高于手术当天;术后第28天,两组创面面积小于术后第14天,且治疗组小于同期对照组,胃肠道生活质量指数高于术后第14天,且治疗组高于同期对照组(P<0.05)。熏洗14 d后,两组创面分泌物中PDFG、VEGF水平均高于熏洗前,且治疗组高于对照组(P<0.05)。结论促愈熏洗方能有效减轻复杂性肛瘘患者术后并发症,促进生长因子分泌,加速创面愈合,临床疗效显著。

Objective To summarize and observe effect of Cuyu Xunxi Decoction on postoperative complications and wound healing of complex anal fistula with syndrome of dampness-heat diffusing downward.Methods A total of 120 complex anal fistula patients with syndrome of dampness-heat diffusing downward which hospitalized and operated in Shushuang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from July 2021 to October 2022 were selected as the study objects,and were divided into treatment group and control group according to random number table method,with 60 cases in each group.After anal fistulectomy,the treatment group was given Cuyu Xunxi Decoction and the control group was given Permanganometric Solution.Both groups were treated for 14 days.Postoperative complication score,wound healing area,and gastrointestinal quality of life score of the two groups were observed at different time points before and after intervention,and the levels of platelet-derived growth factor(PDGF)and vascular endothelial growth factor(VEGF)in wound secretions before and after intervention were compared.Results The pain and exudation scores of the treatment group on the 7th and 14th day after operation were lower than those of the operation day and the control group at the same time;the edema score was higher than that of the operation day,and lower than that of the control group at the same time;the bleeding score on the 14th day after operation was lower than that on the 7th day after operation,and the bleeding score on the 7th day after operation was lower than that in the control group at the same time(P<0.05).The pain and exudation scores of the control group on the 14th day after operation were lower than those on the operation day and the 7th day after operation;the edema scores on the 7th and 14th day after operation were higher than those on the day of operation;the bleeding score on the 7th day after operation was higher than that on the day of operation,and the bleeding score on the 14th day after operation was lower than that on the 7th day after operation(P<0.05).On the 14th and 28th day after operation,the wound area of the two groups was smaller than that on the operation day,and the gastrointestinal quality of life index was higher than that on the operation day;on the 28th day after operation,the wound area of the two groups was smaller than that on the 14th day after operation,and that of the treatment group was smaller than that of the control group at the same time,the gastrointestinal quality of life index of the two groups was higher than that on the 14th day after operation,and that of the treatment group was higher than that of the control group at the same time(P<0.05).After fumigation and washing 14 days,the levels of PDFG and VEGF in wound secretion of the two groups were higher than those before fumigation and washing,and those in the treatment group were higher than those in the control group(P<0.05).Conclusion Cuyu Xunxi Decoction can effectively reduce postoperative complications in patients with complicated anal fistula,promote growth factor secretion,accelerate wound healing,and have significant clinical effects.