Abstract:

Objective　To explore the effect of Shengshu Sanhuang decoction combined with Zijie Shengji ointment on severe mixed hemorrhoids (damp heat bottom pour type) after surgery. Methods　This was a randomized controlled trial. A total of 188 patients with severe mixed hemorrhoids (damp heat bottom pour type) who underwent external peeling and internal ligation surgery in Shangqiu Hospital of Traditional Chinese Medicine from January 2021 to February 2023 were prospectively selected as the study objects, and were divided into group A, group B, group C, and group D according to the random number table method, with 47 cases in each group. In group A, 22 males and 25 females, aged (45.26±8.32) years, received routine intervention. In group B, 21 males and 26 females, aged (46.38±8.59) years, received routine intervention + Shengshu Sanhuang decoction. In group C, 20 males and 27 females, aged (47.13±8.67) years, received routine intervention + Zijie Shengji ointment. In group D, 23 males and 24 females, aged (45.89±8.45) years, received routine intervention + Shengshu Sanhuang decoction + Zijie Shengji ointment. Clinical indicators and levels of inflammatory factors and anal function before and after treatment were compared among the four groups, and the clinical efficacy and adverse events were compared among the four groups. t test, F test, and SNK-q test were used for the measurement data, and χ² test and rank sum test were used for the count data. Results　The pain time, edema time, bloody stool time, anal prolapse time, and wound healing time in group D [(7.15±1.59) d, (7.93±1.76) d, (6.23±1.38) d, (5.98±1.33) d, and (11.56±2.57) d] were shorter than those in group A [(8.97±1.99) d, (9.78±2.17) d, (7.82±1.74) d, (7.45±1.66) d, and (16.16±3.59) d], group B [(8.06±1.79) d, (8.86±1.97) d, (7.05±1.57) d, (6.73±1.51) d, and (14.39±3.24) d], and group C [(7.93±1.76) d, (8.75±1.94) d, (6.91±1.54) d, (6.65±1.48) d, and (13.38±2.97) d], with statistically significant differences (all P<0.05). After treatment, the levels of hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) and anal high-pressure zone length in the four groups were all lower than those before treatment, while the anal canal systolic blood pressure and anal canal resting pressure were both higher than those before treatment, with statistically significant differences (all P<0.05). After treatment, the levels of hs-CRP and TNF-α and anal high-pressure zone length in group D [(11.15±2.48) mg/L, (25.12±5.58) ng/L, and (2.47±0.54) cm] were lower than those in group A [(16.56±3.68) mg/L, (32.78±7.28) ng/L, and (3.05±0.68) cm], group B [(13.17±2.93) mg/L, (28.56±6.35) ng/L, and (2.77±0.62) cm], and group C [(12.56±2.79) mg/L, (27.88±6.21) ng/L, and (2.72±0.61) cm], with statistically significant differences (all P<0.05). After treatment, the anal canal systolic blood pressure and anal canal resting pressure in group D [(135.86±30.19) mmHg (1 mmHg=0.133 kPa) and (60.72±13.49) mmHg] were higher than those in group A [(111.38±24.75) mmHg and (49.76±11.06) mmHg], group B [(122.45±27.19) mmHg and (54.62±12.14) mmHg], and group C [(123.57±27.46) mmHg and (55.35±12.31) mmHg], with statistically significant differences (all P<0.05). The total effective rate of group D [95.74% (46/47)] was higher than that of group A, B, and C [70.21% (33/47), 80.85% (38/47), and 82.98% (39/47)], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse events among the four groups (P>0.05). Conclusion　Shengshu Sanhuang decoction combined with Zijie Shengji ointment has definite postoperative effect on patients with severe mixed hemorrhoids (damp heat bottom pour type) after surgery, which can effectively relieve the clinical symptoms, reduce the levels of inflammatory factors, and improve the anal function, with high safety.

Key words:

Mixed hemorrhoids, Damp heat bottom pour type, Shengshu Sanhuang decoction, Zijie Shengji ointment

摘要：

目的　探讨生熟三黄汤联合紫竭生肌膏在湿热下注型重度混合痔术后的作用。方法　本文为随机对照试验。前瞻性选取2021年1月至2023年2月于商丘市中医院接受外剥内扎术治疗的188例湿热下注型重度混合痔患者作为研究对象，按照随机数字表法分为甲、乙、丙、丁4组，各47例。甲组男22例、女25例，年龄（45.26±8.32）岁，采用常规干预；乙组男21例、女26例，年龄（46.38±8.59）岁，采用常规干预+生熟三黄汤治疗；丙组男20例、女27例，年龄（47.13±8.67）岁，采用常规干预+紫竭生肌膏治疗；丁组男23例、女24例，年龄（45.89±8.45）岁，采用常规干预+生熟三黄汤+紫竭生肌膏治疗。对比4组患者临床指标和治疗前后炎症因子水平、肛门功能，并比较4组患者临床疗效和不良事件发生情况。计量资料采用t检验、F检验、SNK-q检验，计数资料采用χ²检验、秩和检验。结果　丁组疼痛时间、水肿时间、便血时间、肛门下坠时间、创面愈合时间［（7.15±1.59）d、（7.93±1.76）d、（6.23±1.38）d、（5.98±1.33）d、（11.56±2.57）d］均短于甲组［（8.97±1.99）d、（9.78±2.17）d、（7.82±1.74）d、（7.45±1.66）d、（16.16±3.59）d］、乙组［（8.06±1.79）d、（8.86±1.97）d、（7.05±1.57）d、（6.73±1.51）d、（14.39±3.24）d］、丙组［（7.93±1.76）d、（8.75±1.94）d、（6.91±1.54）d、（6.65±1.48）d、（13.38±2.97）d］，差异均有统计学意义（均P<0.05）。4组治疗后超敏C-反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）及肛管高压带长度均低于治疗前，肛管收缩压、肛管静息压均高于治疗前，差异均有统计学意义（均P<0.05）。治疗后，丁组hs-CRP、TNF-α、肛管高压带长度［（11.15±2.48）mg/L、（25.12±5.58）ng/L、（2.47±0.54）cm］均低于甲组［（16.56±3.68）mg/L、（32.78±7.28）ng/L、（3.05±0.68）cm］、乙组［（13.17±2.93）mg/L、（28.56±6.35）ng/L、（2.77±0.62）cm］、丙组［（12.56±2.79）mg/L、（27.88±6.21）ng/L、（2.72±0.61）cm］，差异均有统计学意义（均P<0.05）。治疗后，丁组肛管收缩压、肛管静息压［（135.86±30.19）mmHg（1 mmHg=0.133 kPa）、（60.72±13.49）mmHg］均高于甲组［（111.38±24.75）mmHg、（49.76±11.06）mmHg］、乙组［（122.45±27.19）mmHg、（54.62±12.14）mmHg］、丙组［（123.57±27.46）mmHg、（55.35±12.31）mmHg］，差异均有统计学意义（均P<0.05）。丁组总有效率［95.74%（46/47）］高于甲组、乙组、丙组［70.21%（33/47）、80.85%（38/47）、82.98%（39/47）］，差异均有统计学意义（均P<0.05）。4组不良事件发生率比较，差异无统计学意义（P>0.05）。结论　生熟三黄汤联合紫竭生肌膏应用于湿热下注型重度混合痔术后疗效确切，可有效缓解患者临床症状，降低炎症因子水平，改善肛门功能，且安全性高。

关键词:

混合痔, 湿热下注型, 生熟三黄汤, 紫竭生肌膏