本文關(guān)鍵詞： 負壓封閉引流 高位肛周膿腫 炎癥介質(zhì) 血管內(nèi)皮生長因子　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:高位肛周膿腫因其膿腔深、術(shù)后創(chuàng)面大且恢復(fù)緩慢,被認為是肛腸科棘手病種。負壓封閉引流(VSD)技術(shù)因其獨特的持續(xù)負壓吸引原理,適用于多種難愈性創(chuàng)面,已在外科相關(guān)領(lǐng)域得到大量應(yīng)用和廣泛認可。本研究擬探討VSD技術(shù)對高位肛周膿腫術(shù)后炎癥介質(zhì)及血管內(nèi)皮生長因子(VEGF)的影響。方法:前瞻性收集2015年3月至2016年2月于安徽醫(yī)科大學(xué)附屬六安醫(yī)院肛腸科住院手術(shù)治療的高位肛周膿腫患者38例,按隨機數(shù)字表法隨機分為2組:實驗組19例行內(nèi)口封閉+VSD技術(shù),對照組19例行低位切開高位掛線術(shù)。分別檢測患者術(shù)前、術(shù)后1d、術(shù)后5d血清炎癥介質(zhì)IL-6、TNF-α、hs-CRP、IL-4、IL-10含量;術(shù)前、術(shù)后3d、術(shù)后5d、術(shù)后7d血清VEGF蛋白含量。將以上檢測指標進行組間及組內(nèi)比較。結(jié)果:1.兩組患者術(shù)前、術(shù)后促炎介質(zhì)含量組間比較術(shù)前、術(shù)后1天、術(shù)后5天,兩組患者促炎介質(zhì)(IL-6、TNF-α、hs-CRP)含量呈現(xiàn)先升高后降低趨勢。術(shù)前、術(shù)后1天兩組患者IL-6、TNF-α、hs-CRP含量組間對比,P0.05,無統(tǒng)計學(xué)差異。術(shù)后5天兩組患者IL-6、TNF-α、hs-CRP含量組間比較,實驗組患者IL-6、TNF-α、hs-CRP含量均低于對照組,P0.05,差異均有統(tǒng)計學(xué)意義。2.實驗組患者促炎介質(zhì)含量組內(nèi)比較術(shù)后1天實驗組患者各促炎介質(zhì)(IL-6、TNF-α、hs-CRP)含量均較術(shù)前升高,P0.05,差值d均有統(tǒng)計學(xué)意義。術(shù)后5天IL-6、TNF-α、hs-CRP含量均較術(shù)后1天降低,P0.05,差值d均有統(tǒng)計學(xué)意義。3.兩組患者術(shù)前、術(shù)后抗炎細胞因子含量組間比較術(shù)前、術(shù)后1天、術(shù)后5天,兩組患者抗炎細胞因子(IL-4、IL-10)含量變化呈現(xiàn)先降低后升高趨勢。術(shù)前、術(shù)后1天兩組患者IL-4、IL-10含量組間對比,P0.05,無統(tǒng)計學(xué)差異。術(shù)后5天兩組患者IL-4、IL-10含量組間比較,實驗組患者IL-4、IL-10含量均高于對照組,P0.05,差異均有統(tǒng)計學(xué)意義。4.實驗組患者抗炎細胞因子含量組內(nèi)比較術(shù)后1天實驗組患者各抗炎細胞因子(IL-4、IL-10)含量均較術(shù)前降低,P0.05,差值d均有統(tǒng)計學(xué)意義。術(shù)后5天IL-4、IL-10含量均較術(shù)后1天升高,P0.05,差值d均有統(tǒng)計學(xué)意義。5.兩組患者術(shù)前、術(shù)后VEGF含量組間比較術(shù)前、術(shù)后3天、術(shù)后5天、術(shù)后7天,兩組患者VEGF含量呈現(xiàn)先升高后降低趨勢,且在術(shù)后5天達到高峰。術(shù)前兩組患者VEGF含量組間對比,P0.05,無統(tǒng)計學(xué)差異。術(shù)后3天、術(shù)后5天、術(shù)后7天兩組患者VEGF含量組間比較,實驗組患者VEGF含量均高于對照組,P0.05,差異均有統(tǒng)計學(xué)意義。6.實驗組患者VEGF含量組內(nèi)比較術(shù)后3天實驗組患者VEGF含量較術(shù)前升高,P0.05,差值d有統(tǒng)計學(xué)意義。術(shù)后5天VEGF含量較術(shù)后3天升高,P0.05,差值d有統(tǒng)計學(xué)意義。術(shù)后7天VEGF含量較術(shù)后5天降低,P0.05,差值d有統(tǒng)計學(xué)意義。結(jié)論:與肛周膿腫低位切開高位掛線術(shù)比較,內(nèi)口封閉+VSD技術(shù)在高位肛周膿腫治療中能更顯著的降低促炎介質(zhì),升高抗炎細胞因子,使機體炎癥反應(yīng)趨于平緩,促炎、抗炎介質(zhì)達到平衡,機體朝著炎癥消退、有利恢復(fù)的方向發(fā)展。同時,內(nèi)口封閉+VSD技術(shù)能更顯著的升高VEGF蛋白含量表達,從而促進術(shù)后血管新生、創(chuàng)面愈合。因此,在高位肛周膿腫的手術(shù)治療中,VSD技術(shù)的運用對炎癥介質(zhì)及血管生成的影響是有益的。
[Abstract]:Objective: high perianal abscess due to the abscess cavity, postoperative wound and slow recovery, is believed to be intractable anorectal diseases. Vacuum sealing drainage (VSD) technology because of its unique continuous negative pressure attraction principle, applicable to a variety of refractory wounds, a large number of applications and has been widely recognized in the surgical field. This paper intends to discuss the technology of VSD on inflammatory mediators and vascular endothelial growth factor of perianal abscess postoperative (VEGF) effect. Methods: We prospectively collected from March 2015 to February 2016 in Lu'an Hospital Affiliated to Medical University Of Anhui Affiliated Hospital of 38 patients with surgical treatment of perianal abscess were randomly divided into 2 groups: the experimental group of 19 cases and closed +VSD, the control group of 19 cases of low incision and high hanging line operation. Patients were detected before surgery, postoperative 1D, postoperative 5D serum inflammatory mediators IL-6, TNF- alpha, hs-CRP, IL-4, IL-10 content; before surgery, surgery 鍚，

本文編號：1460338