目的 临床观察白花蛇舌草干预湿热瘀滞型肠内多发息肉患者内镜治疗术后复发情况。方法 采用前瞻性的随机空白对照试验设计，选取2019年9月1日—2020年12月31日上海中医药大学附属普陀医院消化科收治的门诊及住院结直肠多发息肉患者132例作为研究对象。采用随机方法分为对照组和试验组，每组66例。对照组行内镜治疗术给予常规治疗后无药物干预，试验组在对照基础上给予白花蛇舌草汤剂（每日取白花蛇舌草15 g、大枣3枚，煎取400 mL汤剂，分2次饭后温服）治疗，连续干预1年。观察并比较两组术前与术后1年肠道内息肉的复发率、息肉数目、息肉最大直径、中医证候评分及肝肾功能及血常规的差异。结果 干预1年后，试验组复发9例（14.75%），对照组复发21例（33.33%），两组息肉复发率比较，差异有统计学意义（P＜0.05）。试验组腺瘤、伴重度异型增生、体质量指数（BMI）≥24 kg·m^-2患者治疗后息肉复发率均较对照组同类型降低，差异显著（P＜0.05）；术后1年试验组息肉最大直径及息肉数目均较对照组显著减小，差异显著（P＜0.05）；术后1年试验组中医证候各项评分均显著低于对照组（P＜0.05）；术后1年，两组中医证候疗效比较，差异具有统计学意义（P＜0.05），且术前、术后1年两组患者肝肾功能、凝血功能等安全性指标无显著差异。结论 应用白花蛇舌草干预结直肠息肉术后患者，1年后明显降低肠内息肉的复发率，尤以腺瘤性息肉、重度异型增生、BMI超重患者更显著，不仅改善临床症状，还能有效预防结直肠息肉的复发，改善患者的预后。

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年引进人才基金项目（2017316A）