壳聚糖联合纳米银对宫颈高级别鳞状上皮内病变患者环形电切术治疗后创面恢复的影响

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摘要目的:探讨壳聚糖联合纳米银对宫颈高级别鳞状上皮内病变（highgrade squamous intraepithelial lesion, HSIL）患者环形电切术（loop electrosurgical excision procedure,LEEP）治疗后创面恢复的影响。方法:选择2020年9月至2021年5月江苏大学第四附属医院收治并经LEEP治疗后病理确诊为HSIL且切缘阴性的患者160例,随机均分为4组,每组40例,分别为对照组、壳聚糖组、纳米银组和联合组（壳聚糖联合纳米银）；除对照组外,其余组分别相应用药2次/周,共8次。观察各组患者术后2月内创面情况、术后2周阴道分泌物清洁度和并发症等。采用ELISA法检测术前和术后1、2、3、4周宫颈分泌物中TNF-α、IL-6、IL-8和高迁移率族蛋白1（highmobility group box 1 protein,HMGB1）等炎症因子含量。结果:与对照组、壳聚糖组和纳米银组比较,联合组阴道排液消失时间、创面脱痂时间和创面愈合时间均明显缩短（P均<0.05）；与对照组、壳聚糖组比较,联合组术后下腹痛和脓性分泌物发生率均明显降低（P均<0.05）；与对照组、壳聚糖组比较,联合组术后1、2、3、4周HMGB1、TNF-α、IL-6和IL-8含量均显著降低（P均＜0.05）；与纳米银组比较,联合组HMGB1（术后1、2、4周）、TNF-α（术后1、2、3、4周）、IL-6（术后1、2、3周）和IL8（术后1、3、4周）含量均显著降低（P均＜0.05）。结论:壳聚糖和纳米银联合使用既可以促进LEEP治疗后宫颈创面愈合又能预防术后并发症。

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	张亚娇
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关键词 ：高级别鳞状上皮内病变, 环形电切术, 创面愈合, 并发症, 炎症因子, 壳聚糖, 纳米银

Abstract：Objective: To investigate the effect of chitosan combined with nanosilver on the wound recovery of patients with highgrade squamous intraepithelial lesion （HSIL） who underwent loop electrosurgical excision procedure （LEEP） treatment. Methods: A total of 160 patients who were admitted to the Fourth Affiliated Hospital of Jiangsu University from September 2020 to May 2021 pathologically diagnosed with HSIL and negative margins after LEEP treatment were enrolled in the study. Then the patients were randomly divided into control group, chitosan group, nanosilver group, combined group （chitosan combined nanosilver） and control group, with 40 cases in each group. Except for the control group, the other three groups were administrated with the corresponding treatment twice a week, for a total of 8 times. In each group within 2 months after the operation, the wounds after the operation, the cleanliness of the vaginal secretions in 2 weeks after the operation and postoperative complications were observed and recorded. ELISA was used to detect the content of inflammatory factors such as TNF-α, IL-6, IL-8 and highmobility group box 1 protein （HMGB1） in cervical secretions before and 1, 2, 3, 4 weeks after operation. Results: Compared with control group, the disappearance time of vaginal discharge, the time to scab off the wound, and the time of wound healing in the combined group were significantly reduced in chitosan group and nano-silver group（all P<0.05）. Compared with the control group and the chitosan group, the incidence of lower abdominal pain and purulent secretions after operation in the combined group were greatly reduced（all P<0.05）. Compared with the control group and the chitosan group, the content of HMGB1, TNF-α, IL-6 and IL-8 in combined group were significantly reduced in 1, 2, 3, 4 weeks after operation（all P<0.05）. Compared with the nanosilver group, the content of HMGB1（1, 2, 4 weeks after operation）, TNF-α （1, 2, 3, 4 weeks after operation）, IL-6 （1, 2, 3 weeks after operation）, IL-8（1, 3, 4 weeks after operation） in the combined group were remarkably decreased（all P<0.05）. Conclusion: The combined application of chitosan and nanosilver could not only promote the healing of cervical wounds after LEEP treatment, but also prevent postoperative complications.

收稿日期: 2021-07-21

基金资助:江苏省卫健委“六个一工程”拔尖人才科研项目（LGY2019027）；镇江市社会发展项目（SH2019062

通讯作者: 殷新明（通讯作者）,主任医师,硕士生导师,E-mail:1979648426@qq.com

作者简介: 张亚娇（1993—），女,硕士研究生；

引用本文:

张亚娇, 刘颂平, 殷新明, 石文印, 赵诗杰. 壳聚糖联合纳米银对宫颈高级别鳞状上皮内病变患者环形电切术治疗后创面恢复的影响[J]. 江苏大学学报:医学版, 2022, 32(02): 161-166. ZHANG Yajiao, LIU Songping, YIN Xinming, SHI Wenyin, ZHAO Shijie. Effect of chitosan combined with nano-silver on wound recovery in patients with high-grade squamous intraepithelial lesion after LEEP treatment#br#. Journal of Jiangsu University(Medicine Edition), 2022, 32(02): 161-166.

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http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2022/V32/I02/161

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