龙胆泻肝汤坐浴联合低位全部切开高位挂线术对肛瘘患者创面愈合、肛肠动力学的影响

目的:探讨龙胆泻肝汤坐浴联合低位全部切开高位挂线术对肛瘘患者临床疗效、创面愈合、表皮生长因子及肛肠动力学指标的影响。方法:选取湿热下注型肛瘘患者102例,随机分成对照组和观察组,每组51例。对照组行高位全部切开高位挂线术治疗,观察组在对照组上述治疗的同时给予龙胆泻肝汤治疗。观察两组患者治疗1、7、15 d后创面面积、创面疼痛、创口愈合时间; 评估临床疗效; 酶联免疫吸附法测定患者血清中表皮生长因子(EGF)和血管内皮生长因子(VEGF)水平; 检查直肠静息压(RRP)、肛管静息压(ARP)、肛管最长收缩时间(ALCT)和肛管最大收缩压(AMCP)肛肠学指标。结果:治疗后观察组创面疼痛、创面面积及创口愈合时间均明显低于对照组(P<0.05)。两组之间总有效率比较差异无统计学意义(P>0.05)。观察组血清EGF和VEGF水平明显高于对照组(P<0.05); 两组治疗1 d后,血清EGF和VEGF水平比较无统计学差异(P>0.05)。两组组间及治疗前后AMCP和ALCT指标水平无明显变化(P>0.05)。两组间RRP和ARP水平较治疗前无统计学差异(P>0.05); 观察组RRP和ARP水平明显高于对照组(P<0.05)。与治疗前相比,两组治疗后RRP和ARP水平均显著降低(P<0.05)。 结论:龙胆泻肝汤坐浴联合低位全部切开高位挂线术可促进肛瘘患者创面愈合,保护肛门功能。

Effects of Longdan Xiegan decoction for sitz bath combined with low incision and high thread-drawing on wound healing and anorectal dynamics in patients with anal fistula

Objective:To explore the effects of Longdan Xiegan decoction for sitz bath combined with low incision and high thread-drawing on clinical efficacy,wound healing,epidermal growth factor and anorectal dynamics indexes in patients with anal fistula.Methods:A total of 102 patients with anal fistula of dampness-heat pouring downward type were enrolled.They were randomly divided into control group and observation group,51 cases in each group.The control group was treated with low incision and high thread-drawing,while observation group was treated with Longdan Xiegan decoction on basis of control group.The wound area,wound pain and wound healing time in both groups were observed after 1 d and 15 d of treatment.The clinical curative effect was evaluated.The levels of serum epidermal growth factor(EGF)and vascular endothelial growth factor(VEGF)were detected.The anorectal indexes rectal rest pressure(RRP),anal rest pressure(ARP),rectal longest contraction time(ALCT),anal maximal contraction pressure(AMCP)] were examined.Results:After treatment,wound pain,wound area and wound healing time in observation group were significantly lower than those in control group(P<0.05).There was no significant difference in the total response rate between the two groups(P>0.05).After treatment,levels of serum EGF and VEGF in observation group were significantly higher than those in control group(P<0.05).After 1 d of treatment,there was no significant difference in levels of serum EGF and VEGF between the two groups(P>0.05).There was no significant change in AMCP or ALCT between the two groups before and after treatment(P>0.05).There was no significant difference in levels of RRP and ARP between the two groups before treatment(P>0.05).The levels of RRP and ARP in observation group were significantly higher than those in control group(P<0.05).After treatment,RRP and ARP levels in both groups were significantly decreased(P<0.05).Conclusion:Longdan Xiegan decoction for sitz bath combined with low incision and high thread-drawing can promote wound healing and protect anal function in patients with anal fistula.