一次性根治术和分期手术对小儿肛周脓肿预后影响的对比研究  

Prognostic comparison of one-stage radical resection versus staged surgery for perianal abscess in children

作　　者：莫智峰 袁马保 谢俊锋[2] 招卡媚 赖思聪 李斌德[4] 颜禄斌[3] Mo Zhifeng;Yuan Mabao;Xie Junfeng;Zhao Kamei;Lai Sicong;Li Binde;Yan Lubin(Center for Emergency and Disaster Medicine,Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,China;Department of Pediatrics,Seven Affiliated Hospital,Zhongshan University,Shenzhen 518107,China;Department of Pediatric Surgery,Sixth Affiliated Hospital,Zhongshan University,Guangzhou 516055,China;Department of Pediatric Surgery,Lanzhou University Second Hospital,Lanzhou 730030,China;Department of Pediatric Surgery,Shenzhen Bao'an District Maternal&Children's Health Hospital,Shenzhen 518101,China)

机构地区：[1]中山大学附属第七医院急诊与灾难医学中心,深圳518107 [2]中山大学附属第七医院儿科,深圳518107 [3]中山大学附属第六医院小儿外科,广州516055 [4]兰州大学第二医院小儿外科,730030 [5]深圳市宝安区妇幼保健院小儿外科,518101

出　　处：《中华小儿外科杂志》2021年第1期49-52,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的对比一次性根治术和分期手术治疗小儿肛周脓肿形成肛瘘患儿的预后差异。方法收集中山大学附属第七医院(37例)、中山大学附属第六医院(42例)和兰州大学第二医院(21例)在2017年2月至2018年2月收治肛周脓肿并形成肛瘘的患儿共100例作为研究对象,按照随机数字表法分为一次性根治手术组和分期手术组。其中,一次性根治手术组50例,男41例,女9例;年龄为(5.2±0.3)个月,范围为2个月至4岁;病程时间为(15.4±1.6)d,范围为1~64 d。分期手术组50例,男39例,女11例;年龄为(5.4±0.2)个月,范围为2个月至3岁;病程时间为(15.6±1.8)d,范围为1~52 d。对比两组患儿的治愈率、肛门功能、肛周疼痛情况、愈合时间、肛瘘复发率和家长满意度。结果一次性根治手术组所收治肛周脓肿患儿的临床治愈率为90%(45/50),分期手术组患儿的为68%(34/50),两组间对比的差异具有统计学意义(P<0.05);一次性根治手术组患儿肛门功能正常率为88%(44/50),高于分期手术组的70%(35/50),差异具有统计学意义(P<0.05);一次性根治手术组患儿的肛周疼痛分级中0级占比为56%(28/50),高于分期手术组42%(21/50),差异具有统计学意义(P<0.05);一次性根治手术组术后创口愈合时间为(13.5±2.3)d,分期手术组为(13.1±2.4)d,差异无统计学意义(P>0.05);一次性根治手术组患儿的肛瘘复发率低于分期手术组[2%(1/50)比16%(8/50)],差异具有统计学意义(P<0.05)。结论对于小儿肛周脓肿形成肛瘘的患儿,应采用一次性根治术来治疗,与分期手术比较,可明显提高治愈率,改善肛门功能,缓解疼痛,减少肛瘘复发事件,具有非常重要的实施价值。Objective To compare the prognosis of children of perianal abscess treated by one-stage radical resection versus staged surgery.Methods From February 2017 to February 2018,100 hospitalized children with perianal abscesses and anal fistula at Department of Pediatric Surgery of Seventh Affiliated Hospital,Sun Yat-sen University were selected as research subjects.They were divided randomly into one-stage radical surgery group(A,n=50)and staged surgery group(B,n=50).In group A,there were 41 boys and 9 girls with an average age of(5.2±0.3)(2-48)months and an average duration of disease(15.4±1.6)(1-64)days;in group B,there were 39 boys and 11 girls with an average age of(5.4±0.2)(2-36)months and an average duration of disease(15.6±1.8)(1-52)days.Curative rate,anal function,perianal pain,healing time,anal fistula recurrence rate and parental satisfaction were compared.Results The clinical curative rate of two groups was(90%,45/50 vs 68%,34/50)and the inter-group difference was statistically significant(P<0.05).The normal rate of anus function was higher in one-stage radical surgery group than that in staged surgery group(88%,44/50 vs 70%,35/50)and the difference was statistically significant(P<0.05).The percentage of grade 0 perianal pain was higher in one-stage radical surgery group than that in staged surgery group(56%,28/50 vs 42%,21/50)and there was statistically significant difference(P<0.05).The postoperative wound healing time of one-stage radical surgery group was longer than that of staged surgery group[(13.5±2.3)vs(13.1±2.4)days]and no statistically significant difference between two groups(P>0.05).The anal fistula recurrence rate was lower in one-stage radical surgery group than that in staged surgery group(2%,1/50 vs 16%,8/50)and the difference was statistically significant(P<0.05).Conclusions As compared with staged surgery,one-stage radical resection may significantly improve curative rate,improve anal function,relieve pain and prevent the recurrence of anal fistula in children with perianal abscesse

关 键 词：儿童 肛周脓肿 一次性根治术 分期手术 治愈率 

分 类 号：R726.5[医药卫生—儿科]