主灶切开加弧形开窗引流治疗复杂性肛周脓肿的临床研究  

Main incision and cruved window to treat complex perianal abscess

作　　者：张辉 王志民 高荣青 陈璐 ZHANG Hui;WANG Zhi-min;GAO Rong-qing;CHEN Lu(Clinical Medical College of Weifang Medical University(Weifang,261000,China);Department of Anorectal Surgery,Qianfoshan Hospital Affiliated to Shandong University(Jinan,250014,China))

机构地区：[1]潍坊医学院临床医学院,山东潍坊261042 [2]山东大学附属千佛山医院肛肠二科,山东济南250014

出　　处：《中国现代普通外科进展》2019年第4期266-269,共4页Chinese Journal of Current Advances in General Surgery

基　　金：山东省中医药科技发展项目(2015-283);济南市科技发展计划资助项目(201506022)

摘　　要：目的:探讨主灶切开加弧形开窗引流治疗复杂性肛周脓肿的临床效果。方法:182例复杂性肛周脓肿患者随机分为观察组(主灶切开加弧形开窗引流)92例和对照组(主灶切开加放射状开窗引流)90例,比较两组患者治愈时间、后遗肛瘘发生情况、肛门测压结果、瘢痕大小。结果:观察组治愈时间为15~25 d,对照组治愈时间为17~35 d,观察组平均治愈时间(19.35±3.29)d,明显短于对照组平均治愈时间(26.58±5.32)d,差异有统计学意义(P<0.05)。随访1年,观察组后遗肛瘘4例,对照组后遗肛瘘7例。观察组后遗肛瘘发生率(4.34%)明显低于对照组发生率(7.78%),差异有统计学意义(P<0.05)。观察组与对照组术前肛管静息压均值分别为11.33 kPa和10.35 k Pa,肛管收缩压均值分别为15.35 kPa和16.36 kPa,差异均无统计学意义(P>0.05)。术后3个月观察组与对照组肛管静息压均值分别为11.26kPa和13.05 kPa,肛管收缩压均值分别为17.87 k Pa和15.41 kPa,差异均有统计学意义(P<0.05)。观察组瘢痕评分为5~11,对照组瘢痕评分为4~12,观察组瘢痕平均评分(5.23±1.23),低于对照组瘢痕平均评分(9.06±2.36),差异有统计学意义(P<0.05)。结论:主灶切开加弧形开窗引流治疗复杂性肛周脓肿治愈时间短,后遗肛瘘少,肛门瘢痕小,肛门功能恢复好。Objective: To investigate the clinical effect of main incision and curved fenestration in the treatment of complicated perianal abscess. Methods: A total of 182 patients with complicated perianal abscess were randomly divided into observation group(main incision and curved window opening) and control group(main incision plus radial window opening) in 90 cases. Time, post^anal fistula, anal pressure measurement results, scar size were compared. Results: The healing time of the observation group was 15~25 d, and the healing time of the control group was 17~35 d. The average healing time of the observation group(19.35±3.29)d was significantly shorter than that of the control group(26.58±5.32)d(P<0.05). After 1 year of follow^up, 4 cases of anal fistula occurred in the observation group, and 7 cases of anal fistula occurred in the control group. The incidence of anal fistula in the observation group(4.34%) was significantly lower than that in the control group(7.78%, P<0.05). The mean resting pressure of the anal canal in the observation group and the control group was11.33 vs 10.35 KPa, respectively(P>0.05), the mean value of anal canal systolic pressure was15.35 vs16.36 KPa(P>0.05). At 3 months after operation, the mean anal canal resting pressure was11.26 vs 13.05 KPa(P<0.05), and the mean anal canal systolic pressure was 17.87 vs 15.41 KPa(P<0.05). The scar score of the observation group was observed. For the 5~11, the scar score of the control group was 4~12, and the average score of the scar in the observation group(5.23±1.23) was lower than that of the control group(9.06 ±2.36, P<0.05). Conclusion: The main incision and curved fenestration for the treatment of complicated perianal abscess have a short healing time, less anal fistula, less anal scar and good anal function recovery.

关 键 词：肛周脓肿 主灶切开 弧形开窗 

分 类 号：R574.8[医药卫生—消化系统]