国医大师陈民藩教授是福建省中医肛肠科的主要奠基人,根据自身丰富的临床及科研经验,从事肛肠临床与教研工作60余年,创立福建陈氏肛肠学术流派,形成独特的学术思想."存体寡损"是国医大师陈民藩教授提出创新性中医肛肠病学术思想."存体寡损"意在外保形态,内保功能,强调注重对肛门形态的保护以及通过精细的手术以减少创伤,从而实现兼顾肛门形态保全以及肛门功能保护.这一学术思想在阳证肛痈的治疗运用中疗效颇佳,通过以早期湿热论治,内外并重,中期术药并用,后期以通为用,形神兼备,分期论论治阳证肛痈.将陈老"存体寡损"的学术思想在阳证肛痈治疗的应用进行阐述与总结,以供同道参考.

Objective To explore the risk factors of anal dysfunction after complex anal fistula surgery treated by Chinese medicine and western medicine. Methods The clinical data of 217 patients with complex anal fistula admitted to the Anorectal Department of The People’s Hospital of Fujian University of Chinese Medicine from July 2020 to January 2022 were analyzed retrospectively. The patients were divided into dysfunction group（n =47） and normal function group（n =170） according to the postoperative condition. Univariate analysis and multifa ctor Logistic regression analysis were conducted based on the patient’s perioperative conditions, operation methods, and factors affecting TCM diagnosis and treatment. Results The incidence of postoperative anal dysfunction was 21.66%, with mild symptoms [Cleveland Clinic Florida Fecal incontinence score（CCFIS）=（3.72±0.949）]. The results of multifactor Logistic regression analysis showed that: fistula type of supra-sphincter fistula（OR=6.036, 95%CI1.809～20.140, P=0.003）, perianal abscess or fistula surgery with more than once in the past（OR=15.597, 95%CI 3.371～72.439, P=0.000）, thread-drawing method（OR=1.435, 95%CI 1.088～1.894, P=0.011）, qi-blood deficiency（OR=2.762, 95%CI 1.002～7.613, P=0.049）and pattern of healthy qi deficiency and pathogenic qi attacking（OR=5.339, 95%CI 1.277～12.318, P=0.022）, were independent risk factors for postoperative anal dysfunction（P＜0.05）; the resting pressure（OR=0.107, 95%CI 0.033～0.345, P=0.000） and the intervention of Chinese medicine after operation（OR=0.311, 95%CI 0.122～0.790, P =0.014） were negatively correlated with postoperative anal dysfunction（P＜0.05, OR＜1）, which were protective factors for postoperative anal function. Conclusion The risk factors of western medicine include fistula type of supra-sphincter fistula, perianal abscess, fistula surgery with more than once in the past, threaddrawing method, and low resting pressure. The risk factors of Chinese medicine include qi-blood deficiency, pattern of healthy qi deficiency and pathogenic qi attacking, and no application of TCM after surgery. Early identification of risk factors of postoperative anal dysfunction can be referred for the individualized treatment plan for clinical complex anal fistula.

目的:观察双黄消痔方坐浴对混合痔术后创面愈合的影响.方法:将符合纳入标准的60例混合痔术后患者,随机分为两组各30例,两组均予痔术后常规治疗.治疗组在常规治疗基础上予双黄消痔方坐浴,对照组则予高锰酸钾溶液坐浴,比较两组创面疼痛及水肿的情况、血清炎性因子(IL-1β、TNF-α)表达变化.结果:治疗组总有效率为96.7％,对照组总有效率为90.0％,两组比较差异无统计学意义(P＞0.05);治疗后第7天、14天,治疗组疼痛评分、水肿评分均低于对照组,差异有统计学意义(P＜0.05).两组治疗后第7天,IL-1β、TNF-α水平较治疗前下降,且治疗组低于对照组(P＜0.05).结论:双黄消痔方坐浴可以缓解混合痔术后创面疼痛及水肿情况,降低血清炎症因子IL-1β、TNF-α的水平,促进创面的愈合.

目的 观察全国名中医陈民藩教授经验方清草饮在肛周脓肿热毒炽盛证术后应用的临床疗效.方法 选取86例肛周脓肿热毒炽盛证术后住院患者,采用随机数字表法分为对照组与观察组各43例.对照组术后采用常规抗生素口服治疗,观察组在对照组治疗基础上联合中药清草饮内服,2组疗程均为5d.观察2组治疗前后白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)等炎症指标和视觉模拟评分(VAS)变化情况,并比较其创面愈合时间和疗效.结果 与治疗前比较,2组术后5 d后炎症指标WBC、CRP、PCT均明显降低(P<0.05);与对照组比较,观察组创面平均愈合时间明显缩短(P<0.05),术后3 d、5 d的VAS评分均明显降低(P<0.05);术后25天观察组有效率(42/43,97.67％)优于对照组(38/43,88.37％)(P<0.05).结论 清草饮联合抗生素可促进肛周脓肿热毒炽盛证术后创面愈合,减少患者术后疼痛.

目的 分析低位切开留皮桥高位挂线术治疗高位复杂性肛瘘的临床疗效.方法 回顾性分析2017年1月至2019年1月福建中医药大学附属人民医院收治的120例高位复杂性肛瘘患者的临床资料,患者均接受低位切开留皮桥高位挂线术及术后随访,记录疗效、复发、术后并发症(肛门变形、肛门失禁)发生情况,创面愈合时间,术前以及术后3个月的肛管直肠压力(肛管最大收缩压、肛管静息压、直肠静息压).结果 中位随访时间为1.2年,治愈111例、好转1例、未愈2例,复发6例,其中4例复发患者接受二次低位切开留皮桥高位挂线术后治愈,另2例复发患者为克罗恩病肛瘘、带瘘生存.所有患者均未出现肛门失禁、肛门变形.术后创面愈合时间为32～73 d,平均愈合时间为(49.4±15.2)d.术后3个月的肛管最大收缩压与术前比较差异无统计学意义(P＞0.05);术后3个月,直肠静息压、肛管静息压均较术前下降,差异有统计学意义(均P＜0.05).结论 低位切开留皮桥高位挂线术治疗高位复杂性肛瘘疗效良好,治愈率较高,对肛门功能影响较小.

目的 观察两种不同切口的低位切开留皮桥高位挂线术式治疗肛周脓肿的疗效.方法 选取我院肛肠科收治的80例深部肛周脓肿住院患者,按随机数字表法分为:A组40例采用原发灶脓腔放射状切口、继发性脓腔弧形切口的方式进行手术,B组40例采用原发灶脓腔和继发性脓腔均放射状切口的方式进行手术.比较2组术后24 h疼痛评分、创面愈合时间、肛门功能(漏气、漏液、漏便情况);随访1年,观察术后3个月、术后1年的肛门压力测定及术后1年复发情况.结果 与B组比较,A组术后24 h疼痛评分较低(P＜0.01),创面愈合时间缩短(P＜0.05),肛门功能(漏气、漏液、漏便情况)及术后1年的复发率无明显差异(P＞0.05);术后3个月,A组肛管静息压、肛管最大收缩压显著高于B组(P＜0.05);术后1年,A组肛管静息压、直肠静息压、肛管最大收缩压均高于B组(P＜0.05).结论 低位切开留皮桥高位挂线术式采用原发灶脓腔放射状切口、继发性脓腔弧形切口治疗深部肛周脓肿较原发灶脓腔和继发性脓腔均采用放射状切口方式,具有减轻术后疼痛、缩短疗程、保护肛门功能的优势.

近年来,婴幼儿肛周脓肿及肛瘘的发病率逐年升高,目前治疗方式包括保守治疗和外科手术治疗。治疗方式虽多,不同的治疗方式产生的疗效不尽相同,故肛肠医师对最佳治疗方式尚未形成统一意见。本文将从婴幼儿肛周脓肿及肛瘘的发病原因、临床特点及表现、治疗方式展开详细的论述,以期寻求一种更安全、有效的治疗方式。

迄今,如何加速肛周脓肿术后创面愈合、减轻术后创面疼痛等是目前诸多学者关注的重点.中药油膏作为中医外治法传统剂型之一,在治疗肛周脓肿术后创面具有可靠疗效.近年来,不少研究证实中药油膏的促愈机制可能与生长因子相关,本文以目前中药油膏可能通过促进关键生长因子的表达从而促进肛周脓肿术后创面有效愈合的研究进展进行归纳总结,为今后研究中药油膏的促愈机制提供参考.

Background: Hemorrhoids are one of the most common conditions in the world, and grade III and IV internal hemorrhoids are mainly treated with surgery. However, there are many different surgical methods, and many postoperative complications occur. Therefore, we aimed to update and expand our previous work to compare the safety and efficacy of the procedure for prolapse and hemorrhoids (PPH), Milligan-Morgan hemorrhoidectomy (MMH) and tissue-selecting therapy stapler (TST) in the treatment of grade III and IV internal hemorrhoids. Methods: We performed a network meta-analysis. We searched the Cochrane library, Embase, PubMed, Medline, Web of Science, CNKI, Wangfang, and VIP databases up to May 20, 2019. All randomized controlled trials (RCTs) comparing PPH, MMH and TST in the treatment of grade III and IV internal hemorrhoids were included. We performed a Bayesian network meta-analysis to integrate the adverse events of all treatments. This work is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. This study was registered with PROSPERO, number CRD42019137270. Result: Twenty-two RCTs that recruited 3511 patients were identified. Among these patients, 1379 patients underwent PPH, 805 patients underwent TST, and 1327 patients underwent MMH. In terms of adverse events, TST presented the lowest urinary retention rates and fecal incontinence rates. TST exhibited fewer incidences of anal stenosis than PPH and MMH. Importantly, PPH showed the weakest effects on reducing recurrence rates in hemorrhoid patients. Conclusions: The current study indicated that TST showed optimal potential superior clinical effects for grade III and IV hemorrhoids compared to PPH and MMH. However, high-quality large sample RCTs are still expected.

目前临床上以手术治疗肛瘘为原则。随着近年来新技术、新材料的应用已经产生了许多新的微创术式，这些微创术式都以肛门功能的损伤最小化为目标，但目前肛瘘的治疗仍面临着疗效与功能难以兼顾、术式与规范难以统一的问题。因此，本文根据循证医学、指南及临床研究的证据，对肛瘘微创术式的疗效与安全性做一综述，以期提高对肛瘘术式的正确认识，为今后肛瘘的术式提供参考。目前，像瘘管激光闭合术、肛瘘栓、视频辅助治疗肛瘘等微创术式是另一种治疗选择，但是要根据患者的肛瘘分型、内口位置、瘘管走向等情况选择最合适的手术方案，权衡括约肌损伤程度与疗效、肛门功能之间的利弊，以高治愈率、低复发率、高质量生活为远期目标。

肛裂是指肛管皮肤粘膜纵行全层裂开,主要症状是周期性便时肛门疼痛、便时出血.近年来肛裂在我国的发病率逐年上升,其治疗方式也层出不穷.目前肛裂常见治疗方法主要可分为三大方面,即保守疗法、药物疗法以及手术疗法,各有其适应症及治疗特点.本文旨在综合叙述当前这三种治疗方法在国内外的研究进展.

克罗恩病(CD)是一种发病机制尚未明确的慢性炎症性肠病,26％以上的CD患者会并发肛瘘,常规的治疗方法主要包括抗生素、免疫抑制剂和生物制剂等.间充质干细胞(MSC)是一种非造血功能的多能干细胞,能够下调免疫反应并促进组织愈合,在临床上应用于抗炎治疗、组织再生及自身免疫性疾病等方面.近年研究表明,MSC在治疗CD肛瘘方面具有一定的安全性和有效性,有广泛的应用前景.本文就MSC在CD肛瘘治疗中的应用作一综述.

Objective To observe the effect of Xiaoyanshengji ointment on wound healing after operation of low perianal abscess.Methods 100 patients were randomly assigned to treatment group(n=50) and control group(n=50).All patients received operation of low perianal abscess.The treatment group was treated with Xiaoyanshengji ointment on wounds from the first day after the operation,and the control group was given Rivanol from the same day.The changes of anal ache,anal swelling and wound exudate of two groups were recorded before the operation and the 3rd,5th and 7th day after the operation.The wound healing rate and wound healing time were detected at the 15th and 20th day after the operation.The total curative effects were observed at the 28th day after the operation.Results There were significant differences in anal ache,anal swelling and wound exudate score between the two groups(P0.05).The wound healing rates at the 15th and 20th day after the operation were significantly different(P0.05).There was significant difference in wound healing time between the two groups(P0.05).There was significant difference in total curative effect at the 28th day after the operation between the two groups(P0.05).Conclusion Xiaoyanshengji ointment could effectively relieve the anal ache and anal swelling,reduce wound exudate and promote wound healing.It has promoting effect on wound healing after operation of low perianal abscess,and the curative effect is better than that of Rivanol.Xiaoyanshengji ointment is a secure and efficient traditional Chinese medicine preparation.

目的探讨选择性痔上黏膜切除钉合术(TST术)治疗环状混合痔的临床疗效。方法将80例病人按随机数字表分为治疗组和对照组各40例,均采用腰硬联合麻醉,治疗组行TST术式,对照组行环状混合痔外剥内扎术。结果两组病例在术后肛门疼痛评分、肛缘水肿评分、肛门狭窄程度及愈合时间上比较的差异有统计学意义(P<0.05),治疗组在减少术后并发症及缩短愈合时间上优于对照组。结论 TST术式手术时间短、安全有效、恢复快、术后并发症少,是当今治疗环状混合痔的一种有效安全的治疗方法。

<正>随着人们生活水平的日益提高,及工作节奏和压力的日益增大,肛肠疾病已逐渐发展成现代常见疾病之一,并愈来愈受到人们的重视。患者在寻求手术的同时,常出现肛门疼痛、肛缘水肿、创面渗液及由此引起的肛周湿疹等并发症,使患者在治疗过程中较为痛苦。近年来中药熏洗疗法在治疗肛肠疾病中得到了广泛的应用,并取得了很好的临床疗效,尤其是于肛肠疾病手术后,在促进伤口愈合、消除水肿和止痛等方面具有西医无可比拟的优势[1]。现将近年来国内有关中药熏洗在肛肠疾病术后的应用研究,综述如下:

<正>肛瘘是肛周皮肤和直肠或肛管相通的一种慢性感染性管道,由内口、瘘管及外口三部分组成。肛瘘是常见的肛管直肠疾病之一,任何年龄都可发病,高位单纯性肛瘘为其中一种。切开挂线法是治疗高位肛瘘的一种经典术式,应用范围广。此疗法能较好保护肛门括约肌功能,不易造成肛门失禁,但是会造成挂线异物感,疼痛剧烈,分泌物较多,创面愈合时间较长等并发症。近年来,临床医生在防治这些并发症上做了大量的工作,如:采用镇痛消炎膏换药、肛肠外科洗剂熏洗、术后予双氯芬酸钠栓剂塞肛门等,但是效果均不理想。为了寻求一种全面兼顾的治疗方法,笔者运用中药超声雾化熏洗治疗高位单纯性肛瘘术后并发症,取得较满意的疗效。

肛裂是发生在齿线以下肛管的小溃疡,常引起排便时肛门剧痛及出血、便秘,愈合较困难.治疗上多采用手法扩肛及手术治疗,患者很难接受.我们应用增液汤治疗61例肛裂患者,取得了很好的治疗效果,现报告如下.

肛旁炎是指肛旁软组织浅部或深部炎症,常表现为亚急性过程,它不同于急性脓肿与慢性肛瘘,治疗不及时,往往病情加剧,形成肛旁脓肿,病变复杂,必须行手术治疗.笔者对65例肛旁炎患者在中医辨证施治的同时予紫白膏外敷,取得较满意的疗效,现介绍如下.

肛裂是肛肠科常见病之一,患者多为中年和青年,儿童和老年人少见.临床上常表现为疼痛、出血反复发作,常常干扰患者的学习工作及日常生活.笔者应用微波照射和外敷紫白膏治疗肛裂50例,取得较满意的疗效,现报告如下.

肛周脓肿是指肛门直肠周围间隙发生的急性或慢性化脓性感染,因感染间隙的不同,可分为肛周皮下脓肿,坐骨直肠窝脓肿,肛管后间隙脓肿等.本病的特点是发病急骤,疼痛剧烈且常伴发热症状,延误治疗往往会使病情加重,病变复杂.临床治疗上一般争取早期切开,并作一次性根治手术.笔者对55例肛周脓肿患者在术后常规处理同时予中药辨证治疗,取得较满意的疗效,现介绍如下.