止带化毒方联合壳聚糖对宫颈病变环形电切术后患者康复的影响

Rehabilitation Effect of Zhidai Huadu Decoction Combined with Chitosan Treatment on Cervical Lesions Patients After Loop Electrosurgical Excision Procedure Surgery

摘要:

目的: 探讨止带化毒方联合壳聚糖生物海绵敷料对宫颈病变环形电切术(LEEP)后患者康复的作用,对宫颈局部分泌物白细胞介素-2(IL-2),IL-4,IL-10及肿瘤坏死因子-α(TNF-α)水平的影响.方法: 160例宫颈病变(CIN)行LEEP术治疗后随机分为观察组和对照组各80例.对照组LEEP术后外用红汞液涂于创面;口服阿奇霉素片,0.5 g/次,1次/d,连续服用5 d;内服益母草口服液,10 mL/次,3次/d.观察组术后外用壳聚糖生物海绵敷料处理创面,阿奇霉素片使用同对照组,并内服止带化毒方,1剂/d,两组疗程均为8周.随访观察记录阴道排液时间及排液量,阴道出血时间及出血量及宫颈创面伤口愈合情况;检查术前及术后12周宫颈口周围的黏液及分泌物人乳头瘤病毒脱氧核糖核酸(HPV DNA);检测治疗前及术后8周宫颈局部分泌物白细胞介素-2(IL-2),IL-4,IL-10及TNF-α水平;记录晚期出血、术后感染、宫颈瘢痕形成、粘连和狭窄等并发症情况.结果: 经有序资料卡方检验,观察组疗效优于对照组(P<0.05);观察组术后平均阴道流血时间短于对照组,平均阴道出血量少于对照组(P<0.01);观察组术后平均阴道排液时间短于对照组,平均阴道排液量少于对照组(P<0.01);术后8周观察组HPV DNA阳性率为8.75%,低于对照组的23.75%(P<0.01);治疗后观察组宫颈局部分泌物中IL-4,IL-10和TNF-α水平下降,并明显低于对照组,IL-2水平升高并显著高于对照组(P<0.01);观察组累积并发症发生率为7.5%,低于对照组的27.5%(P<0.01).结论: 止带化毒方联合壳聚糖生物海绵敷料用于宫颈病变LEEP术后患者,能缩短术后平均阴道流血/排液时间,减少阴道排血/液量,清除HPV残留感染,降低并发症的发生率,其作用机制可能与调节hl/Th2失衡,提高机体的抗病毒能力有关.

Abstract:

Objective:To discuss recovery effect of Zhidai Huadu decoction combined with chitosan biological sponge dressing on patients after loop electrosurgical excision procedure (LEEP) and to observe its influence on local secretion of cervical such as interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10(IL-10) and tumour necrosises factor-α (TNF-α). Method: One hundred and sixty patients with cervical intraepithelial neoplasia (CIN) after LEEP were randomly divided into control group (80 cases) and observation group (80 cases) by random number table. Patients in control group received externally mercurochrome on wound, orally 0.5 g azithromycin tablets once daily for 5 days, and orally 10 mL Leonurus Japonicus Houtt. Oral Liquid 3 times daily. Patients in observation group received externally of chitosan biological sponge dressing. Orally 0.5 g azithromycin tabletsonce daily for 5 days, and orally 1 dose Zhidai Huadu decoction divided twice daily. The patients in two groups received 1 8-week period of treatment. Time and volume of vaginal discharge, vaginal bleeding and intention status of wounds were recorded during the follow-up. Human papilloma virus (HPV) and desoxyribonucleic acid (DNA) in mucus and secretion around cervix were detected before and after 12 weeks of operation. Levels of IL-2, IL-4, IL-10 and TNF-α of cervical partial discharge were detected before and after 8 weeks of operation. Complications such as late hemorrhage, postoperative infection, cervical scar formation, adhesion and stenosis were recorded. Result: The curative effect of observation group was superior to that of control group (P<0.05) through ordinal data card test. The average time and amount of vaginal bleeding in observation group were less than those in control group after treatment (P<0.01). The average time and amount of vaginal discharge in observation group were less than those in control group (P<0.01). Positive rate of HPV DNA in observation group was 8.75%, which was lower than 23.75% in control group after 8-week treatment (P<0.01). Levels of IL-4, IL-10 and TNF-α in cervical partial discharge of observation group were decreased, which was obviously lower than those of control group. The level of IL-2 in observation group was increased, which was higher than that in control group after treatment (P<0.01). The cumulative incidence of complications of 7.5% in observation group was significant less than that of 27.5% in control group (P<0.01). Conclusion: Using Zhidai Huadu decoction combined with chitosan sponge dressing could reduce the average vaginal bleeding/discharge time and vaginal discharge blood/liquid volume, remove HPV residual infection, reduce complications incidence in cervical lesions patients after LEEP surgery. The action mechanism may be related to regulating imbalance of Thl/Th2 and improving antiviral ability.