从“祛腐–生肌–收口”分期论治肛痈术后创面愈合的中西医研究进展

Research Progress on the Staged Treatment of Postoperative Wound Healing in Anal Carbuncle with Traditional Chinese and Western Medicine from the Perspective of “Removing Necrosis—Promoting Granulation—Closing the Wound”

摘要: 肛痈术后创面常常呈现深大开放的状态，常需二期愈合，而疼痛、愈合缓慢则是临床处理所面临的难点。中医的“祛腐生肌”理论对于创面演变的划分，和西医创面愈合阶段在时间顺序上存在着对应的关系。本文以“祛腐–生肌–收口”作为线索，对肛痈术后创面愈合的中西医研究进展进行了梳理，并且探讨了分期对应关系与换药路径。祛腐期大致相当于炎症期，西医主要是以清创引流、控制感染、创面床准备为主，而中医则强调提脓祛腐，像搔刮、升丹制剂、祛腐生肌膏剂与托法等手段能够促使腐肉脱落并且毒素尽除。生肌期即增殖期，西医常常借助湿性愈合的理念、生长因子制剂、红光照射、负压封闭引流等方式来推动肉芽组织的生长，中医采用益气养血、活血生肌作为治疗方法，像生肌膏剂、坐浴引流、康复新液、紫草制剂等从多个方面促进肉芽组织的生长和血管新生。收口期与再上皮化期、重塑期相对应，西医注重创面床管理、新生上皮保护、瘢痕防治，中医则运用益气养血、托毒生肌、敛疮收口的方法来促进上皮覆盖、减轻瘢痕形成。中西医在分期时序、治疗目标方面相互契合且互为补充，今后仍需统一分期与疗效评价标准，开展大样本、多中心随机对照试验并加强机制研究，进而形成规范化的中西医结合分期换药路径。

Abstract: Postoperative wounds from anal abscesses are often deep, extensive, and open frequently requiring secondary healing; pain and slow healing are major challenges in the clinical management. The classification of wound progression based on the Traditional Chinese Medicine (TCM) theory of “removing necrotic tissue and promoting tissue regeneration” corresponds chronologically to the stages of wound healing in Western medicine. This article uses the sequence “removing necrotic tissue—promoting tissue regeneration—wound closure” as a framework to review recent advances in both traditional Chinese and Western medical research on postoperative wound healing following anal abscess surgery, and discusses the correspondence between wound stages and dressing change protocols. The necrotic tissue removal phase roughly corresponds to the inflammatory phase. In Western medicine, treatment primarily focuses on debridement and drainage, infection control, and preparation of the wound bed, whereas Traditional Chinese Medicine emphasizes the removal of pus and necrotic tissue. Methods such as scraping, Shengdan formulations, ointments for removing necrotic tissue and promoting tissue regeneration, and the “tuo” technique can facilitate the shedding of necrotic tissue and the complete elimination of toxins. The tissue regeneration phase, also known as the proliferative phase, is often addressed in Western medicine through approaches such as the concept of moist healing, growth factor preparations, red light therapy, and negative pressure wound therapy to promote granulation tissue growth. In Traditional Chinese Medicine, treatment focuses on tonifying qi and nourishing blood, as well as promoting blood circulation and tissue regeneration. Methods such as tissue-regenerating ointments, sitz baths for drainage, Kangfu Xin Liquid, and lithospermum preparations promote granulation tissue growth and angiogenesis through multiple mechanisms. The wound closure phase corresponds to the re-epithelialization and remodeling phases. Western medicine focuses on wound bed management, protection of the newly formed epithelium, and scar prevention and treatment, while Traditional Chinese Medicine employs methods such as tonifying qi and nourishing blood, expelling toxins and promoting tissue regeneration, and astringing sores and promoting wound closure to facilitate epithelial coverage and reduce scar formation. Traditional Chinese medicine and Western medicine are complementary and align with one another in terms of staging sequences and treatment goals. Moving forward, it will be necessary to standardize staging and efficacy evaluation criteria, conduct large-scale, multicenter randomized controlled trials, and strengthen mechanistic research, thereby establishing a standardized integrated TCM-Western medicine staged dressing-change pathway.