Three-cavity clearance(TCC)can decrease the fistula rate after drainage of a perianal abscess:a case–control study  

三腔间隙引流(TCC)可降低肛周脓肿术后肛瘘发生率:一项匹配病例对照研究

作　　者：Heiying Jin Yan Chen Bei Zhang 

机构地区：[1]Department of Colorectal Surgery,The Second Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,China [2]Graduate School of Nanjing University of Chinese Medicine,Nanjing,China [3]Department of Colorectal Surgery,The Third Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,China

出　　处：《Gastroenterology Report》2018年第3期221-224,I0003,共5页胃肠病学报道（英文）

基　　金：supported by the National Nature Science Foundation of China(No.30572447,No.30973837 and No.81273944);the Jiangsu Nature Science Foundation(No.BK20151081).

摘　　要：Objective:The aim of this study was to evaluate the safety and efficacy of three-cavity clearance(TCC)used for the treatment of perianal abscess.Methods:A case–control study of patients with perianal abscess was conducted at the Second and Third Affiliated Hospitals of Nanjing University of Chinese Medicine from June 2013 to March 2016.Clinical data from 46 patients who had TCC were analysed.At the same time,46 patients had simple incision and drainage and 46 patients had abscess drainage and cutting seton(radical abscess incision);the data from these patients were also analysed.The length of hospital stay,time of wound healing,fistula rate and anal incontinence were assessed.Results:The rate of fistula formation in the TCC group was 13.0%—significantly lower than that in the group with simple incision and drainage(39.1%,p<0.01)and similar to the group with radical abscess incision(8.7%,p>0.05).Two patients(4.3%)in the group with radical abscess incision had anal incontinence,flatus and soiling;their Wexner scores were 6 and 3,respectively.There was no anal incontinence in the TCC group or the simple incision and drainage group.There were no statistical differences in the time of wound healing and length of hospital stay among the three groups(both p>0.05).Conclusion:TCC is a safe and effective sphincter-preserving procedure for perianal abscess formation and can decrease the fistula rate after perianal abscess drainage.It appears to be a valuable method that can be used in clinical practice;however,further studies are needed to verify this finding.目的:本研究目的旨在评估三腔间隙引流(TCC)治疗肛周脓肿的安全性和有效性。方法:收集2013年6月至2016年3月间在南京中医药大学附属第二和第三医院的肛周脓肿患者的病例资料,其中,46例患者接受了TCC治疗。按照性别、年龄、脓肿部位进行1:1:1匹配,选取同期行单纯切开引流术的46例患者和行一期切开引流挂线术(根治性手术)的46例患者进行对比分析。比较三组患者的住院时间、切口愈合时间、肛瘘发生率及肿门失禁情况。结果:TCC组患者术后肛瘘发生率为13.0%,显著低于单纯切开引流组(39.1%,P<0.01),与根治性脓肿切开组相当(8.7%,P>0.05)。根治性脓肿切开组有2例患者术后出现肛门失禁、腹胀和污粪,其Wexner失禁评分分别为6分和3分;而TCC组和单纯切开引流组无肛门失禁发生。三组患者切口愈合时间和住院时间的差异均无统计学意义(均P>0.05)结论:TCC是一项安全有效的保留括约肌功能的肛周脓肿治疗术式,可降低脓肿引流术后肛瘘发生率。该术式有望在临床实践中推广应用,其临床疗效尚需进一步研究证实。

关 键 词：Three-cavity clearance(TCC) perianal abscess anal fistula drainage cutting seton 

分 类 号：R65[医药卫生—外科学]