愈创汤治疗肛瘘术后创面瘢痕组织的疗效及其对胶原Ⅰ和胶原Ⅲ的影响

何大香 朱虹霖

摘要 目的：探究愈創汤治疗肛瘘术后创面瘢痕组织的疗效及其对胶原Ⅰ（Collagen-Ⅰ）、胶原Ⅲ（Collagen-Ⅲ）的影响。方法：选取2014年8月至2016年4月雅安市中医医院收治的肛瘘患者90例，随机分为观察组与对照组，各45例。对照组进行常规处理，观察组在常规处理基础上加用愈创汤治疗。比较2组临床疗效以及治疗前后Collagen-Ⅰ/Collagen-Ⅲ比值，对治疗前后肛门功能采用wexner评分进行评价，并记录不同时间愈合情况，同时检测血清人表皮生长因子（EGF）水平。结果：观察组治疗7 d后Collagen-Ⅰ/Collagen-Ⅲ显著高于对照组，观察组治疗7 d、14 d后EGF显著高于对照组，差异有统计学意义（P<0.05），2组治疗3 d后EGF差异无统计学意义（P>0.05），治疗3 d、14 d Collagen-Ⅰ/Collagen-Ⅲ差异无统计学意义（P>0.05）;治疗总有效率观察组与对照组比较，差异有统计学意义（P<0.05）;观察组术后10 d、14 d愈合率显著高于对照组（67.67%比48.67%，85.05%比65.77%），差异有统计学意义（P<0.05），术后7 d无差异无统计学意义（P>0.05）;对照组治疗前后wexner评分差异显著，治疗后观察组稀便、干便、气体、需衬垫、改变生活方式评分均显著低于对照组，差异有统计学意义（P<0.05）。结论：肛瘘术后常规处理愈合时间较长，加用愈创汤能够改善肛门功能，显著缩短愈合时间，可能与增加创面瘢痕组织EGF，调控Collagen-Ⅰ、Collagen-Ⅲ有关。

关键词 愈创汤;肛瘘术;创面瘢痕;临床疗效;作用机制;成纤维细胞Ⅰ;成纤维细胞Ⅲ;表皮生长因子

Efficacy of Yuchuang Decoction in the Anal Fistula Postoperative Wound Scar Tissue

and Effects on Collagen-Ⅰ and Collagen-Ⅲ

He Daxiang， Zhu Honglin

（The Anus of the Chinese Medicine Hospital of Ya′an City， Ya′an 625000， China）

Abstract Objective：To explore the efficacy of Yuchuang Decoction in the anal fistula postoperative wound scar tissue and its influence on fibroblasts Ⅰ （Collagen-Ⅰ） and fibroblasts Ⅲ （Collagen-Ⅲ）. Methods：A total of 90 patients with anal fistula after operation who were treated in our hospital from August 2014 to April 2016 were selected and randomly divided into observation group and control group. The control group received routine treatment， and observation group was added Yuchuang Decoction on the basis of conventional treatment. The clinical curative effects and Collagen-Ⅰ/Collagen-Ⅲ ratio before and after the treatment were compared， and the anal function using wexner score before and after the treatment was evaluated. The different time to heal was recorded， and the serum epidermal growth factor （EGF） level was detected. Results：Collagen-Ⅰ/Collagen-Ⅲ of observation group were significantly higher than the control group after 7 d treatment， and EGF was significantly higher than that of control group 7 d， 14 d after treatment， with statistical significance （P<0.05）. There was no significant difference in 3 d EGF of two groups. There were no significant differences in 14 d Collagen-Ⅰ/Collagen-Ⅲ （P>0.05）; There was no significant difference in the total effective rate between treatment group and control group （P<0.05）. The healing rate of 10 d and 14 d after surgery was significantly higher than that in the control group （67.67% vs 48.67 %， 85.05% vs 65.77%）， with statistical significance （P<0.05）， and no significant difference in 7 d after surgery （P>0.05）. There was significant difference in wexner score of control group before and after treatment. Scores of loose stools， dry stools， gas， need to pad， change the way of life of observation group after treatment were significantly lower than the control group， with statistical significance （P<0.05）. Conclusion：The healing time of postoperative anal fistula with conventional treatment is longer， and combined Yuchuang Decoction can improve the function of the anus， significantly shorten the healing time， and increase the wound scar tissue EGF， regulating the Collagen-Ⅰ， Collagen-Ⅲ.

Key Words Yuchuang Decoction; Anal fistula operation; Wound scar; Clinical effect; Mechanism of action; Collagen-Ⅰ; Collagen-Ⅲ; EGF

中图分类号：R289.5文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.03.021

肛瘘是较为常见的肛肠科疾病，病因复杂，中青年发病率较高，主要因肛门及直肠不同程度的损伤、肛裂、外科手术、反复感染等引起。临床症状集中在直肠与肛门，表现为流脓、肿痛、排便疼痛、肛门瘙痒等。该病治疗反复，干预治疗不及时可诱发一系列并发症，严重者甚至出现肛周癌，降低患者的生命质量。临床上主要依靠肛瘘手术治疗，但因其发病位置特殊，术后恢复时间长、伤口易受污染，肛门下坠感、渗液、疼痛等症频发。陆……