CN115814008A - Traditional Chinese medicine medicated thread for treating perianal abscess and application - Google Patents
Traditional Chinese medicine medicated thread for treating perianal abscess and application Download PDFInfo
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Abstract
The invention discloses a traditional Chinese medicine medicated thread for treating perianal abscess and application thereof. The traditional Chinese medicine liquid is prepared by decocting a traditional Chinese medicine composition, and the basic medicinal materials of the traditional Chinese medicine liquid at least comprise 26.5 to 34.5 parts of frankincense, 26.5 to 34.5 parts of lithospermum, 26.5 to 34.5 parts of dragon's blood, 35 to 45 parts of astragalus and 8.5 to 11.5 parts of liquorice in parts by mass. Compared with the conventional mode of one-time radical operation of perianal abscess and conventional dressing change treatment, the operation double-string treatment and conventional dressing change treatment for perianal ischia rectal interstitial abscess by adopting the traditional Chinese medicine thread can effectively shorten the healing time of the wound surface after the operation and protect the anus function.
Description
Technical Field
The invention relates to the technical field of traditional Chinese medicine, in particular to a traditional Chinese medicine medicated thread for treating perianal abscess and application thereof.
Background
Medicated thread drainage is a traditional Chinese medicine external treatment method, and is first seen in the Taiping Shenghui Fang. The current medicated thread is widely applied to the surgical treatment of perianal abscess, especially high-position perianal abscess as one category of thread used in thread-hanging therapy. The medical thread and thread hanging therapy is applied to the operation treatment of perianal abscess, so that the pain degree and the duration of the wound surface after the perianal abscess operation can be reduced, the thread-off time is shortened, and the wound surface healing is promoted.
The thread-hanging therapy is a special feature of traditional Chinese medicine, is widely used for perianal abscess, especially for surgical treatment of high-position perianal abscess, has the advantages of having small influence on the function of anal sphincter, avoiding the problem of complete anal incontinence caused by cutting off the anal sphincter in perianal abscess surgery, reducing the defect of anal canal and surrounding tissues and ensuring smooth drainage.
However, the preparation of various medical lines in the prior art lacks of exact traditional Chinese medicine theory guidance, the effect of promoting wound healing is not outstanding, and the requirement of clinical postoperative recovery of perianal abscess cannot be met; the thread hanging therapy in the prior art can avoid the problem of complete incontinence of the anus, but can still cause the anal canal to be damaged in different degrees, thereby resulting in air leakage and liquid leakage of the anus.
Disclosure of Invention
In view of the defects and shortcomings of the prior art, the invention provides a traditional Chinese medicine medicated thread for treating perianal abscess, a preparation method and innovative application thereof, and aims to solve the problems that the effect of promoting wound healing is not outstanding, anal canal defects of different degrees are caused by thread hanging therapy, and anus leakage is caused.
In order to achieve the purpose, the invention adopts the main technical scheme that:
in a first aspect, the present invention provides a traditional Chinese medicine medicated thread for treating perianal abscess, wherein the medicated thread is obtained by decocting or soaking silk thread in a traditional Chinese medicine liquid prepared from a traditional Chinese medicine composition, and the traditional Chinese medicine composition comprises: 26.5 to 34.5 parts of frankincense, 26.5 to 34.5 parts of lithospermum, 26.5 to 34.5 parts of dragon's blood, 35 to 45 parts of astragalus and 8.5 to 11.5 parts of liquorice.
According to a preferred embodiment of the invention, the wire is a surgical 7 gauge wire.
According to a preferred embodiment of the present invention, the Chinese medicinal composition comprises: 30 parts by mass of frankincense, 30 parts by mass of lithospermum, 30 parts by mass of dragon's blood, 40 parts by mass of astragalus and 10 parts by mass of liquorice.
According to the preferred embodiment of the invention, the preparation method of the traditional Chinese medicine medicated thread comprises the following steps:
s1, preparing water according to the mass of 1.8-2.5 times of the medicinal materials, boiling astragalus membranaceus in the water for 30-35min, removing residues, continuing to add frankincense, lithospermum, dragon' S blood and liquorice, continuing to boil, concentrating to 0.35-0.50 times of the original volume, putting a No. 7 surgical silk thread into the medicinal liquid, decocting with slow fire until the medicinal liquid is soaked in a dry or aseptic environment for 30-60 days, and taking out the silk thread;
s2, placing and airing the silk threads, then carrying out high-pressure steam sterilization to obtain the traditional Chinese medicine medicated thread for treating perianal abscess, and then storing the medicated thread in a dark place.
Wherein, the dragon's blood is sweet, salty and mild in taste and is nontoxic; entering liver and heart meridians; has effects in promoting blood circulation, relieving pain, dispelling blood stasis, stopping bleeding, healing sore, and promoting granulation. The frankincense is pungent and bitter in taste and warm in nature and enters liver, heart and spleen channels; has effects of promoting blood circulation, activating qi-flowing, relieving pain, eliminating swelling and promoting granulation. Radix Arnebiae is sweet, salty and cold in flavor, and enters heart and liver meridians; has effects of clearing heat, cooling blood, promoting blood circulation, removing toxic substances, and promoting eruption. Astragalus root, radix astragali, sweet in taste and bitter in flavor, slightly warm in nature, enters lung and spleen meridians; has effects in invigorating spleen and stomach, invigorating yang, supporting the depressed vital energy, consolidating superficial resistance, promoting urination, removing toxic materials, and promoting granulation. The liquorice is sweet and neutral in nature and enters heart, lung, spleen and stomach meridians; has the effects of invigorating spleen and replenishing qi, eliminating phlegm and relieving cough, relieving spasm and pain, clearing away heat and toxic materials, and harmonizing the medicines.
The traditional Chinese medicine liquid used by the invention is prepared by decocting the components under the guidance of the theory of the simmered pus and fleshy flesh method, wherein the dragon's blood and the frankincense mainly promote blood circulation to remove blood stasis, heal sores and promote tissue regeneration, can reach the qi and blood of the wound surface and promote resuscitation; the lithospermum has cold nature, can cool blood and clear heat, activate blood and remove toxicity, excels in eliminating toxic heat remained on the wound surface and activates blood to dissipate blood stasis; astragalus root, radix astragali, being warm in nature, has the effects of expelling toxin and pus, healing sore and promoting granulation, and can nourish the body fluid of wound surface, warm pus and grow flesh; licorice root, radix Glycyrrhizae is designed to regulate and help warm and tonify; the combination of five flavors can achieve the effect of stewing pus and harmonizing warmth.
In a second aspect, the present invention also provides a traditional Chinese medicine medicated thread for treating perianal abscess, wherein the medicated thread is obtained by decocting or soaking silk thread in a traditional Chinese medicine liquid prepared from a traditional Chinese medicine composition, and the traditional Chinese medicine composition comprises: 26.5 to 34.5 parts of frankincense, 26.5 to 34.5 parts of lithospermum, 26.5 to 34.5 parts of dragon's blood, 35 to 45 parts of astragalus, 8.5 to 11.5 parts of liquorice, 15 to 18 parts of angelica and 1 to 3 parts of perilla oil.
The radix Angelicae Dahuricae has effects of removing necrotic tissue, promoting granulation and resisting allergy. Perilla oil can reduce the production of allergic substance (leucotriene and intermediate platelet aggregation activating factor), and the rosmarinic acid contained in the perilla oil is a kind of aromatic acid compound, has antioxidant effect, can inhibit anaphylaxis, and can reduce skin pruritus or allergic condition.
According to the preferred embodiment of the invention, the preparation method of the traditional Chinese medicine medicated thread comprises the following steps:
s1, preparing water according to the mass of 1.8-2.5 times of the medicinal materials, boiling astragalus membranaceus in water for 30-35min, removing residues, continuing to add frankincense, lithospermum, dragon' S blood, liquorice and angelica dahurica, continuing to boil, concentrating to 0.35-0.50 time of the original volume, putting No. 7 surgical silk into the medicinal liquid, decocting with slow fire until the medicinal liquid is soaked in a dry or sterile environment for 30-60 days, and taking out the silk;
s2, placing and airing the silk threads, and then performing high-pressure steam sterilization (20 minutes at 121 ℃ or 30 minutes at 115 ℃);
s3, soaking the silk thread into perilla oil for 1-3min, taking out, drying in the shade in a clean and sterile environment,
the traditional Chinese medicine medicated thread for treating perianal abscess is obtained, and then the medicated thread is stored in dark.
Perilla oil mainly has antiallergic and surface smoothness improving effects. The perilla oil should be soaked at last, so as to prevent the perilla oil from being heated and denatured or volatilized and dispersed during high-pressure steam sterilization.
In a third aspect, the present invention also provides a traditional Chinese medicine medicated thread for treating perianal abscess, wherein the medicated thread is obtained by decocting or soaking silk thread in a traditional Chinese medicine liquid, the traditional Chinese medicine liquid is prepared from a traditional Chinese medicine composition, and the traditional Chinese medicine composition comprises: 26.5 to 34.5 parts of frankincense, 26.5 to 34.5 parts of lithospermum, 26.5 to 34.5 parts of dragon's blood, 35 to 45 parts of astragalus, 8.5 to 11.5 parts of liquorice, 15 to 18 parts of angelica dahurica, 1 to 3 parts of perilla herb oil, 5 to 10 parts of galangal and 5 to 10 parts of coptis root.
The main component of the coptis is berberine, has broad-spectrum antibacterial effect and can obviously inhibit various cocci and bacilli. The rhizoma Alpiniae Officinarum has effects of clearing heat and detoxicating, promoting blood circulation and relieving swelling, and can be used for treating soft tissue injury.
According to the preferred embodiment of the invention, the preparation method of the traditional Chinese medicine medicated thread comprises the following steps:
s1, preparing water according to the mass of 1.8-2.5 times of the medicinal materials, boiling astragalus membranaceus in water for 30-35min, removing residues, continuing to add frankincense, lithospermum, dragon' S blood, liquorice, angelica dahurica and coptis chinensis, continuing to boil, concentrating to 0.35-0.50 time of the original volume, putting No. 7 surgical silk into the medicinal liquid, decocting with slow fire until the medicinal liquid is soaked in a dry or sterile environment for 30-60 days, and taking out the silk;
s2, placing and airing the silk threads, and then performing high-pressure steam sterilization;
s3, cleaning and airing the galangal, scrubbing and disinfecting the surface of the galangal with disinfectant alcohol, mashing the galangal, filtering to obtain residue-free juice, diluting the juice with 1-3 times of distilled water, atomizing and spraying the diluted juice on the surface of the silk threads, and drying in the shade in a clean and sterile environment;
s4, soaking the silk threads into perilla oil for 1-3min, taking out, drying in the shade in a clean and sterile environment to obtain the traditional Chinese medicine thread for treating perianal abscess, and storing in the dark.
The application of the traditional Chinese medicine thread according to any one of the schemes in preparing thread-hanging treatment materials for treating perianal abscess, ischial-rectal gap abscess or anal fistula.
The beneficial effects of the invention are:
the invention provides a traditional Chinese medicine medicated thread for treating perianal abscess, which is prepared by decocting or soaking No. 7 silk threads in traditional Chinese medicine liquid medicine for surgical operation, wherein the formula for preparing the traditional Chinese medicine liquid medicine is a medicine prescription under the guidance of the theory of simmering pus and growing meat, and the basic medicinal materials such as frankincense, lithospermum, dragon's blood, astragalus, liquorice and the like are reasonably proportioned and decocted. The dragon's blood and the frankincense mainly promote blood circulation to remove blood stasis, heal sores and promote tissue regeneration, can smooth qi and blood of wound surfaces and promote regeneration by relaxing; the lithospermum has cold nature, can cool blood and clear heat, promote blood circulation and remove toxicity, thoroughly remove toxic heat remained on the wound surface, and promote blood circulation to dissipate blood stasis; astragalus root, radix astragali, being warm in nature, has the effects of expelling toxin and pus, healing sore and promoting granulation, and can nourish the body fluid of wound surface, warm pus and grow flesh; licorice root, radix Glycyrrhizae is designed to regulate and help warm and tonify; the combination of five flavors can achieve the effect of stewing pus and harmonizing warmth. The perianal abscess Chinese medicinal line is used for surgical hanging-line treatment of perianal ischial rectal interstitial abscess, so that the wound healing time after operation can be effectively shortened, and the wound healing quality is improved.
Meanwhile, the perianal abscess traditional Chinese medicine thread is used for surgical thread-hanging treatment of ischial rectal interstitial abscess by combining a double-hanging method of the medicine thread, can obviously reduce the recurrence rate of perianal abscess and the formation rate of anal fistula, furthest reduce the damage to internal and external sphincters, protect the anus function, and solve the problems of anal canal defect of different degrees, anal air leakage, liquid leakage and the like caused by thread-hanging therapy in the prior art.
The traditional Chinese medicine thread for treating perianal abscess is prepared by using the theory of the traditional Chinese medicine 'simmered pus and long-meat method' as guidance and dispensing the medicine, and has remarkable effects of shortening the healing time of a wound surface and improving the healing quality of the wound surface by external application through long-term clinical observation, and is safe and has no toxic or side effect.
Detailed Description
For a better understanding of the present invention, reference will now be made in detail to the present invention by way of specific embodiments thereof.
The traditional Chinese medicine medicated thread of the invention has the following formula principle: the traditional Chinese medicine composition is prepared by taking the traditional Chinese medicine theory of 'pus-stewing and meat growing' as guidance and combining the characteristics of the wound surface after perianal ischiarectal space abscess operation and a prescription. The method for promoting pus secretion of wound surface is a special therapy for wound surface with slough removed and new flesh difficult to grow in traditional Chinese medicine, and specifically comprises the step of externally applying Chinese herbal medicine ointment or powder on the wound surface to promote pus secretion of the wound surface so as to carry pathogenic factors out in the process of wound surface healing. The "pus-stewed meat-growing" has been a surgical treatment with the characteristics of traditional Chinese medicine for a long time. There is cloud in Tang Dynasty Sun Simiao's "Bei Jie Qian jin Yao Fang": the specific discussion of the disease stages with ordered and quantitative evidence-based drug cutting provides not only a method for debridement and granulation promotion of the drugs, but also a clinical practice foundation for the simmered suppurative fleshy meat growth method. Ming dynasty Shen Dou Yuan put forward the specific concept of simmered pus-growing meat in the 'medical treatise on open air of surgery and Ming chuang Yi Bian' for the first time, emphasizes that the Taiyi paste can be pasted to the simmered pus-growing meat only when the open toxin is determined and the muscle is not grown, not only the application time of the simmered pus-growing meat is regulated, but also the specific operation method is clarified. Later, many doctors have further discussed and perfected the "pus-removing and meat-growing method" in the related works, for example, chen Shigong further details the refining method of the recipes for removing putrefaction and for removing pus and meat-growing (red lead, shengji san, etc.) in "orthodox surgery", wang Weide points out the "pus-removing mechanism that pus is generated and qi and blood is generated due to pus in" the Collection of the general surgery ". Therefore, the perianal abscess traditional Chinese medicine line has deep theoretical inheritance.
The following are specific examples of the present invention.
Example 1
The embodiment provides a traditional Chinese medicine medicated thread for treating perianal abscess, which is formed by decocting No. 7 thread for surgical operation in traditional Chinese medicine liquid, wherein the traditional Chinese medicine liquid is prepared from the following raw materials by weight: 30g of frankincense, 30g of lithospermum, 30g of dragon's blood, 40g of astragalus and 10g of liquorice. The preparation method comprises the following steps:
(1) Boiling radix astragali in 250mL water for 30min, removing residue, adding Olibanum, radix Arnebiae, sanguis Draxonis, radix astragali, and Glycyrrhrizae radix, boiling to 100mL, adding number 7 silk thread, decocting with slow fire until the liquid medicine is dry, and taking out the silk thread;
(2) And (3) placing the silk threads under the sunshine, drying, sterilizing by high-pressure steam to obtain the traditional Chinese medicine medicinal thread for treating perianal abscess, and filling a brown bottle for keeping in the dark for later use.
The application method comprises the following steps: the medicinal string is combined with the medicinal string double-hanging method, and is used for hanging the surgical string for perianal abscess in ischiorectal space, in particular to a string which is respectively led into an abscess inner opening and the highest point of the abscess through an anal internal and external sphincter intermeatus.
Example 2
The embodiment provides a traditional Chinese medicine medicated thread for treating perianal abscess, which is formed by infusing No. 7 thread for surgical operation in traditional Chinese medicine liquid, wherein the traditional Chinese medicine liquid is prepared from the following raw materials by weight: 33g of frankincense, 32g of lithospermum, 32g of dragon's blood, 44g of astragalus and 11.5g of liquorice. The preparation method comprises the following steps:
(1) Boiling radix astragali in 300mL water for 30min, removing residue, adding Olibanum, radix Arnebiae, sanguis Draxonis, radix astragali, and Glycyrrhrizae radix, boiling to 120mL, adding number 7 silk thread, sealing and soaking in sterile environment for 30 days, and taking out silk thread;
(2) And (3) placing the silk threads under the sunshine, drying, sterilizing by high-pressure steam to obtain the traditional Chinese medicine medicinal thread for treating perianal abscess, and filling a brown bottle for keeping in the dark for later use.
The application method is the same as in example 1.
Example 3
The embodiment provides a traditional Chinese medicine medicated thread for treating perianal abscess, which is formed by soaking No. 7 thread for surgical operation in traditional Chinese medicine liquid, wherein the traditional Chinese medicine liquid is prepared from the following raw materials by weight: 30g of frankincense, 30g of lithospermum, 30g of dragon's blood, 40g of astragalus, 10g of liquorice, 1691 g of angelica dahurica and 3g of perilla oil. The preparation method comprises the following steps:
(1) Boiling radix astragali in 400mL water for 30min, removing residue, adding Olibanum, radix Arnebiae, sanguis Draxonis, radix astragali, radix Angelicae Dahuricae, and Glycyrrhrizae radix, boiling to 160mL, adding the prepared No. 7 silk thread, decocting with slow fire until the liquid medicine is dried, and taking out the silk thread;
(2) Drying the silk in the sun, and sterilizing with high pressure steam;
(3) Soaking the silk thread in perilla oil for 2min, taking out, drying in the shade in a clean and sterile environment to obtain the traditional Chinese medicine medicated thread for treating perianal abscess, and packaging into brown bottles for keeping in the dark for later use.
The application method is the same as in example 1.
Example 4
The embodiment provides a traditional Chinese medicine medicated thread for treating perianal abscess, which is formed by soaking No. 7 thread for surgical operation in traditional Chinese medicine liquid. The traditional Chinese medicine liquid is prepared from the following raw materials in parts by weight: 30g of frankincense, 30g of lithospermum, 30g of dragon's blood, 40g of astragalus, 10g of liquorice, 1lg of angelica dahurica, 3g of perilla oil, 9g of coptis chinensis and 7g of galangal. The preparation method comprises the following steps:
(1) Boiling radix astragali in 400mL water for 30min, removing residue, adding Olibanum, radix Arnebiae, sanguis Draxonis, radix astragali, radix Angelicae Dahuricae, and Glycyrrhrizae radix, boiling to 150mL, adding number 7 silk thread, decocting with slow fire until the liquid medicine is dry, and taking out the silk thread;
(2) Drying the silk in the sun, and sterilizing with high pressure steam;
(3) Cleaning rhizoma Alpiniae Officinarum, air drying, cleaning with sterilized alcohol and aseptic cotton, mashing rhizoma Alpiniae Officinarum, filtering to obtain residue-free juice, diluting the juice with 3 times of distilled water, atomizing and spraying onto silk thread surface, and drying in the shade in clean and sterile environment;
(4) Soaking the silk thread in perilla oil for 2min, taking out, drying in the shade in a clean and sterile environment to obtain the traditional Chinese medicine medicated thread for treating perianal abscess, and packaging into brown bottles for keeping in the dark for later use.
The application method is the same as in example 1.
By adopting the traditional Chinese medicine thread prepared in the above examples 1-4 and combining the double-hanging method of the thread, the thread-hanging treatment is carried out on the perianal ischial rectal interstitial abscess, the wound healing time can be effectively shortened, the recurrence rate of the perianal abscess and the anal fistula formation rate can be reduced, the sphincter can be kept, and the anal function can be protected.
Clinical trials of medicated thread
In order to prove the clinical effect of the traditional Chinese medicine thread, a subject group carries out a single-center random contrast study on perianal abscess treated by double-thread hanging between anal sphincters in subsidiary hospitals of Jiangxi traditional Chinese medicine university (batch number: JZFYKYLL 20200420007), which is relevant to the invention, and the invention has proved that the traditional Chinese medicine thread has outstanding clinical effect, safety and no side effect.
The following are the clinical randomized control experimental data for the double-hanging surgical string treatment of ischiorectal interstitial abscess using the traditional Chinese medicine string (observation group) of example 1 and the simple silk thread (control group) without soaking in the liquid medicine, respectively:
1. clinical efficacy and relapse rate of two groups of patients were compared: the difference between the clinical curative effect of two groups of patients after operation and treatment has statistical significance (P is less than 0.05), while the difference between the relapse rate of two groups of patients has no statistical significance (P is more than 0.05).
Table 1: clinical efficacy and recurrence Rate (%)
2. Wound healing time and hospital days of two groups of patients were compared: the comparative difference of wound healing time of two groups of patients after treatment has statistical significance, and the comparative difference of the hospitalization days has no statistical significance. (P < 0.05)
Table 2: wound healing and hospitalization time of two groups of patients (
±s）
Note: * P <0.05 compared to control.
3. Wound score comparison for two groups of patients: the wound surface score mainly covers wound surface seepage, edema, granulation tissue growth and wound surface pain degree, the scores of 7 th and 14 th days after operation of two groups of patients are lower than those of the first day, the difference has statistical significance (P is less than 0.05), and the wound surface condition of the two groups of patients is obviously improved. Compared with the control group, the wound surface exudate edema and pain conditions of the observation group are improved more obviously (P is less than 0.05) on the seventh postoperative day, but compared with the improvement conditions of the two groups of patients with wound surface granulation growth conditions, the difference of the wound surface scores of the two groups of patients is not statistically significant (P is more than 0.05). On the fourteenth postoperative day, the scores of the wound surfaces of the patients in the observation group are obviously superior to those of the patients in the control group (P is less than 0.05), and the wound surface condition is obviously improved.
Table 3: comparison of wound scores in two groups of patients (
±s）
Note: compared with the first day of the group, P is less than 0.05; * P <0.05 compared to control.
4. The resting pressure of the anal canal of two groups of patients and the maximum systolic pressure change of the anal canal are compared: the resting pressure of the anal canal and the maximum contraction pressure of the anal canal of two groups of patients rise after operation, the resting pressure of the anal canal and the maximum contraction pressure of the anal canal of an observation group are first after operation, the resting pressure and the maximum contraction pressure of the anal canal are improved more obviously in the third month compared with a control group, and the difference has statistical significance (P is less than 0.05).
Table 4: the resting anal canal pressure and the maximum systolic anal canal pressure of the two groups of patients were compared (kPa,
±s）
note: compared with the first day of the group, P is less than 0.05; * P <0.05 compared to control.
In order to demonstrate the difference in clinical effects between the herbal lines prepared in the different examples, the subject groups further tested the herbal lines prepared in examples 1 and 3 to 4 in clinical trials. The clinical trial details are as follows:
1. a subject: the subjects were 240 perianal abscess ischiorectal interstitial type abscess patients.
2. The source of the cases is: all subjects were diagnosed in anorectal department of subsidiary hospitals of the university of traditional Chinese medicine in Jiangxi, diagnosed as perianal ischial rectal interstitial abscess and were subjected to perianal abscess surgical treatment, and were randomly and blindly brought into experiments according to diagnosis and exclusion standards of the United states guide for treatment of perianal abscess and anal fistula and the Standard for the diagnosis and treatment of the traditional Chinese medicine syndrome in the republic of China, namely the Standard for the treatment of the perianal abscess and anal fistula in 2011.
3. Diagnostic criteria
(1) Western diagnostic criteria: refer to the guidelines for perianal abscess and anal fistula treatment (us, 2011 edition). Diagnosis typically combines clinical symptoms with imaging examinations.
(1) The local red swelling and pain with wave motion and no obvious general symptoms generally exist, which is located in the gaps below levator ani and belongs to low perianal abscess, including ischial rectal gap abscess, perianal subcutaneous abscess and sphincter muscle gap abscess.
(2) The general symptoms of chill, high fever, hypodynamia, rapid pulse and the like appear. The patients with increased total number of blood leukocytes and neutrophils, and pus can be drawn out by local puncture, which are located in the gaps above levator ani and belong to high perianal abscess, including pelvic-rectal gap abscess, postrectal gap abscess, and submucosal rectal abscess.
(3) Transluminal ultrasound or perianal magnetic resonance examination is shown as perianal abscess.
(2) The traditional Chinese medicine diagnosis and dialectical standard (refer to the Chinese medicine industry standard of the people's republic of China and the standard of curative effect of diagnosis of traditional Chinese medicine syndrome): the anal diseases mainly manifest by fever, aversion to cold, red swelling, burning and pain of the anus and easy anal fistula formation after being melted and ulcerated.
4. Inclusion criteria were:
(1) the medicine accords with the diagnosis standard of the middle and western medicine of perianal abscess, and belongs to a patient with ischial-rectal interstitial abscess caused by glandular infection;
(2) age 18 to 65 years;
(3) the surgical method adopted by the research institute can be tolerated, and no surgical contraindications exist;
(4) the relevant laboratory checks that no obvious abnormality is found;
(5) agreeing to surgery and willing to participate in clinical trials and signing the consenter;
(6) postoperative consenting to the follow-up patients.
5. Exclusion criteria:
(1) patients with other perianal diseases, enteritis, malignant tumor, HIV, etc.;
(2) pregnant and lactating women;
(3) patients with serious cardiovascular and cerebrovascular diseases, mental diseases, autoimmune diseases or malignant tumors;
(4) (iv) participants in other drug trials;
(5) other factors that may affect the results;
(6) refusing the follow-up
6. Culling and shedding case criteria:
(1) those who develop adverse events, complications;
(2) those who are not matched with treatment and clinical observers
(3) Those who participate in other treatments to affect outcome;
(4) incomplete data
7. And (3) random grouping: generating random number on computer by SAS software package according to simple random division method, filling random division
Allocating cards, marking serial numbers and grouping, and filling in opaque and sealed envelopes.
Blind method: the clinical experiment adopts a single blind design, the testee does not know the grouping of the testee, and three separation steps, namely, the separation of an implementer, a recorder and an analyst, are carried out to avoid human factors.
Comparison: in the clinical experiment, a control group is established and compared with an observation group for comparison and research, namely the observation group 1 adopts the traditional Chinese medicine line combined with the line double-hanging method and the conventional dressing change treatment of the perianal abscess prepared in the embodiment 1; the observation group 2 adopts the traditional Chinese medicine medicated thread combined medicated thread double hanging method of perianal abscess prepared in the embodiment 3 and the conventional dressing change treatment; the observation group 3 adopts the traditional Chinese medicine medicated thread combined medicated thread double hanging method of the perianal abscess prepared in the example 4 and the conventional dressing change treatment, and the control group adopts the one-time radical operation of the perianal abscess and the conventional dressing change treatment.
8. And (3) surgical treatment:
(1) anorectal department is prepared before the routine operation.
1) Relevant laboratory examinations such as hematology, biochemical complete set, PT series, hepatitis series, syphilis + HIV, tumor series, electrocardiogram, chest CT, perianal MRI, etc. are perfected.
2) The disease condition is controlled by the broad-spectrum antibiotic which is given regularly as soon as possible, sufficient and standard, and symptomatic treatment such as pain relieving, fever reducing, electrolyte correcting and the like is given.
3) Skin preparation before operation and cleaning enema.
4) Before operation, the patients and family members are communicated with the disease condition and the risk after operation, and the patients and family members sign an operation treatment consent form after understanding and consent.
(2) The anesthesia is performed by lumbar spinal anesthesia.
(3) The operation method comprises the following steps:
9. and (5) observing the group, and performing the operation of the medical line double-hanging method. After lumbar anesthesia, taking a proper position of a patient, spreading a towel by conventional disinfection, probing an index finger into the anus to find out the abscess part of the patient, determining the range, and searching whether an original internal orifice exists; observing whether the patients have pus overflow, red swelling and other conditions at the anal crypt through an anoscope and determining the position of an inner opening; an arc-shaped or radial incision is made at the position with obvious central fluctuation of the abscess, the skin and subcutaneous tissues are incised, after the pus is fully discharged, hydrogen peroxide and normal saline are adopted to flush the abscess cavity in sequence, and the internal and external sphincters are separated along the intertrochanteric canal. And (3) binding the medicated thread corresponding to each observation group on one side of the probe, then slowly probing the probe bound with the medicated thread from the inter-sphincter ditch into the anus, searching the inner opening, penetrating out the pulled medicated thread from the inner opening, closing and ligating, penetrating the probe bound with the medicated thread from the inter-sphincter ditch into the external sphincter, entering the pus cavity, penetrating out from the cut position at the highest position of the pus cavity, pulling out the medicated thread from the pus cavity, closing and ligating two ends, cleaning pus, secretion and necrotic tissues in the wound cavity of the patient and the periphery of the wound by using normal saline after thorough hemostasis, and then disinfecting and binding by using an iodophor cotton ball.
10. Control group: the one-time radical operation of perianal abscess is implemented, a patient takes a proper body position after lumbar anesthesia, a conventional disinfection drape is used for determining the position of an inner opening and the scope of the abscess, a radial fusiform incision taking an anus as the center is made on the skin at the abscess part, free skin is cut off, pus is discharged, a probe is used for probing into the abscess cavity and probing out from the inner opening, tissues from the inner opening to the abscess cavity are cut along the probe, wound edges at two sides are trimmed, necrotic tissues around the inner opening and in the abscess cavity are removed, so that the drainage is smooth, and an iodophor tampon is used for disinfection and bandaging.
11. Post-operative treatment
1) Observation groups for each group: after the operation, the patient is taken out of the pillow and lies flat for 6 hours, the patient is forbidden to drink for 6 hours, broad-spectrum antibiotics and electrolytes are used for supplementing, nutrition support is enhanced, the routine laboratory tests of blood, blood sedimentation, liver function, kidney function, blood coagulation function and the like are periodically reviewed after the operation until all indexes are recovered to be normal, the medical line is kept for five days before the operation to carry out local dressing change, normal saline is used for washing the wound surface, and iodophor cotton balls are used for dressing change.
2) Control group: the conventional treatment is the same as that of the observation group, and the local dressing change operation is performed after the operation, the wound surface is washed by normal saline, and the dressing change is performed by an iodophor cotton ball.
12. Observation method
Through the combination of clinical observation, outpatient reexamination and telephone follow-up, the pain scores, the anus functions, the wound healing time, the perianal abscess recurrence rate and the anal fistula formation rate of two groups of patients are compared, and the observation time of all the patients is 120 days.
13. Observation index
(1) Pain: the pain conditions of three groups of patients at the same time point on the day of operation and 1, 2, 3, 7 and 30 days after operation were evaluated by Visual Analogue Scale (VAS), with a score of 0-10, 0 being no pain, 1-3 being mild pain, 4-6 being moderate pain, 7-9 being severe pain, 10 being severe pain, and the pain being intolerable, the higher the score, the deeper the pain level.
(2) Anus function: anal incontinence was assessed on a Wexner scale for three pre-and post-operative groups at 4 weeks, with a total score of 30, including difficult bowel movements, frequency of bowel movements, assisted bowel movements, time of bowel movements, painful bowel movements, history of medical history and completeness, with scores of 0 being normal, 1-10 being mild incontinence, 11-20 being moderate incontinence, 21-30 being severe incontinence, and with higher scores the patients had more severe anal incontinence.
(3) Healing time of the wound surface: the first day after operation is that the wound surface is cut and the wound surface is completely covered by the skin for the required days.
(4) The days of hospitalization: days from the day of surgery to patient discharge.
(5) Abscess recurrence rate and anal fistula formation rate: the recurrence refers to the recurrence of perianal abscess at the primary site after the patient enters the recovery period, and the diagnosis of postoperative anal fistula is based on the guidelines for perianal abscess and anal fistula treatment (U.S. 2011 edition).
14. Statistical treatment
(1) All data from the experiments were statistically analyzed by the SPSS26.0 software.
(2) The description of the data of the measured data is expressed by means of mean plus or minus standard deviation (x plus or minus S), and the rate is expressed by percent;
(3) the measured data obeys normal distribution, the variances are uniform, and T test analysis is adopted; the data distribution does not conform to the normal distribution and is analyzed by rank sum test;
(4) checking the count data with a chi-square; the order person adopts the rank sum test;
(5) the test levels α =0.05, P-ties 0.05 are statistically significant for the differences, and P < 0.01 is considered to be highly significant.
All data obtained from the tests were statistically analyzed and processed by the software SPSS26.0 to obtain the following comparative statistical tables:
table 5-comparison of VAS scores for the observation and control groups on the day of surgery and 1, 2, 3, 7, 30 days post-surgery:
note: comparing the observed group with the control group, P is less than 0.05, and the difference has statistical significance.
And (4) conclusion: the pain degree of patients in each group of observation groups (perianal abscess traditional Chinese medicine line and line combined double-hanging method group) after 1 month is obviously lower than that of the control group, the postoperative recovery status observation group 3 is superior to the observation group 2, and the observation group 2 is superior to the observation group 1.
TABLE 6 comparison of hospitalization and wound healing time for each observation group and control group: (
±S,d)：
Note: the difference between each group of observation group and the control group is statistically significant, and P is less than 0.05.
And (4) conclusion: the average hospitalization days and wound healing time of patients in each group of observation groups (perianal abscess traditional Chinese medicine medicated thread combined medicated thread double-hanging method group) are both obviously shorter than those in a control group, the hospitalization time observation group 3 is smaller than that in the observation group 2, and the observation group 2 is smaller than that in the observation group 1.
Table 7-comparison of pre-treatment anal incontinence in the observation and control groups n (%):
note: the difference between each group of the observation group and the control group is statistically significant, and P is more than 0.05.
And (4) conclusion: the anus incontinence degree before operation of each group of the observation group and the control group is not obviously different on the whole.
Table 8-comparison of anal incontinence after 4 weeks of surgery for the observation and control groups n (%):
note: the difference between each group of the observation group and the control group has statistical significance, and P is less than 0.05.
And (4) conclusion: compared with the 4-week anal incontinence degree after operation in the observation group, the perianal abscess Chinese medicinal line and medicinal line double-hanging method group is obviously superior to the perianal abscess one-time radical treatment group in the aspects of protecting the anus function and reducing the risk of anal incontinence, the observation group 3 is superior to the observation group 2, and the observation group 2 is superior to the observation group 1.
Table 9-post-operative abscess recurrence rate and anal fistula formation rate for each observation group and control group n (%):
note: the difference between each group of the observation group and the control group has statistical significance, and P is less than 0.05.
And (4) conclusion: the abscess recurrence rate and the anal fistula formation rate of each group of patients (perianal abscess traditional Chinese medicine medicated thread combined medicated thread double-hanging group) of the observation group are both obviously lower than those of the control group.
Example of diagnosis and treatment cases
The following cases are real clinical diagnosis and treatment cases, with the patient name hidden for privacy protection.
Case 1
Yang Mou, male, age 32, visit time 2020/2/11. From the following symptoms: and 3 days of right-side perianal swelling and pain, diagnosis: perianal abscess. Admission perianal magnetic resonance flat scan: a horseshoe-shaped high signal can be seen in the internal and external sphincter gaps at the lithotomy position distance of 6-12 points, the ischial rectum gap high signal image on the same side is shown, and the right sphincter edema is obvious; during operation, the perianal abscess traditional Chinese medicine thread in the embodiment 1 is subjected to thread hanging treatment by combining a double-hanging method of the medicine thread, the medicine thread is removed 5 days after operation, the patient is discharged 10 days after operation, and wound surface granulation is fresh and alive, good recovery and smooth drainage are realized during discharge; the wound surface is basically healed after 30 days of postoperative hospital reexamination, and the finger diagnosis is used for exploring the non-false healing dark cavity. The recovery time is obviously shorter than that of the conventional anal abscess, and the recovery quality is obviously higher than that of the perianal abscess treated by using a common silk thread or a rubber band hanging thread.
Case 2
Li Mou, male, age 46, visit time 2020/08/06. From the following symptoms: and (3) diagnosing the swelling and pain of the anus for 1 week: perianal abscess. Admission perianal magnetic resonance shows: annular high signal images can be seen between internal and external sphincters at the perianal position of the lithotomy, and the left ischial rectum gap high signal image is seen; in the operation, the perianal abscess traditional Chinese medicine thread in the embodiment 1 is combined with a double-hanging method of the medicine thread to carry out thread hanging treatment, the medicine thread is removed 7 days after the operation, the patient is discharged 15 days after the operation, the wound surface condition is good when the patient is discharged, the secretion is moderate, and the drainage is smooth; after 45 days of operation, hospital reexamination shows that the wound surface is basically healed, the anus has good function, and the patient has no air leakage and liquid leakage. The recovery time is obviously shorter than that of the conventional anal abscess, and the recovery quality is obviously higher than that of the perianal abscess treated by using a common silk thread or a rubber band hanging thread.
Case 3
Xu Mou, male, age 21, visit time 2021/3/19. From the following symptoms: left side perianal swelling and pain for 2 days, diagnosis: perianal abscess. Admission perianal magnetic resonance shows: annular high signal images can be seen between the internal and external sphincters at the lithotomy position 2-5, and the left ischial-rectal space is high; the perianal abscess traditional Chinese medicine medicated thread of example 4 is combined with a medicated thread double-hanging method for thread hanging treatment in the operation, the medicated thread is removed 4 days after the operation, the patient is discharged 12 days after the operation, the wound surface condition is good when the patient is discharged, no obvious pain exists, the secretion is moderate, and the drainage is smooth; the hospital reexamination is carried out after 40 days of operation, the wound surface is basically healed, the anus has good function, and the patient has no air leakage and liquid leakage. Compared with the transverse direction, the recovery time is obviously shorter, and the recovery quality is obviously higher than that of perianal abscess treated by common silk thread or rubber band hanging thread to the same extent.
Case 4
Mo Mou, male, age 46, visit time 2021/8/21. From the following symptoms: and (3) diagnosing the right side perianal swelling and pain for 1 week: perianal abscess. Admission perianal magnetic resonance shows: high signal images can be seen between internal and external sphincters at 6-10 point positions of the lithotomy position, and the high signal images can be seen in the right ischial rectum gap; the perianal abscess traditional Chinese medicine medicated thread of the embodiment 1 is used for thread hanging treatment by combining a medicated thread double-hanging method in the operation, the medicated thread is removed 6 days after the operation, the patient is discharged 9 days after the operation, the wound surface condition is good when the patient is discharged, no obvious pain exists, the secretion is moderate, and the drainage is smooth; after 32 days of operation, hospital reexamination is carried out, the wound surface is basically healed, the anus has good function, the patient can not self-complain about air leakage and liquid leakage, and the patient can not have unclosed dark cavity by finger diagnosis. Compared transversely, the recovery time is obviously shorter, and the recovery quality is obviously higher than that of perianal abscess treated by a common silk thread or a rubber band hanging thread to the same extent.
Case 5
Pan Mou, female, age 38, visit time 2022/2/1. From the following symptoms: left side perianal swelling and pain for 3 days, diagnosis: perianal abscess. Admission perianal magnetic resonance shows: high signal images can be seen between the internal and external sphincters at 1-7 points of the lithotomy position, and the left ischia-rectum gap is high; the perianal abscess traditional Chinese medicine medicated thread of the embodiment 1 is used for thread hanging treatment by combining a medicated thread double-hanging method in the operation, the medicated thread is removed 5 days after the operation, the patient is discharged 12 days after the operation, the wound surface condition is good when the patient is discharged, no obvious pain exists, the secretion is moderate, and the drainage is smooth; after 45 days of operation, hospital reexamination is carried out, the wound surface is basically healed, the anus has good function, the patient can not self-complain about air leakage and liquid leakage, and the patient can not have unclosed dark cavity by finger diagnosis. Compared in the transverse direction, the recovery time is obviously shorter, and the recovery quality is obviously higher than that of perianal abscess treated by common silk thread or rubber band hanging thread to the same extent.
Finally, it should be noted that: the above embodiments are only used to illustrate the technical solution of the present invention, and not to limit the same; while the invention has been described in detail and with reference to the foregoing embodiments, it will be understood by those skilled in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some or all of the technical features may be equivalently replaced; and the modifications or the substitutions do not make the essence of the corresponding technical solutions depart from the scope of the technical solutions of the embodiments of the present invention.
Claims (9)
1. A traditional Chinese medicine medicated thread for treating perianal abscess is characterized in that the medicated thread is obtained by decocting or soaking silk threads in traditional Chinese medicine liquid, wherein the traditional Chinese medicine liquid is prepared from traditional Chinese medicine compositions, and the traditional Chinese medicine compositions at least comprise: 26.5 to 34.5 parts of frankincense, 26.5 to 34.5 parts of lithospermum, 26.5 to 34.5 parts of dragon's blood, 35 to 45 parts of astragalus and 8.5 to 11.5 parts of liquorice.
2. The herbal thread of claim 1, wherein the thread is a surgical No. 7 thread.
3. The traditional Chinese medicine thread of claim 1, wherein the traditional Chinese medicine composition comprises: 30 parts by mass of frankincense, 30 parts by mass of lithospermum, 30 parts by mass of dragon's blood, 40 parts by mass of astragalus and 10 parts by mass of liquorice.
4. The traditional Chinese medicine medicated thread according to claim 1, wherein the preparation method of the traditional Chinese medicine medicated thread comprises:
s1, preparing water according to the mass of 1.8-2.5 times of the medicinal materials, boiling astragalus membranaceus in water for 30-35min, removing residues, continuing to add frankincense, lithospermum, dragon' S blood and liquorice, continuing to boil, concentrating to 0.35-0.50 time of the original volume, putting No. 7 surgical silk into the medicinal liquid, decocting with slow fire until the medicinal liquid is soaked in a dry or sterile environment for 30-60 days, and taking out the silk;
s2, drying the silk threads in the air, and performing high-pressure steam sterilization to obtain the traditional Chinese medicine medicated thread for treating perianal abscess, and storing the medicated thread in a dark place.
5. A traditional Chinese medicine medicated thread for treating perianal abscess is characterized in that the medicated thread is obtained by decocting or soaking silk threads in traditional Chinese medicine liquid, wherein the traditional Chinese medicine liquid is prepared from traditional Chinese medicine compositions, and the traditional Chinese medicine compositions comprise: 26.5 to 34.5 parts of frankincense, 26.5 to 34.5 parts of lithospermum, 26.5 to 34.5 parts of dragon's blood, 35 to 45 parts of astragalus, 8.5 to 11.5 parts of liquorice, 15 to 18 parts of angelica and 1 to 3 parts of perilla oil.
6. The traditional Chinese medicine medicated thread according to claim 5, wherein the preparation method of the traditional Chinese medicine medicated thread comprises:
s1, preparing water according to the mass of 1.8-2.5 times of the medicinal materials, boiling astragalus membranaceus in the water for 30-35min, removing residues, continuing to add frankincense, lithospermum, dragon' S blood, liquorice and angelica dahurica, continuing to boil, concentrating to 0.35-0.50 times of the original volume, putting the No. 7 surgical silk thread into the medicinal liquid, decocting with slow fire until the medicinal liquid is soaked in a dry or aseptic environment for 30-60 days, and taking out the silk thread;
s2, placing and airing the silk threads, and then performing high-pressure steam sterilization;
s3, soaking the silk thread into perilla oil for 1-3min, taking out, drying in the shade in a clean and sterile environment,
the traditional Chinese medicine medicated thread for treating perianal abscess is obtained and stored in dark.
7. A traditional Chinese medicine medicated thread for treating perianal abscess is characterized in that the medicated thread is obtained by decocting or soaking silk threads in traditional Chinese medicine liquid, wherein the traditional Chinese medicine liquid is prepared from traditional Chinese medicine compositions, and the traditional Chinese medicine compositions comprise: 26.5 to 34.5 parts of frankincense, 26.5 to 34.5 parts of lithospermum, 26.5 to 34.5 parts of dragon's blood, 35 to 45 parts of astragalus, 8.5 to 11.5 parts of liquorice, 15 to 18 parts of angelica dahurica, 1 to 3 parts of perilla herb oil, 5 to 10 parts of galangal and 5 to 10 parts of coptis root.
8. The traditional Chinese medicine medicated thread according to claim 7, wherein the preparation method of the traditional Chinese medicine medicated thread comprises:
s1, preparing water according to the mass of 1.8-2.5 times of the medicinal materials, boiling astragalus membranaceus in water for 30-35min, removing residues, continuing to add frankincense, lithospermum, dragon' S blood, liquorice, angelica dahurica and coptis chinensis, continuing to boil, concentrating to 0.35-0.50 time of the original volume, putting No. 7 surgical silk into the medicinal liquid, decocting with slow fire until the medicinal liquid is soaked in a dry or sterile environment for 30-60 days, and taking out the silk;
s2, placing and airing the silk threads, and then performing high-pressure steam sterilization;
s3, cleaning and airing the galangal, scrubbing and disinfecting the surface of the galangal with disinfectant alcohol, mashing the galangal, filtering to obtain residue-free juice, diluting the juice with 1-3 times of distilled water, atomizing and spraying the diluted juice on the surface of the silk threads, and drying the silk threads in the shade in a clean and sterile environment;
s4, soaking the silk threads into perilla oil for 1-3min, taking out, placing in a clean sterile environment, drying in the shade to obtain the traditional Chinese medicine thread for treating perianal abscess, and storing in the dark.
9. Use of a traditional Chinese medicine thread according to any one of claims 1 to 8 for the preparation of a thread-hanging therapeutic material for the treatment of perianal abscess, ischiorectal interstitial abscess or anal fistula.
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