目的 臨床觀察白花蛇舌草干預(yù)濕熱瘀滯型腸內(nèi)多發(fā)息肉患者內(nèi)鏡治療術(shù)后復(fù)發(fā)情況。方法 采用前瞻性的隨機(jī)空白對(duì)照試驗(yàn)設(shè)計(jì)，選取2019年9月1日—2020年12月31日上海中醫(yī)藥大學(xué)附屬普陀醫(yī)院消化科收治的門診及住院結(jié)直腸多發(fā)息肉患者132例作為研究對(duì)象。采用隨機(jī)方法分為對(duì)照組和試驗(yàn)組，每組66例。對(duì)照組行內(nèi)鏡治療術(shù)給予常規(guī)治療后無(wú)藥物干預(yù)，試驗(yàn)組在對(duì)照基礎(chǔ)上給予白花蛇舌草湯劑（每日取白花蛇舌草15 g、大棗3枚，煎取400 mL湯劑，分2次飯后溫服）治療，連續(xù)干預(yù)1年。觀察并比較兩組術(shù)前與術(shù)后1年腸道內(nèi)息肉的復(fù)發(fā)率、息肉數(shù)目、息肉最大直徑、中醫(yī)證候評(píng)分及肝腎功能及血常規(guī)的差異。結(jié)果 干預(yù)1年后，試驗(yàn)組復(fù)發(fā)9例（14.75%），對(duì)照組復(fù)發(fā)21例（33.33%），兩組息肉復(fù)發(fā)率比較，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。試驗(yàn)組腺瘤、伴重度異型增生、體質(zhì)量指數(shù)（BMI）≥24 kg·m^-2患者治療后息肉復(fù)發(fā)率均較對(duì)照組同類型降低，差異顯著（P＜0.05）；術(shù)后1年試驗(yàn)組息肉最大直徑及息肉數(shù)目均較對(duì)照組顯著減小，差異顯著（P＜0.05）；術(shù)后1年試驗(yàn)組中醫(yī)證候各項(xiàng)評(píng)分均顯著低于對(duì)照組（P＜0.05）；術(shù)后1年，兩組中醫(yī)證候療效比較，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05），且術(shù)前、術(shù)后1年兩組患者肝腎功能、凝血功能等安全性指標(biāo)無(wú)顯著差異。結(jié)論 應(yīng)用白花蛇舌草干預(yù)結(jié)直腸息肉術(shù)后患者，1年后明顯降低腸內(nèi)息肉的復(fù)發(fā)率，尤以腺瘤性息肉、重度異型增生、BMI超重患者更顯著，不僅改善臨床癥狀，還能有效預(yù)防結(jié)直腸息肉的復(fù)發(fā)，改善患者的預(yù)后。

Objective To observe the recurrence of intestinal polyps patients with Hedyotis diffusa intervention after endoscopic treatment. Methods A prospective randomized blank controlled trial design was used. A total of 132 outpatients and inpatients with colorectal polyps were selected from the Department of Gastroenterology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 1, 2019 to December 31, 2020. They were randomly divided into control group and experimental group, with 66 cases in each group. Patients in control group were received endoscopic therapy without drug intervention after routine treatment. On the basis of the control group, patients in experimental group were treated with Hedyotis diffusa Decoction (15 g Hedyotis diffusa, three jujubes, 400 mL decocted every day, and taken warm after meals twice) for one year. The recurrence rate of intestinal polyps, the number of polyps, the maximum diameter of polyps, the score of traditional Chinese medicine syndrome, liver and kidney function and blood routine were observed and compared between two groups before and one year after operation. Results One year after intervention, nine cases (14.75%) recurred in the experimental group and 21 cases (33.33%) recurred in the control group. There was significant difference in the recurrence rate of polyps between two groups (P < 0.05). The recurrence rate of polyps in patients with adenoma, severe dysplasia and body mass index (BMI) ≥ 24 kg·m^-2 in experimental group was significantly lower than that in control group (P < 0.05). One year after operation, the maximum diameter and number of polyps in experimental group were significantly smaller than those in control group (P < 0.05). One year after operation, the scores of TCM syndromes in experimental group were significantly lower than those in control group (P < 0.05). One year after operation, there was significant difference between two groups in the efficacy of traditional Chinese medicine syndromes (P < 0.05), and there was no significant difference between two groups in liver and kidney function, coagulation function and other safety indicators (P > 0.05). Conclusion The intervention of Hedyotis diffusa on postoperative patients with colorectal polyps can significantly reduce the recurrence rate of intestinal polyps after one year, especially in patients with adenomatous polyps, severe dysplasia and overweight BMI. It can not only improve clinical symptoms, but also effectively prevent the recurrence of colorectal polyps and improve the prognosis of patients.

R975

2018年引進(jìn)人才基金項(xiàng)目（2017316A）