中药熏洗联合双柏散外敷对混合痔术后患者水肿消退的影响因素分析

Analysis of Influencing Factors for Postoperative Edema Resolution in Patients with Mixed Hemorrhoids Treated by Traditional Chinese Medicine Fumigation and Washing Combined with Topical Application of Shuang Bai San

摘要: 目的：分析接受中药熏洗联合双柏散外敷治疗的混合痔术后患者疼痛、渗液及水肿的变化，并探讨术后水肿消退的影响因素，为临床优化治疗方案、实施个体化干预提供循证依据。方法：回顾性收集2020年1月至2025年12月珠海市中西医结合医院肛肠科54例混合痔外剥内扎术后接受中药熏洗联合双柏散外敷治疗患者的病历资料。记录术后第1、3、6天疼痛数字评分(NRS)和创面渗液评分，以及术后第1、6天肛周水肿情况，比较不同时点指标变化；按术后第6天水肿是否消退分为消退组与未消退组，采用单因素分析探讨水肿消退的影响因素。结果：54例患者年龄(46.46 ± 14.27)岁。NRS评分由术后第1天的(4.17 ± 0.64)分降至第3天的(3.06 ± 0.53)分、第6天的(2.09 ± 0.76)分(F = 246.775, P < 0.01)；渗液评分第6天(0.46 ± 0.50)分较第1天(1.02 ± 0.14)分显著降低(P < 0.01)；术后第1天54例(100.00%)均存在水肿，第6天28例(51.85%)水肿消退(P < 0.01)。单因素分析显示，合并糖尿病与术后第6天水肿未消退相关(P = 0.047)；年龄、性别、手术时间、合并高血压及术后早期疼痛、渗液评分与水肿消退无明显相关(P > 0.05)。结论：中药熏洗联合双柏散外敷可有效减轻混合痔术后疼痛与创面渗液，促进肛周水肿消退；合并糖尿病可能是术后早期水肿持续存在的相关因素，临床应加强此类患者的血糖管理与创面评估。

Abstract: Objective: To analyze the changes of pain, wound exudate and perianal edema in patients with mixed hemorrhoids treated by traditional Chinese medicine (TCM) fumigation and washing combined with topical application of Shuang Bai San after surgery, and to explore the influencing factors of postoperative edema resolution, providing an evidence base for optimizing clinical treatment regimens and implementing individualized interventions. Methods: The medical records of 54 patients with mixed hemorrhoids who underwent external dissection and internal ligation and received the combined treatment at the Department of Anorectal Surgery of Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to December 2025 were retrospectively collected. Numeric Rating Scale (NRS) pain scores and wound exudate scores on postoperative days 1, 3 and 6, as well as perianal edema on days 1 and 6, were recorded. Changes over time were compared, and patients were divided into an edema-resolved group and an edema-unresolved group according to whether edema had resolved by day 6; univariate analysis was performed to explore the influencing factors of edema resolution. Results: The mean age of the 54 patients was (46.46 ± 14.27) years. NRS scores decreased from (4.17 ± 0.64) on day 1 to (3.06 ± 0.53) on day 3 and (2.09 ± 0.76) on day 6 (F = 246.775, P < 0.01); exudate scores on day 6 (0.46 ± 0.50) were significantly lower than those on day 1 (1.02 ± 0.14) (P < 0.01). All 54 patients (100.00%) had edema on day 1, and edema had resolved in 28 patients (51.85%) by day 6 (P < 0.01). Univariate analysis showed that diabetes was associated with persistent edema on day 6 (P = 0.047), while age, gender, operative duration, hypertension and early postoperative pain and exudate scores were not (P > 0.05). Conclusion: TCM fumigation and washing combined with topical application of Shuang Bai San can effectively relieve postoperative pain and wound exudate and promote perianal edema resolution in patients with mixed hemorrhoids. Diabetes may be associated with persistent early postoperative edema, and blood glucose management and wound assessment should be strengthened in such patients.