五味消毒饮加味保留灌肠促进肛瘘术后创面愈合的临床观察

目的：观察五味消毒饮加味保留灌肠在减轻肛瘘术后并发症的临床疗效并探讨其作用机理。方法：在符合纳入标准的病例中选择60例病人，随机分为治疗组和对照组，各30例。两组患者均诊断为低位单纯性肛瘘，并采用低位单纯性肛瘘切开术，术后换药时分别给予五味消毒饮加味或复方黄柏液各30 mL保留灌肠，每日1次。详细观察创面渗液、色泽、肛周瘙痒情况，并评分，比较腐肉脱落时间、新生上皮出现时间、创面缩小率、创面愈合时间及术后第21天临床总疗效。结果：两组比较，创面渗液情况在术后第7天、第14天治疗组优于对照组，第21天两组无显著差异；创面色泽情况在术后第7 天、第14天治疗组优于对照组；肛周瘙痒情况在术后第7天、第14天、第21天治疗组优于对照组；创面腐肉脱落时间及新生上皮出现时间，治疗组均早于对照组；术后第7天、第14天、第21天两组创面缩小率无显著差异；术后第21天两组临床总疗效以及两组创面平均愈合时间均无明显差异。结论：五味消毒饮加味可缩短炎症反应阶段、减少创面渗出、减轻瘙痒症状，可使腐肉尽早脱，促进新生上皮组织生长。

Clinical Observation on Promotion Effect of Wound Healing Postoperative Anal Fistula by Retention Enema of Modified Wu-Wei Xiao-Du Decoction

This study was aimed to observe the promotion effect of wound healing retention enema for postoperative anal fistula by modified Wu-Wei Xiao-Du (WWXD) decoction, in order to explore its mechanism. A total of 60 patients who met the inclusion criteria were randomly divided into the treatment group and control group, with 30 cases in each group. Patients in both groups were diagnosed as simple low anal fistula and treated with low anal fistula incision. The retention enema of 30 mL modified WWXD decoction or complex Huang-Bai fluid were given once a day for postoperative dressing changes. Detailed observations and scores were made on wound exudate, color, and itching around the anus. The comparisons were made on carrion off time, new epithelium time, rate of wound-reducing, wound healing time, and the total clinical efficacy 21 days after operation. The results showed that the wound exudate on the 7th and 14th postoperative day was better than that of the control group. There was no significant difference on the 21st day between two groups. The wound color of the treatment group was better than that of the control group on the 7th and 14th postoperative day. The itching around anus of the treatment group was better than that of the control group on the 7th, 14th and 21st postoperative day. The carrion wound off time and new epithelium time of the treatment group were earlier than that of the control group. There was no significant difference on the rate of wound-reducing. There were no significant differences on the total clinical efficacy 21 days after operation as well as the total average healing time of both groups. It was concluded that modified WWXD decoction can shorten the inflammation phase, reduce the wound exudate and itching, promote early carrion fall and as well as the wound healing.