改良负压封闭引流技术治疗肛周坏死性筋膜炎的效果评价  

Investigation of improved VSD in the treatment of perianal necrotizing fasciitis

作　　者：张雷[1] 田颖[1] 于洪顺[1] 张玉茹[1] 王彦芳[1] 殷毅 田磊[1] 于国志[1] 葛强[1] 石岩 Zhang Lei;Tian Ying;Yu Hongshun;Zhang Yuru;Wang Yanfang;Yin Yi;Tian Lei;Yu Guozhi;Ge Qiang;Shi Yan(Department of Anorectal Surgery,Beijing Anorectal Hospital(Erlong Road Hospital,Beijing),Beijing 100120,China;不详)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)肛肠外科,北京100120 [2]北京市隆福医院肛肠科

出　　处：《中国临床保健杂志》2020年第4期495-499,共5页Chinese Journal of Clinical Healthcare

基　　金：首都临床特色应用研究(z171100001017100)。

摘　　要：目的探讨改良负压封闭引流术治疗肛周坏死性筋膜炎的临床效果。方法选择2018年1月至2020年1月收治的77例肛周坏死性筋膜炎患者作为研究对象,按照不同的治疗方式分为对照组(n=40)与观察组(n=37),其中对照组患者采取常规清创术,而观察组患者则在清创术的基础上实施改良负压封闭引流术进行治疗,对比两组患者的临床效果。结果在清创次数、愈合时间以及住院时间方面观察组均明显小于对照组(P<0.05);两组患者疼痛观察在术前的视觉模拟评分法(VAS)差异无统计学意义(P>0.05);经过手术后,两组患者的VAS评分均有明显下降(P<0.05),其中观察组患者的下降程度比对照组患者更为显著(P<0.05)。观察组患者引流术后第2周、4周时创面血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)较术后当天明显升高并且均高于对照组,差异均有统计学意义(P<0.05)。两组患者术后第4周肛管静息压(ARP)、肛管最大收缩压(AMCP)与术后当天差异均无统计学意义(P>0.05)。结论将改良VSD术应用于肛周坏死性筋膜炎患者的清创治疗中,可有效促进患者创面的愈合,这可能与VSD促进创面bFGF、VEGF生长因子形成有关;且改良VSD术可改善患者术后疼痛情况,对肛门ARP、AMCP的影响微弱,对保护患者肛门功能、改善预后有实际临床意义。Objective To probe into the clinical effect of improved vacuum sealing drainage in the treatment of perianal necrotizing fasciitis.Methods 77 cases of patients with perianal necrotizing fasciitis and who treated from January 2018 to January 2020 were selected as the research objects in this study,and the patients were divided into control group(n=40)and observation group(n=37)according to different treatment methods.The control group were treated with routine debridement,while the observation group were treated with improved vacuum sealing drainage on the basis of debridement.Then,the clinical effects of two groups of patients were compared.Results The number of debridement,healing time and hospitalization time in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in VAS score between the two groups(P>0.05).After operation,the VAS scores of the two groups were significantly decreased(P<0.05).The decrease degree in the observation group was significantly more than that in the control group(P<0.05).After drainage for 2nd and 4th week,the wound vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)in the observation group were significantly higher than those on the day after operation and in the control group,and the difference was statistically significant(P<0.05).The anal resting pressure(ARP)and the anal maximum systolic pressure(AMCP)after operation for 4 weeks were lower than those in the day after operation,but there was no significant difference(P>0.05).Conclusion The application of improved VSD in debridement of perianal necrotizing fasciitis can effectively promote wound healing,and it may be related to VSD in promoting the growth of bFGF and VEGF growth factor,and improved VSD can improve postoperative pain.The effect on ARP and AMCP of anus is weak,and thus it has practical clinical significance for protecting anal function and improving prognosis.

关 键 词：筋膜炎 坏死性 肛门 负压伤口疗法 清创术 

分 类 号：R47[医药卫生—护理学]