摘要
目的探究分期施方熏洗对肛瘘术后患者创面肉芽组织生成的影响。方法选取2022年1月到2023年11月于成都大学附属医院肛肠科接受肛瘘手术的患者120例,其中采用高锰酸钾药液熏洗治疗(对照组)和分期施方熏洗治疗(观察组)的患者各60例,采用倾向评分匹配法对两组患者的临床资料进行1∶1匹配,调整均衡性。比较两组患者临床疗效、创面愈合率,创面疼痛、水肿、分泌物评分,创面肉芽组织生成情况及创面肉芽组织免疫及炎症相关指标。采用广义估计方程模型(GEE)分析两组创面肉芽组织生成的影响程度及影响因素。结果两组患者的临床治疗总有效率分别为观察组100.00%(54/54)和对照组87.04%(47/54),观察组的临床治疗总有效率显著高于对照组(χ^(2)=7.485,P=0.006)。在经过对比研究后,术后7 d、14 d、21 d、28 d两组的创面愈合率均呈现显著增长,观察组术后7 d的创面愈合率与对照组比较差异无统计学意义(t=0.140,P=0.889),术后14 d(t=2.432,P=0.017)、21 d(t=3.210,P=0.002)、28 d(t=4.632,P<0.001)的愈合率均显著高于对照组。术后3 d、7 d、14 d,两组的创面疼痛、创缘水肿及分泌物评分均较术后1 d显著降低,且观察组的降低程度显著优于对照组(P<0.05)。同时,两组的肉芽组织生长评分在术后3 d、7 d、14 d均显著上升,其中观察组的增长幅度显著超过对照组(P<0.05)。术后3 d、7 d、14 d两组创面肉芽组织中的免疫相关指标CD86表达量较术后1 d显著降低(P<0.05),CD206、CD31表达量升高(P<0.05);炎症相关指标IL-1β表达量较术后1 d显著降低(P<0.05),VEGF、vWF表达量升高(P<0.05),观察组改善情况优于对照组(P<0.05)。经GEE分析可见,观察组术后创面组织中CD206、CD31、VEGF、vWF的升高程度和CD86、IL-1β的降低程度均优于对照组(P<0.05)。CD86、CD206、CD31、VEGF、vWF、IL-1β、治疗方法均显著影响患者创面肉芽组织生成(P<0.05)。结论分期施方熏洗对肛瘘术后创面具有显著疗效,能够促进创面愈合,改善患者症状,同时还能改善肉芽组织中CD86、CD206、CD31、IL-1β、VEGF、vWF的表达水平,安全可靠。
Objective Exploring the effect of staged fumigation and washing on the generation of granulation tissue on the wound of patients after anal fistula surgery.Methods 120 patients who underwent anal fistula surgery at the Colorectal Department of Chengdu University Affiliated Hospital from January 2022 to November 2023 were selected.Among them,sixty patients were treated with potassium permanganate solution fumigation(control group)and 60 patients were treated with staged formula fumigation(observation group).The clinical data of the two groups of patients were matched 1:1 using propensity score matching method to adjust the balance.Compare the clinical efficacy,wound healing rate,wound pain,edema,secretion scores,granulation tissue generation,and immune and inflammatory related indicators of granulation tissue between two groups of patients.Using Generalized Estimation Equation Modeling(GEE)to analyze the degree and influencing factors of granulation tissue generation in two groups of wounds.Results The total effective rates of clinical treatment in the two groups of patients were 100.00%(54/54)in the observation group and 87.04%(47/54)in the control group,respectively.The total effective rate of clinical treatment in the observation group was significantly higher than that in the control group(χ^(2)=7.485,P=0.006).After a comparative study,the wound healing rates of the two groups at 7,14,21,and 28 days after surgery showed a significant increase.There was no significant difference in the wound healing rate between the observation group and the control group at 7 days after surgery(t=0.140,P=0.889).The healing rates at 14 days after surgery(t=2.432,P=0.017),21 days after surgery(t=3.210,P=0.002),and 28 days after surgery(t=4.632,P<0.001)were significantly higher than those in the control group.On postoperative days 3,7,and 14,the wound pain,wound margin edema,and secretion scores in both groups were significantly reduced compared to postoperative day 1,and the degree of reduction in the observation group was significantly better than that in the control group(P<0.05).At the same time,the granulation tissue growth scores of both groups significantly increased on postoperative days 3,7,and 14,with the observation group showing a significantly greater increase than the control group(P<0.05).The expression levels of immune related markers CD86 in granulation tissue of two groups of wounds at 3,7,and 14 days after surgery were significantly reduced compared to 1 day after surgery(P<0.05),while the expression levels of CD206 and CD31 increased(P<0.05).The expression level of inflammation related indicators IL-1β was significantly reduced(P<0.05)compared to postoperative day 1,while the expression levels of VEGF and vWF increased(P<0.05).The improvement in the observation group was better than that in the control group(P<0.05).As observed by GEE,the increase in CD206,CD31,VEGF,and vWF levels and the decrease in CD86 and IL-1β levels in the postoperative wound tissue of the observation group were superior to those of the control group(P<0.05).CD86,CD206,CD31,VEGF,vWF,IL-1β and treatment methods significantly affected the generation of granulation tissue in patients'wounds(P<0.05).Conclusion Staged application of formula fumigation and washing has significant therapeutic effects on postoperative anal fistula wounds,promoting wound healing,improving patient symptoms,and also improving the expression levels of CD86,CD206,CD31,IL-1β,VEGF,and vWF in granulation tissue.It is safe and reliable.
作者
胡安丽
黄建
王建平
王晓培
陈宏亮
陈虹羽
Hu Anli;Huang Jian;Wang Jianping;Wang Xiaopei;Chen Hongliang;Chen Hongyu(Department of Proctology,Affiliated Hospital of Chengdu University,Chengdu 610081,China)
出处
《中华结直肠疾病电子杂志》
2024年第5期402-410,共9页
Chinese Journal of Colorectal Diseases(Electronic Edition)
基金
四川省中医管理局项目(No.2022JC0075)。
关键词
肛瘘
创面
分期施方熏洗
疗法
Anal fistulas
Wound
Staged prescription fumigation
Therapeutics
作者简介
通信作者:胡安丽,Email:24282279@qq.com。
