沈建良+++潘良明++孔祥东++吴鸣+++袁绍峰

[摘要] 目的 探討大黄芒硝散对阑尾周围脓肿的干预效果，评估其临床应用价值。方法 选择SD大鼠（n=36）随机分为假手术组、给药组、对照组，每组12只，其中给药组和对照组通过盲肠结扎穿孔术制备阑尾周围脓肿模型，假手术组仅开腹翻动盲肠。给药组在右下腹涂抹大黄芒硝散5 g治疗，隔天给药；对照组涂抹凡士林，假手术组术后不予处理。对动物的体温、体重和白细胞数量等进行观察，检测血浆中炎症因子白介素1β（IL-1β）和肿瘤坏死因子α（TNF-α）水平。对病区组织标本HE染色大体评估各组局部组织炎症反应的强度和变化趋势，通过免疫组化和TUNEL实验进一步检测组织中炎症因子的分泌量及组织发生凋亡的程度。结果 各组动物的体温及体重之间差别无统计学差异（P > 0.05）；白细胞数量和TNF-α水平均是以对照组升高最明显，其次为给药组（P < 0.05）；而IL-1β在各组动物的变化不显著（P > 0.05）；HE染色、免疫组化及TUNEL实验结果显示对照组出现小肠壁增厚，炎症细胞浸润和TNF-α分泌量增加以及组织凋亡水平增强的表现，而应用大黄芒硝散干预后，上述表现均得到一定缓解。结论 大黄芒硝散用于阑尾周围脓肿的治疗可在一定程度上缓解炎症、消除肿胀，具有较好的临床应用价值。

[关键词] 大黄芒硝散；阑尾周围脓肿；炎症反应；组织凋亡

[中图分类号]R965 [文献标识码] A [文章编号] 1673-7210（2017）04（c）-0151-04

[Abstract] Objective To explore the intervention effect of rhubarb-mirabilite ointment on periappendiceal abscess and evaluate its clinical application value. Methods SD （Sprague Dawley） rats （n=36）were randomly divided into 3 groups： sham operation group， drug group and control group. The drug group and the control group were employed to periappendiceal abscess animal model by cecal ligation and puncture （CLP），while animals in sham operation group were only turned the cecum without CLP. The drug group were treated with rhubarb-mirabilite ointment （5 g） on the right ventral surface of the skin. The control group were treated with vaseline using the same method of delivery. While the sham operation group would not be treated after surgery. Firstly， the general indicators， such as body temperature， wight and white blood cells， were observed. And then the inflammation cytokine IL-1β and TNF-α was detected by ELISA. Further， local samples were collected in which the degree and variation trend of inflammation reaction was observed through the HE staining. And then immunohistochemical staining and TUNEL assay were also carried out to examine the secretion level of TNF-α and the degree of apoptosis in the local tissues of different groups. Results Body temperature and the weight of animals showed no significant change among different groups（P > 0.05）. It was showed that the levels of white blood cells and TNF-α were the highest in the control group， while rhubarb-mirabilite could appropriately block the rise of these two indicators （P < 0.05）. Besides， IL-1β didn't have obvious changes in each group （P > 0.05）. Further， the results of HE staining， immunohistochemical staining and TUNEL assay indicated that significantly thickened small intestinal wall， increased inflammatory cells infiltration and TNF-α secretion and enhanced apoptosis level were observed in control group， however， these indicators could be effectively relieved in rhubarb-mirabilite ointment treated group. Conclusion rhubarb-mirabilite ointment possessed a certain effect of easing inflammation and relieving swelling in periappendiceal abscess. It has good clinical application value.

[Key words] Rhubarb-mirabilite ointment； Periappendiceal abscess； Inflammation reaction； Apoptosis

急性阑尾炎是最常见的急腹症，其在人的一生中的发病风险为7%～8%[1]。所有急性阑尾炎的患者中有7%的人会形成阑尾周围脓肿[2]。阑尾周围脓肿的形成对手术切除阑尾造成一定的困难，可能增加手术并发症[3]，因此，阑尾周围脓肿的保守治疗已被外科专家所认可[4]。