局部使用甲硝唑（10%）可减轻痔切除术后疼痛并促进愈合。

Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing.

作者信息

Nicholson Thomas J, Armstrong David

机构信息

Georgia Colon and Rectal Surgical Clinic, Atlanta, Georgia 30342, USA.

出版信息

Dis Colon Rectum. 2004 May;47(5):711-6. doi: 10.1007/s10350-003-0129-z. Epub 2004 Apr 2.

DOI:10.1007/s10350-003-0129-z

PMID:15054681

Abstract

INTRODUCTION

Oral metronidazole has been previously demonstrated to decrease postoperative pain after open diathermy hemorrhoidectomy. The current study investigates the efficacy of topical metronidazole (10 percent) in reducing postoperative pain and promoting wound healing after Harmonic Scalpel hemorrhoidectomy.

METHODS

A prospective, randomized trial was conducted to compare posthemorrhoidectomy pain and wound healing with use of topical metronidazole (10 percent) vs. placebo carrier, applied to the surgical site. Surgical indications included grade 3 or 4 internal or external hemorrhoidal disease, with or without a fissure-in-ano. Pain was assessed using a visual analog score (VAS) preoperatively and on postoperative days 1, 2, 7, 14, and 28. Twenty-four-hour narcotic use (hydrocodone 10 mg) was recorded on postoperative days 1, 2, 7, 14, and 28. Digital photographs of the surgical site were taken at 14 days postoperatively. The photographs were independently ranked by three blinded observers according to a) postoperative edema, b) primary vs. secondary healing, and c) overall wound healing.

RESULTS

Twenty patients were randomized in a prospective manner, ten to the topical 10 percent metronidazole group and ten to the placebo carrier group. Patients in the topical metronidazole group experienced significantly less postoperative pain at day 7 (VAS +/- SEM, 3.4 +/- 0.4 vs. 6.3 +/- 0.5; P = 0.002) and day 14 (1.0 +/- 0.4 vs. 3.2 +/- 0.7, P = 0.02). There was no statistical difference in narcotic analgesic requirements between groups. In the metronidazole group, postoperative edema was ranked significantly lower (mean score, 3.0 vs. 7.0, P < 0.01) and overall wound healing ranked significantly better (4.0 vs. 7.0, P = 0.03) than in controls.

CONCLUSION

Topical 10 percent metronidazole significantly reduces posthemorrhoidectomy discomfort at days 7 and 14 postoperatively. Postoperative edema is reduced and overall healing is improved, compared with that of carrier controls.

摘要

引言

先前已证明口服甲硝唑可减轻开放透热疗法痔切除术后的疼痛。本研究调查了局部用甲硝唑（10%）在减轻超声刀痔切除术后疼痛及促进伤口愈合方面的疗效。

方法

进行一项前瞻性随机试验，比较局部应用10%甲硝唑与安慰剂载体对痔切除术后疼痛和伤口愈合的影响，将其应用于手术部位。手术指征包括3级或4级内痔或外痔疾病，伴或不伴有肛裂。术前及术后第1、2、7、14和28天使用视觉模拟评分（VAS）评估疼痛。记录术后第1、2、7、14和28天24小时的麻醉药物使用情况（氢可酮10毫克）。术后14天拍摄手术部位的数码照片。由三名不知情的观察者根据以下方面对照片进行独立排序：a）术后水肿情况；b）一期愈合与二期愈合情况；c）整体伤口愈合情况。

结果

20例患者被前瞻性随机分组，10例进入局部用10%甲硝唑组，10例进入安慰剂载体组。局部用甲硝唑组患者在术后第7天（VAS +/- SEM，3.4 +/- 0.4对6.3 +/- 0.5；P = 0.002）和第14天（1.0 +/- 0.4对3.2 +/- 0.7，P = 0.02）的术后疼痛明显减轻。两组间麻醉性镇痛药的需求量无统计学差异。与对照组相比，甲硝唑组术后水肿的评分明显更低（平均评分，3.0对7.0，P < 0.01），整体伤口愈合情况的评分明显更好（4.0对7.0，P = 0.03）。