11例肛门直肠外伤和肛周坏死性筋膜炎导致的重症肛周感染诊治体会  

Diagnosis and treatment of severe perianal infection due to anorectal injuries and perianal necrotic fasciitis:an analysis of eleven patients

作　　者：吉小昌[1] 高金颖[1] 王芳丽[2] Ji Xiaochang;Gao Jinying;Wang Fangli(Department of Health Management,The Central Hospital of China Aerospace Corporation,Beijing 100049,China;Department of General Surgery,The Central Hospital of China Aerospace Corporation,Beijing 100049,China)

机构地区：[1]航天中心医院健康管理部,北京100049 [2]航天中心医院普外科,北京100049

出　　处：《结直肠肛门外科》2020年第6期751-754,共4页Journal of Colorectal & Anal Surgery

基　　金：北京肛肠学会科研基金项目(ABCP2019-011)。

摘　　要：目的总结11例肛门直肠外伤和肛周坏死性筋膜炎导致的重症肛周感染的临床诊治体会。方法回顾性分析2014年10月至2019年10月我院收治的11例肛门直肠外伤和肛周坏死性筋膜炎导致的重症肛周感染患者临床资料,分析其诊治经过,总结临床治疗经验。结果3例为肛门直肠外伤导致重症肛周感染患者,均早期行粪便转流手术(乙状结肠造口术)结合肛周清创术;8例为肛周坏死性筋膜炎导致重症肛周感染患者,均早期急诊行跳跃式接力切开、短程挂线引流的手术方式。所有患者治疗效果均良好,无死亡病例,住院时间11~183 d,中位住院时间56.0(27.3,69.8)d。肛门直肠外伤导致重症肛周感染患者均接受2次及以上手术治疗,1例患者因肛门及直肠下段结构缺失,行肛门会阴封闭术,余2例患者行括约肌成形术,经术后肛门功能锻炼恢复良好;坏死性筋膜炎导致重症肛周感染患者均完全治愈,随访1年无复发病例。结论早期根据病史、结合临床表现和必要的实验室检查做出快速准确的诊断,肛门直肠外伤患者尽早行粪便转流手术结合肛周清创术,肛周坏死性筋膜炎患者尽早行跳跃式接力切开、短程挂线引流的手术方式,采取充分清创、早期使用广谱抗生素、术后精细换药、多学科协作等综合干预措施,临床疗效良好,并可提高患者的生活质量。Objectives To analyze the diagnosis and treatment of eleven patients with severe perianal infection due to anorectal injuries and perianal necrotic fasciitis.Methods This is a retrospective analysis of eleven patients with severe perianal infection due to anorectal injuries and perianal necrotic fasciitis treated in our hospital between October 2014 and October 2019.We sum⁃marized our experiences of diagnosis and management of this condition.Results There were three patients with severe perianal infection due to anorectal injuries.All three patients received early fecal diversion(early sigmoidostomy)and perianal debride⁃ment.The other eight patients with severe perianal infection were caused by perianal necrotic fasciitis,and they received early acute salutatory fistulotomy and short-term seton.All patients achieved good outcome,and there was no death.Hospitalization du⁃ration ranged between 11 to 183 days with a median of 56.0(27.3,69.8)days.All patients with severe perianal infection due to anorectal injuries had to undergo repeated surgery,including one patient with severe perianal infection due to defect of anus and lower rectum undergoing anal and perineal blockage and two patients undergoing sphincteroplasty.The two patients had a good recovery after physical exercise.All patients with severe perianal infection due to perianal necrotic fasciitis were cured and did not experience recurrence after 1 year follow-up.Conclusion After early diagnosis based on medical history,clinical presenta⁃tion,and laboratory results,patients with severe perianal infection due to anorectal injuries should undergo early fecal diversion and perianal debridement.Patients with severe perianal infection due to perianal necrotic fasciitis should undergo acute salutatory fistulotomy and short-term seton.All patients should receive appropriate debridement,early use of broad-spectrum antibiotics,dedicated wound dressing,and multidisciplinary management.With these good practices in place,patients can achieve good clini⁃cal out

关 键 词：重症肛周感染 肛门直肠外伤 肛周坏死性筋膜炎 

分 类 号：R657.1[医药卫生—外科学]