微切口联合改良柱状海绵材料VSD治疗肛门深部脓肿的临床疗效观察  

Microincision combined with vacuum sealing drainage with modified columnar sponge for deep anal abscess

作　　者：刘轩良[1] 杨中权[1] 廖信芳 Liu Xuanliang;Yang Zhongquan;Liao Xinfang(Department of Anorectal Diseases,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市中医院肛肠科,广东佛山528000

出　　处：《结直肠肛门外科》2022年第4期374-378,共5页Journal of Colorectal & Anal Surgery

基　　金：佛山市卫生健康局课题(20210304)。

摘　　要：目的 观察微切口联合改良柱状海绵材料负压封闭引流技术(VSD)治疗肛门深部脓肿的临床疗效。方法 选取2019年4月至2021年6月佛山市中医院肛肠科收治的43例肛门深部脓肿患者作为研究对象,随机分为治疗组(n=22,采用微切口联合改良柱状海绵材料VSD治疗)和对照组(n=21,采用传统切扩术式治疗)。比较两组手术相关指标(手术时间、创面愈合时间、手术切口长度、手术切口数量、住院时间),术后不同时点(术后第1、第3、第5天)换药时肛门局部疼痛评分,术后肛门功能评分及疗效。结果 治疗组的创面愈合时间、住院时间均短于对照组,手术切口长度短于对照组,手术切口数量少于对照组,但手术时间长于对照组(均P<0.05)。重复测量方差分析结果显示治疗组术后不同时点换药时肛门局部疼痛评分均低于对照组(均P<0.05);测量时间对术后换药时肛门局部疼痛评分没有影响(P>0.05)。术前,两组Wexner肛门失禁评分比较差异无统计学意义(P>0.05);术后,治疗组的Wexner肛门失禁评分与术前比较差异无统计学意义(P>0.05),但低于对照组(P<0.05);对照组的Wexner肛门失禁评分高于术前(P<0.05)。治疗组的治愈率为81.8%,对照组对应为76.2%,组间比较差异无统计学意义(P>0.05)。结论 与传统切扩术式相比,微切口联合改良柱状海绵材料VSD治疗肛门深部脓肿能缩短创面愈合时间、住院时间,减小手术切口长度,减少手术切口数量,减轻术后换药时肛门局部疼痛及保护肛门功能,具有临床推广的价值。Objectives To investigate the clinical effect of microincision combined with vacuum sealing drainage(VSD) with modified columnar sponge for treating deep anal abscess. Methods Forty-three patients with deep anal abscess treated at the Department of Anorectal Diseases, Foshan Hospital of Traditional Chinese Medicine, between April 2019 and June 2021 were recruited and randomly assigned to the treatment group(n=22, receiving microincision combined with VSD with modified columnar sponge) and the control group(n=21, receiving conventional open surgery). The followings were compared between the two groups: duration of surgery, time to wound healing, incision length, number of incisions, duration of hospitalization, anal pain score during change of dressing at different time points after surgery(1, 3, and 5 days), postoperative anal function score, and overall effectiveness. Results Compared with the control group, the treatment group had significantly shorter time to wound healing, shorter duration of hospitalization, shorter length of incision, and fewer incisions, but longer duration of surgery(P<0.05). Repeated measure analysis of variance showed that anal pain scores during change of dressing were significantly lower in the treatment group than in the control group(P<0.05), and the timing of measurement did not influence postoperative anal pain scores during change of dressing(P>0.05). Preoperative Wexner anal incontinence score was similar between the two groups(P>0.05). After surgery, Wexner anal incontinence score did not change significantly in the treatment group(P>0.05) and was significantly lower than that in the control group(P<0.05), while postoperative Wexner anal incontinence score in the control group was significantly higher than that before surgery(P<0.05). The cure rate was 81.8% in the treatment group and 76.2% in the control group with no significant differences between the groups(P>0.05). Conclusion Compared with conventional open surgery, microincision combined with VSD with modified columnar sp

关 键 词：肛门深部脓肿 微切口 改良柱状海绵材料负压封闭引流技术 疗效 

分 类 号：R657.15[医药卫生—外科学]