防己黄芪汤对腹腔镜腹膜前腹股沟疝修补术后血清肿的预防作用
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摘要
目的观察防己黄芪汤对腹腔镜腹膜前腹股沟疝修补术(TAPP)术后血清肿的防治效果。方法选取2017年10月至2018年7月在天津市南开医院胃肠外科行TAPP的120例腹股沟疝患者为研究对象,分为试验组和对照组,每组60例。两组患者术后均予以局部加压等西医方法防治血清肿的发生;试验组术后服用防己黄芪汤7d,每天2次。比较两组术后1周、1个月血清肿的发生率及血清肿体积,观察术后0、3、7d血浆血管内皮生长因子(VEGF)、肿瘤坏死因子α(TNF-α)水平变化。结果术后1周、1个月,试验组患者血清肿的发生率分别为6.7%、0,对照组分别为23.0%、8.3%,差异有统计学意义(P<0.05)。术后试验组患者血清肿体积明显小于对照组,差异有统计学意义(P<0.05)。术后试验组患者血浆中VEGF、TNF-α水平较对照组明显降低,差异有统计学意义(P<0.05)。结论防己黄芪汤可以降低术后全身炎性反应,对TAPP术后血清肿有防治作用。
Objective To observe the preventive and therapeutic effects of Fangji Huangqi Decoction on seroma after laparoscopic peritoneal inguinal hernia repair(TAPP).Methods One hundred and twenty patients with TAPP in the gastrointestinal surgery department of Tianjin Nankai Hospital from October 2017 to July 2018 were selected as the study subjects and divided into the experimental group and the control group with 60 cases in each group.Both groups were treated with the Western medicine method of local pressurization to prevent the occurrence of seroma.The experimental group took Fangji Huangqi Decoction after operation for 7 d,twice a day.The incidence rate of seroma and seroma volume in 1 week and 1 month after operation were compared between the two groups,and the changes of serum VEGF and TNF-αlevels were observed on postoperative 0,3,7 d.Results The incidence rates of seroma at postoperative 1 week and 1 month in the experimental group were 6.7%and 0 respectively,which in the control group were 23.0%and 8.3%respectively,the experimental group was significantly lower than the control group,and the difference was statistically significant(P<0.05).The seroma volume in the experimental group was significantly smaller than that in the control group,and the difference was statistically significant(P<0.05).The VEGF and TNF-αlevels in the experimental group significantly decreased compared with the control group,and the difference was statistically significant(P<0.05).Conclusion Fangji Huangqi Decoction can decrease the postoperative systemic inflammatory response and has a preventive effect on seroma after TAPP.
Objective To observe the preventive and therapeutic effects of Fangji Huangqi Decoction on seroma after laparoscopic peritoneal inguinal hernia repair(TAPP).Methods One hundred and twenty patients with TAPP in the gastrointestinal surgery department of Tianjin Nankai Hospital from October 2017 to July 2018 were selected as the study subjects and divided into the experimental group and the control group with 60 cases in each group.Both groups were treated with the Western medicine method of local pressurization to prevent the occurrence of seroma.The experimental group took Fangji Huangqi Decoction after operation for 7 d,twice a day.The incidence rate of seroma and seroma volume in 1 week and 1 month after operation were compared between the two groups,and the changes of serum VEGF and TNF-αlevels were observed on postoperative 0,3,7 d.Results The incidence rates of seroma at postoperative 1 week and 1 month in the experimental group were 6.7%and 0 respectively,which in the control group were 23.0%and 8.3%respectively,the experimental group was significantly lower than the control group,and the difference was statistically significant(P<0.05).The seroma volume in the experimental group was significantly smaller than that in the control group,and the difference was statistically significant(P<0.05).The VEGF and TNF-αlevels in the experimental group significantly decreased compared with the control group,and the difference was statistically significant(P<0.05).Conclusion Fangji Huangqi Decoction can decrease the postoperative systemic inflammatory response and has a preventive effect on seroma after TAPP.
引文
[1]CIHAN A,OZDEMIR H,UCAN B H,et al.Fade or fate.Seroma in laparoscopic inguinal hernia repair[J].Surg Endosc,2006,20(2):325-328.
[2]庄哲宏,张剑宝,梁智浩,等.腹腔镜腹股沟疝修补术后血清肿发生原因及对策[J].岭南现代临床外科,2016,16(5):580-583.
[3]唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版)[J].中国实用外科杂志,2017,37(11):1238-1242.
[4]唐华,张蕾,赵鸿雁,等.彩色多普勒超声检查在腹股沟疝无张力修补术后并发症诊断中的应用[J/CD].中华医学超声杂志(电子版),2010,7(9):1483-1489.
[5]姚胜,李基业.B超检查诊断腹壁疝无张力修补术后积液[J].外科理论与实践,2009,14(2):215-216.
[6]许邦文,贺登峰,霍宗红,等.腹腔镜完全腹膜外疝修补治疗腹股沟疝260例报告[J/CD].中华腔镜外科杂志(电子版),2012,5(4):307-310.
[7]BIRCH D W.Characterizing laparoscopic incisional hernia repair[J].Can J Surg,2007,50(3):195-201.
[8]赵攀,赵平武.腹腔镜完全腹膜外腹股沟疝修补术后血清肿临床研究[J].西南军医,2015,14(6):655-658.
[9]司仙科,李炜,杨佳华,等.负压引流在腹腔镜经腹腹膜前疝修补术后减少血清肿的临床应用[J/CD].中华疝和腹壁外科杂志(电子版),2018,12(1):30-33.
[10]陈萌,李爱平,李科,等.防己黄芪汤及其组方化学成分与分析方法研究进展[J].中草药,2018,49(7):1695-1702.
[11]杨会军,刘维,吴沅皞,等.防己黄芪汤现代临床应用证药规律分析[J].中华中医药杂志,2016,31(8):3041-3044.
[12]李梦乔,戴琦,刘宇翔,等.防己黄芪汤临床研究进展[J].实用中西医结合临床,2016,23(7):92-94.
[13]PEREIRA-LUCENA C G,ARTIGIANI-NETO R,LOPESFILHO G J,et al.Experimental study comparing meshes made of polypropylene,polypropylene+polyglactin and polypropylene+titanium:inflammatory cytokines,histological changes and morphometric analysis of collagen[J].Hernia,2010,14(3):299-304.
[14]CHATZIMAVROUDIS G,KOUTELIDAKIS I,PAPAZIOGAS B,et al.The effect of the type of intraperitoneally implanted prosthetic mesh on the systemic inflammatory response[J].Hernia,2008,12(3):277-283.
[2]庄哲宏,张剑宝,梁智浩,等.腹腔镜腹股沟疝修补术后血清肿发生原因及对策[J].岭南现代临床外科,2016,16(5):580-583.
[3]唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版)[J].中国实用外科杂志,2017,37(11):1238-1242.
[4]唐华,张蕾,赵鸿雁,等.彩色多普勒超声检查在腹股沟疝无张力修补术后并发症诊断中的应用[J/CD].中华医学超声杂志(电子版),2010,7(9):1483-1489.
[5]姚胜,李基业.B超检查诊断腹壁疝无张力修补术后积液[J].外科理论与实践,2009,14(2):215-216.
[6]许邦文,贺登峰,霍宗红,等.腹腔镜完全腹膜外疝修补治疗腹股沟疝260例报告[J/CD].中华腔镜外科杂志(电子版),2012,5(4):307-310.
[7]BIRCH D W.Characterizing laparoscopic incisional hernia repair[J].Can J Surg,2007,50(3):195-201.
[8]赵攀,赵平武.腹腔镜完全腹膜外腹股沟疝修补术后血清肿临床研究[J].西南军医,2015,14(6):655-658.
[9]司仙科,李炜,杨佳华,等.负压引流在腹腔镜经腹腹膜前疝修补术后减少血清肿的临床应用[J/CD].中华疝和腹壁外科杂志(电子版),2018,12(1):30-33.
[10]陈萌,李爱平,李科,等.防己黄芪汤及其组方化学成分与分析方法研究进展[J].中草药,2018,49(7):1695-1702.
[11]杨会军,刘维,吴沅皞,等.防己黄芪汤现代临床应用证药规律分析[J].中华中医药杂志,2016,31(8):3041-3044.
[12]李梦乔,戴琦,刘宇翔,等.防己黄芪汤临床研究进展[J].实用中西医结合临床,2016,23(7):92-94.
[13]PEREIRA-LUCENA C G,ARTIGIANI-NETO R,LOPESFILHO G J,et al.Experimental study comparing meshes made of polypropylene,polypropylene+polyglactin and polypropylene+titanium:inflammatory cytokines,histological changes and morphometric analysis of collagen[J].Hernia,2010,14(3):299-304.
[14]CHATZIMAVROUDIS G,KOUTELIDAKIS I,PAPAZIOGAS B,et al.The effect of the type of intraperitoneally implanted prosthetic mesh on the systemic inflammatory response[J].Hernia,2008,12(3):277-283.