垫棉压迫法治疗低位复杂性肛瘘术后创腔闭合的临床研究(1)

http://www.100md.com 2019年6月15日 《世界中医药》 201912

     摘要 目的：觀察和研究垫棉压迫法治疗低位复杂性肛瘘术后创腔闭合的临床疗效。方法：选取2011年5月至2013年12月上海中医药大学附属龙华医院收治的低位复杂性肛瘘拖线术后患者60例作为研究对象，按照单盲、随机、对照的设计方法分为对照组、观察组A和观察组B，每组20例。观察组A(坐压4 h/d)、观察组B(坐压8 h/d)、对照组(自然压迫)，治疗结束后，观察3组疗效及愈合时间，并运用肛管直肠测压对治疗进行安全性评价。结果：3组患者创面愈合时间比较，观察组A、B的愈合速度明显优于对照组(P均<0.01)。分别比较治疗第3、5、7天创腔宽度减小率，观察组A、B加快创腔闭合的速度明显优于对照组(P均<0.01)，其中治疗第5天，坐压8 h/d的效果明显优于坐压4 h/d(P<0.01)。分别比较治疗第3、5、7天创腔内肉芽组织Collagen-Ⅰ、Collagen-Ⅲ含量，观察组A、B与对照组差异有统计学意义(P<0.01)，坐压2组之间比较，差异无统计学意义(P>0.01)。结论：垫棉压迫疗法作为“拖线疗法”治疗低位复杂性肛瘘的联合治疗方案能够有效促进瘘管创腔的快速闭合，减少瘢痕增生，缩短愈合时间。

    关键词 低位复杂性肛瘘;拖线疗法;垫棉压迫法;创面愈合

    Clinical Research of Pad Compression Therapy for Postoperative Wound Closure of Low-complex Anal Fistulae

    Shen Xiao，Cao Yongqing，Yao Yibo，Wang Chen，Liang Hongtao

    (Department of Anorectal Surgery，Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 200032，China)

    Abstract Objective：This study aimed to observe efficacy of pad compression therapy for postoperative wound closure of low-complex anal fistulae.Methods：This study includes 60 cases of low-complex anal fistulae patients after thread—dragging therapy.They are randomly divided into three groups as：(Study group A(pad compression 4 h/d)，Study group B(pad compression 8 h/d)and Control group(natural compression)according to the single blind，randomized and controlled design methods.The curative effect，time of healing，safety evaluation are all measured after treatment.Results：To time of healing，reduction rate of wound cavity，both two study groups are better than control group with significant difference.Study group B′wound healing better than study group A at 5 days after treatment(P<0.01).To Collagen-Ⅰ、Collagen-Ⅲ content，both two study groups are lower than control group with significant difference.Between two study groups，there was no significant difference(P>0.01).Conclusion：Combined with thread-dragging therapy，pad compression therapy can be used to accelerate closure of wound cavity of low-complex anal fistulae.It can reduce scar proliferation，shorten time of healing.

    Key Words Low-complex anal fistulae;Thread-dragging therapy;Pad compression therapy;Wound healing

    中图分类号：R266文献标识码：Adoi：10.3969/j.issn.1673-7202.2019.12.028

    复杂性肛瘘是肛瘘中的一种，指有2个或2个以上内口或外口，有2条以上瘘管或有支管、盲管的肛瘘[1-2]。由于复杂性肛瘘的病变部位高或管道弯曲复杂，常有支管及深部死腔存在，故治疗难度较大[3]，故一直以来国内外学者不断探索治疗复杂性肛瘘的微创治疗方法，以减轻对肛门组织功能的损伤，从而提高患者术后的生命质量[4]。我们采用“拖线疗法”与“垫棉压迫法”相结合治疗低位复杂性肛瘘，具有较好的临床效果，在此基础上进一步探索“垫棉压迫法”坐压时长与创面修复之间的量效关系。探索垫棉压迫治疗的坐压时间最佳值，作为指导临床垫棉压迫治疗的依据。现将结果报道如下。, 百拇医药(沈晓 曹永清 姚一博 王琛 梁宏涛)

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