顶端造口无张力丝线挂线法治疗肛周深部脓肿的疗效观察  

Clinical observation on the treatment of deep anorectal abscess with tension-free thread hanging method of top ostomy

作　　者：赵刚 汪立鑫 纪蓬辉 李秀梅 程伟才 ZHAO Gang;WANG Li-xin;JI Peng-hui(Department of General Surgery,Dajijia Hospital in Yantai Economic and Technological Development Zone,Yantai 264000,China)

机构地区：[1]烟台经济技术开发区大季家医院普外科,264000 [2]烟台市烟台山医院肛肠外科,264000 [3]烟台市烟台山医院急诊科,264000 [4]烟台市烟台山医院手术室,264000

出　　处：《中国现代药物应用》2024年第3期58-60,共3页Chinese Journal of Modern Drug Application

摘　　要：目的观察顶端造口无张力丝线挂线法治疗肛周深部脓肿的疗效。方法对30例肛周深部脓肿患者进行顶端造口无张力丝线挂线法手术治疗,观察手术后各项有效性(新鲜肉芽组织获取时间、治疗效果),安全性指标(肛门疼痛情况、中度或以上疼痛持续时间、术后中度以上发热情况、术后有无尿潴留、术后住院时间、术后肛门功能)及随访结果(术后创口完全愈合时间、有无脓肿复发及肛瘘形成)。结果手术后30例患者的治愈率可达90%(27/30),另有10%(3/30)为好转(形成肛瘘),总有效率为100%;新鲜肉芽组织获取时间为(7.1±0.9)d,术后住院时间为(4.3±1.2)d;术后24 h、7 d、21 d的视觉模拟评分法(VAS)评分分别是(6.3±0.3)、(4.5±0.8)、(2.0±0.5)分,中度或以上疼痛持续时间(3.2±1.3)d;术后8、24、72 h中度以上发热分别为6、3、0例,1例患者出现术后尿潴留,Wexner肛门失禁评分为(1.17±0.80)分。术后创口完全愈合需(33.2±2.2)d;经过6~33个月随访,另有2例脓肿复发。结论顶端造口无张力丝线挂线法治疗肛周深部脓肿疗效确切,方法简单,是一种可选的手术方式。Objective To observe the effect of tension-free thread hanging method of top ostomy in the treatment of deep anorectal abscess.Methods 30 patients with deep anorectal abscess were treated with tension-free thread hanging method of top ostomy.The postoperative effectiveness(duration of fresh granulation tissue acquisition and therapeutic effect),safety indicators(anal pain,moderate or above pain duration,postoperative moderate or above fever,postoperative urinary retention,postoperative hospitalization time,postoperative anal function),and follow-up results(postoperative wound healing time,abscess recurrence,and anal fistula formation)were observed.Results 90%(27/30)of the 30 patients was cured,10%(3/30)was improved(anal fistula formation),and the total effective rate was 100%.The duration of fresh granulation tissue acquisition was(7.1±0.9)d and postoperative hospitalization time was(4.3±1.2)d.The visual analogue scale(VAS)scores were(6.3±0.3),(4.5±0.8)and(2.0±0.5)at 24 h,7 d and 21 d respectively,and the duration of moderate or above pain was(3.2±1.3)d.There were 6 patients with moderate or above fever at 8 h postoperatively,3 patients with moderate fever or above at 24 h postoperatively,0 patient with moderate fever or above at 72 h postoperatively and 1 patient with urinary retention after surgery.Wexner assessment score of anal incontinence was(1.17±0.8)points.It took(33.2±2.2)d for the wound to heal completely.Follow-up results showed that 2 cases had recurrence of anorectal abscess after 6-33 months of follow-up.Conclusion Tension-free thread hanging method of top ostomy is effective and simple in treating deep anorectal abscess.It is an optional surgical procedure.

关 键 词：肛周深部脓肿 顶端造口 挂线法 引流 外科手术 

分 类 号：R657.15[医药卫生—外科学]