保留括约肌微创改良术一期根治蹄铁型肛周脓肿的疗效分析  

Clinical Effectiveness of Sphincter Preservation Method of Improved Minimally Invasive Surgery to Primary Cure for Horseshoe-Shaped Perianal Abscess

作　　者：陈朝晖[1] 陈林[1] 陈红霞[1] 张瑞芳[1] 范永强[1] 毛红[2] 

机构地区：[1]成都医学院第一附属医院肛肠科,四川成都610500 [2]四川省第二中医医院肛肠科,四川成都610031

出　　处：《中国普外基础与临床杂志》2016年第8期948-952,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省教育厅课题项目(编号:12ZA024)~~

摘　　要：目的评价保留括约肌微创改良术一期根治蹄铁型肛周脓肿的临床疗效。方法采用前瞻眭随机、单盲、平行对照的设计方法对2013年1月至2015年2月期间成都医学院第一附属医院及四川省第二中医医院肛肠科收治的符合纳入标准的120例蹄铁型肛周脓肿住院患者进行分析，采用随机数字表法将其随机分为保留括约肌微创改良一期根治术组（观察组）和传统放射状多切口挂线引流术组（对照组）。比较2组患者的一期愈合率、术后9d内疼痛评分、住院时间、切口愈合时间、愈合后瘢痕面积、术后肛门功能评分、围手术期并发症、远期术后并发症及复发率。结果2组患者手术过程均顺利。除观察组中2例、对照组中1例一期手术切口未愈经二期手术后痊愈外，2组其余患者均一期愈合。2组患者术后第1d疼痛评分2组间比较差异无统计学意义（P〉O．05），术后第2～4d及术后第7～9d的疼痛评分观察组明显低于对照组，差异有统计学意义（P〈O．05）。2组患者的住院时间及愈合后瘢痕面积比较差异均无统计学意义（P〉O．05），但观察组的切口愈合时间和术后肛门功能评分均明显低于对照组（P〈O．05）。2组患者均无切口感染及大出血发生，尿潴留、肝肾功能异常发生率及血白细胞总数〉10．Ox10^9／L2组间比较差异均无统计学意义（P〉O．05）。术后随访6个月，2组均未出现远期复发、肛门狭窄及肛门失禁。结论从本组的研究结果初步得出，保留括约肌微创改良术一期根治蹄铁型肛周脓肿的临床疗效确切，愈合快、术后并发症少。Objective To evaluate clinical curative effect of sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess. Methods One hundred and twenty hospitalized patients diagnosed as horseshoe-shaped perianal abscess were analyzed by prospective, random, single-blind, parallel- group design method, and were randomly divided into two groups, one group of sphincter preservation method of improved minimally invasive surgery （observation group）, another group of traditional method of hanging line drainage and multiple incisions of radian shape （control group）. The cure rate, long-term recurrence, postoperative pain score within 9 d, hospitalization time, incision healing time, scar area after healing, postoperative anal function score and perioperative and long-term complications were compared in these two groups. Results All the operations were successfully completed in these two groups. There were 56 cases of primary healing in the observation group and 55 cases of primary healing in the control group. Compared with the control group, the postoperative pain score on day 2-4 or on day 7-9 was lower （P〈0.05）, the incision healing time was shorter （P〈0.05）, and the postoperative anal function score was lower （P〈0.05） in the observation group. There was no incision infection and hemorrhoea in these two groups.The hospitalization time, scar area after healing, incidence rate of urinary retention, hepatic and renal dysfunction, and the total white blood cells 〉10.0x10^9/L had no significant differences between these two groups （P〉0.05）. There was no long-term recurrence, anal stenosis, and anal incontinence during following-up of 6 months in these two groups. Conclusion Preliminary research results show that sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess has a reliable clinical curative effect, fast healing, and less postoperative complications.

关 键 词：肛周脓肿 手术 微创 疗效 

分 类 号：R657.15[医药卫生—外科学]