三间隙引流术和传统切开挂线术在治疗肛周脓肿中的应用价值  

Application value of three-gap drainage and traditional incision and thread hanging in the treatment of perianal abscess

作　　者：刘浏荣[1] 王留珍[1] 孙洁慧[1] 施文陆 张娇娇 王慧[1] LIU Liu-rong;WANG Liu-zhen;SUN Jie-hui(Department of Proctology,Yancheng Third People's Hospital,Yancheng Jiangsu 224001,China)

机构地区：[1]盐城市第三人民医院肛肠科,江苏盐城224001

出　　处：《临床和实验医学杂志》2020年第9期985-988,共4页Journal of Clinical and Experimental Medicine

基　　金：江苏省卫生厅资助基金项目(编号:201702358)。

摘　　要：目的观察和比较三间隙引流术与传统切开挂线术治疗肛周脓肿的临床效果,并评价其应用价值。方法采用前瞻性随机对照研究方法,选取2017年6月至2019年6月盐城市第三人民医院收治的95例肛周脓肿患者,按照简单随机分组法将患者分为两组:对照组患者(n=47)行传统切开挂线术治疗,观察组患者(n=48)行三间隙引流术治疗。观察两组患者的手术相关指标(包括手术时间、术中出血量、创面愈合时间、住院时间),采用Wexner量表评价两组患者治疗前以及治疗后1 d、7 d、30 d的肛门功能,以视觉模拟评分法(VAS)评价两组患者治疗前以及治疗后1 d、7d、30 d的患处疼痛情况,统计两组患者治疗期间的创面感染、肛瘘形成、肛门缺损或畸形等并发症发生率。结果两组患者的手术时间比较差异无统计学意义(26. 93±7. 63 min vs. 25. 49±6. 31 min)(P> 0. 05);观察组患者的术中出血量(24. 69±4. 63 ml vs. 16. 93±3. 27 ml)、创面愈合时间(27. 59±4. 27 d vs. 22. 61±6. 59 d)、住院时间(16. 27±6. 41 d vs. 12. 95±5. 63 d)均少于对照组,差异具有统计学意义(P <0. 05)。观察组患者术后1 d的Wexner量表评分低于对照组(9. 26±1. 58分vs. 7. 88±1. 65分),差异具有统计学意义(P <0. 05),治疗后7 d(4. 69±1. 63分vs. 4. 28±1. 37分)、30 d时(2. 73±0. 67分vs. 2. 51±0. 58分)两组Wexner量表评分比较差异无统计学意义(P>0. 05)。治疗后1 d时两组患者VAS评分比较(6. 75±1. 22分vs. 6. 05±1. 64分),差异无统计学意义(P>0. 05),观察组患者术后7 d、30d的疼痛VAS评分低于对照组(3. 05±0. 41分vs. 2. 33±0. 34分、2. 25±0. 25分vs. 1. 17±0. 24分),差异具有统计学意义(P <0. 05)。两组患者创面感染(4. 26%vs. 2. 08%)、肛门缺损或畸形发生率(2. 13%vs. 0)比较差异无统计学意义(P>0. 05);观察组的肛瘘形成发生率低于对照组(6. 38%vs. 2. 08%),差异具有统计学意义(P <0. 05)。结论相较于传统切开挂线术,Objective To observe and compare the clinical effect of three-gap drainage and traditional incision and thread hanging in the treatment of perianal abscess,and evaluate its application value. Methods A prospective randomized controlled trial was performed to select 95 patients with perianal abscess admitted to the Third People’s Hospital of Yancheng from June 2017 to June 2019. Patients were divided into two groups according to simple randomized method,including control group( n = 47) performed traditional incision and suture technique and observation group( n = 48) underwent triple-graft drainage. The surgical related indexes( including operation time,intraoperative blood loss,wound healing time,hospitalization time) were observed in the two groups. The Wexner scale was used to evaluate the anus function of the two groups before treatment and at 1,7 and 30 days after treatment. Visual analog scale( VAS) was used to evaluate the pain of the two groups of patients before and after 1,7 and 30 days after treatment. The incidence of complications such as wound infection,anal fistula formation,anal defect or deformity during the treatment of the two groups was counted. Results There was no significant difference in the operation time between the two groups( 26. 93 ± 7. 63 min vs. 25. 49 ± 6. 31 min)( P > 0. 05). The intraoperative blood loss of the observation group( 24. 69 ± 4. 63 ml vs.16. 93 ± 3. 27 ml),the healing time of wound surface( 27. 59 ± 4. 27 d vs. 22. 61 ± 6. 59 d) and hospitalization time( 16. 27 ± 6. 41 d vs. 12. 95 ±5. 63 d) were less than those of the control group,and the differences were statistically significant( P < 0. 05). The Wexner scale score was lower in the observation group than that in the control group( 9. 26 ± 1. 58 vs. 7. 88 ± 1. 65),the difference was statistically significant( P < 0. 05).The scores of the Wexner scale between the two groups,7 days after treatment( 4. 69 ± 1. 63 points vs. 4. 28 ± 1. 37 points),30 days( 2. 73 ±0. 67 point vs. 2. 51 ± 0. 58 points),had

关 键 词：肛周脓肿 三间隙引流术 传统切开挂线术 肛门功能 肛瘘 

分 类 号：R657.15[医药卫生—外科学]