观察中药浸渍-吸灌动态管理法管理高位复杂性肛瘘切开挂线术后创面的临床疗效。

将50例高位复杂性肛瘘患者随机分为两组，试验组（25例）术后采用中药浸渍-吸灌动态平衡法，对照组（25例）常规换药（凡士林纱布外敷创面）治疗。

两组患者在年龄、性别、病程长短、术后第1天创面渗液量、疼痛指数上，差异均无统计学意义（P＞0.05）；至术后第5天，试验组患者渗液量（36.60±5.48）mL，明显少于对照组（150.80±12.31）mL（t=42.384，P＜0.01）。在拆除负压海绵引流装置后，试验组的患者创面色泽红活，肉芽致密呈颗粒状，无明显水肿，评分平均为（1.40±0.65）分、（0.68±0.80）分，优于对照组（3.04±0.54）分、（2.48±0.51）分，由于5天内无更换纱布的疼痛，所以试验组疼痛指数（2.88±0.53）分，明显低于对照组（4.52±0.77）分（t=3.545，P＜0.01）。取少量创面组织做CD31免疫组化分析后，显示试验组的微血管密度［（22.91±4.00）个/mm²］明显多于对照组［（19.77±2.05）个/mm²］（t=3.493，P＜0.01）；在术后第10天，试验组患者已拆除负压引流装置，脱离负压吸引状态，恢复常规换药，创面重新受到外界微生物的感染、炎症刺激，渗液量较前期有所增多，平均（99.20±5.72）mL，但是对比同期对照组（114.60±9.46）mL，差异仍有统计学意义（t=6.969，P＜0.05）；在持续的换药过程中，腐肉渐脱，新肉渐长，术后第10、21天试验组肉芽生长质量和速度均优于对照组，试验组的创面肉芽色泽、肉芽致密程度评分（0.60±0.58）分、（0.24±0.44）分低于对照组，术后第14、21、28天试验组创面缩小率（0.117±0.014）、（0.243±0.009）、（0.369±0.017）快于对照组。

中药浸渍-吸灌动态管理法管理高位复杂性肛瘘切开挂线术后创面的疗效较好，能促进创面愈合，减少创面水肿，缓解创面疼痛，降低复发率。

To observe the clinical effect of sucking-irrigation balance method of traditional Chinese medicine in the management of wounds after high complex anal fistula operation.

Fifty patients with high complex anal fistula were randomly divided into two groups. The test group (25 cases) was treated with sucking-irrigation balance method of traditional Chinese medicine, and the control group (25 cases) was treated with routine dressing (vaseline gauze apply on the wound).

There were no significant differences in age, gender, duration of disease, wound exudation and pain index on the first day after surgery (P＞0.05); by the fifth day after operation, the exudation in the test group (36.60±5.48) mL was significantly less than the control group (150.80±12.31) mL (t=42.384, P＜0.01). After the negative pressure drainage device was removed, the patients in the test group had a reddish color and dense granules without obvious edema, the average score is (1.40±0.65) points, (0.68±0.80) points, better than the control group (3.04±0.54) points, (2.48±0.51) points, because there is no pain in changing the gauze within 5 days, so the test group pain index (2.88±0.53) points were significantly lower than the control group (4.52±0.77) points (t=3.545, P＜0.01). Taking a small amount of wound tissue for CD31 immunohistochemical analysis, the microvessel density of the test group[(22.91±4.00)个/mm²] was shown to be significantly more than the control group[(19.77±2.05)/mm²] (t=3.493, P＜0.01). On the 10th day after operation, the patients in the test group had removed the negative pressure drainage device, got rid of the negative pressure attraction state, resumed the routine dressing change, and the wound surface was re-infected by external microorganisms and inflammation. The exudation increased compared with the previous period, with an average of (99.20±5.72) mL, but compared with the control group (114.60±9.46) mL, there was still a statistical difference (t=6.969, P＜0.05); during the continuous dressing change, the carrion gradually detached and the new meat grew longer. The quality and speed of granulation growth in the test group were excellent on the 10th and 21st days after surgery. In the control group, the wound granulation color and granulation density score of the test group were (0.60±0.58) and (0.24±0.44) which were lower than those of the control group, and the reduction rate of the wound in the test group on the 14th, 21st, and 28th days after operation were (0.117±0.014), (0.243±0.009), (0.369±0.017) which were faster than the control groups.

The sucking-irrigation balance method of traditional Chinese medicine has a good effect on the management of wounds after high complex anal fistula operation, which can promote wound healing, reduce wound edema, relieve wound pain and reduce the recurrence rate.