| 锡类散外用对低位单纯性肛瘘术后创面疼痛及瘢痕影响的临床研究 |
| Clinical Observation of the Effects of Applying Xi Lei Powder Externally on Postoperative Wound Pain and Scarring in Patients with Low Simple Anal Fistula |
| DOI： |
| 中文关键词: 锡类散 低位单纯性肛瘘 术后疼痛 术后瘢痕 创面愈合 |
| 英文关键词: Xi Lei Powder, low inter sphincteric anal fistula, postoperative pain, postoperative scar, wound healing |
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| 中文摘要: |
| 目的:研究锡类散外用对低位单纯性肛瘘术后创面疼痛及术后瘢痕的影响,并探讨其可能的作用机制。方法:共纳入患者60例,根据随机对照原则,分为观察组和对照组,每组选取30例患者。每位患者均在安徽中医药大学第一附属医院肛肠二科住院治疗,于腰麻下行“低位肛瘘切除术”,术后第1d开始换药,换药前予以痔瘘洗剂(院内制剂)坐浴熏洗,对照组使用凡士林纱条常规换药,观察组使用锡类散纱条,直至创面愈合。观察统计两组患者术后8ｈ及术后第1d、2d、3d、7d、14d的创面静息疼痛评分、术后72h内止痛药物使用情况、术后第1d及术后第14d血清肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)和白细胞介素-6(Interlukin-6,IL-6)含量、术后第3d、7d、14d创面渗液程度评分、创面愈合时间、术后第14w和18w患者和观察者瘢痕评估量表评分(POSAS评分)。结果:观察组患者术后第3ｄ、7ｄ、14ｄ的创面疼痛评分低于对照组(P<0.05)。总体创面愈合时间显著短于对照组(P<0.05)。术后72h内,观察组使用止痛药物的人数少于对照组(P<0.05)。术后第7d和第14d,观察组的创面渗液评分均低于对照组(P<0.05)。两组患者术后14w和18w的POSAS评分相比较,观察组均比对照组低(P<0.05)。术后第14d,两组患者血清TNF-α、IL-6的含量均低于术后第1d,两组相比较,观察组更低(P<0.05)。不良反应方面,观察组患者术后肉芽组织不良生长情况较少,仅6例患者需进行肉芽修剪,对照组有17例(P<0.05),在治疗过程中均未发生大出血、肛门失禁、肛周坏死等不良事件。结论:锡类散外用可以减轻低位单纯性肛瘘患者术后的创面疼痛、改善术后瘢痕的质量、减少术后创面肉芽组织的不良增生,缩短术后创面愈合时间。 |
| 英文摘要: |
| Objective The study aimed to assess the impact of topically applying Xi Lei Powder on postoperative wound pain and scar formation following low inter sphincteric fistulectomy, while exploring its potential mechanisms of action. Methods Sixty patients participated, divided randomly into an observation group and a control group, each consisting of 30 individuals. Procedures were conducted in the Second Ward of the Anorectal Department, First Affiliated Hospital of Anhui University of Chinese Medicine, with patients undergoing "low ? inter sphincteric fistulectomy" under spinal anesthesia. Dressing changes commenced the day after surgery, application of hemorrhoid fistula lotion followed by fumigation and hip bath prior to the dressing, with the control group using Vaseline gauze and the observation group utilizing Xi Lei Powder gauze until wound recovery. Various parameters such as wound pain scores at rest on postoperative days 1, 2, 3, 7, 14, and at 8 hours after the operation,analgesic drug usage within 72 hours postoperatively, TNF-α(Tumor Necrosis Factor-α) and IL-6(Interlukin-6) levels at postoperative day 1 and 14, wound exudate scores on days 3, 7, and 14, wound healing duration, and the Patient and Observer Scar Assessment Scale (POSAS) at weeks 14 and 18 postoperatively were monitored and statistically analyzed. Results On postoperative days 3, 7, and 14, the observation group exhibited lower wound pain scores compared to the control group (P < 0.05). The wound healing time was remarkably shorter in the observation group than in the control group (P < 0.05). Within the first 72 hours post-surgery, fewer patients in the observation group required analgesics compared to the control group (P < 0.05). Furthermore, on postoperative days 7 and 14, the observation group had reduced wound exudate scores in contrast to the control group (P < 0.05). When assessing the POSAS scores at 14 and 18 weeks post-surgery, the observation group demonstrated lower scores than the control group on both occasions (P < 0.05). Notably, on postoperative day 14, the serum ? levels of TNF-α and IL-6 decreased in both groups compared to preoperative day 1, with the observation group showing even lower levels than the control group (P < 0.05). Fewer adverse reactions were noted in the observation group, particularly a decrease in excessive granulate on tissue growth postoperatively, with only 6 patients necessitating granulation tissue trimming versus 17 patients in the control group (P < 0.05). No significant incidents of major bleeding or anal stenosis were reported during treatment. Conclusion External application of Xi Lei Powder may diminish postoperative pain, enhance postoperative scar quality, mitigate adverse granulation tissue proliferation, and expedite postoperative wound healing in individuals with low simple anal fistula. |
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