肛周深间隙脓肿不同手术入路选择及疗效的研究  

Study on the selection and efficacy of different surgical approaches for deep perianal space abscess

作　　者：秦永罡 马木提江·阿巴拜克热[1] QIN Yonggang;ABABAIKERE Mamutijiang(Proctology Department,The First Affiliated Hospital of Xinjiang Medical University,Urumgi 830000,CHN)

机构地区：[1]新疆医科大学第一附属医院肛肠科,乌鲁木齐835000

出　　处：《河南大学学报（医学版）》2024年第2期137-141,共5页Journal of Henan University:Medical Science

基　　金：2020年度新疆维吾尔自治区创新环境(人才、基地)建设专项(2020D14007)。

摘　　要：目的:探讨不同手术入路治疗肛周深间隙脓肿的疗效。方法:回顾性收集2021年1月至2021年12月于新疆医科大学第一附属医院肛肠科住院治疗的患者并按照接受手术入路不同分为经外括约肌外手术入路组(25例)、经括约肌间手术入路组(30例)进行对照研究。两组患者术前均行肛周超声或核磁共振检查确诊为肛周深间隙脓肿。分析比较两组患者临床疗效、手术时间、术中出血量、脓肿深度、术后VAS评分、创面渗液、白细胞计数、C-反应蛋白、降钙素原、术后换药时间、创面愈合时间、并发症情况、脓肿复发率、肛瘘形成率等情况,采用t检验和χ2检验进行组间比较。结果:经外括约肌外组与经括约肌间组患者在治愈率、手术时间、术中出血量、术后1d疼痛评分、C-反应蛋白、术后并发症、脓肿复发率、肛瘘形成率等方面差异无统计学意义(P>0.05)。经外括约肌外组在创面愈合时间、术后换药时间、住院天数等方面均小于经括约肌间组(P<0.05)。经括约肌间组在术后1d创面渗液量、术后3d疼痛评分、术后白细胞计数下降程度、降钙素原水平、创面瘢痕长度等方面均优于经外括约肌外组(均P<0.05)。结论:经外括约肌外、经括约肌间手术入路在术中、术后多方面因素中各有利弊,但均能有效治疗肛周深间隙脓肿,降低脓肿复发及成瘘率,提高患者满意度,值得进一步推广。Objective:Exploring the efficacy of different surgical approaches in the treatment of deep perianal space abscess.Methods:Patients who were hospitalized in department of anorectal medicine of the first afiliated hospital of Xinjiang medical university from January 2021 to December 2021 were retrospectively olleted and divided into a trans-external sphincter surgical acess group(25 patients)and a trans-intersphincter surgical access group(30 patients)according to the surgical access they received for a controlled study.Patients in both groups were diagnosed with deep perianal space abscess by perianal ultrasound or MRI before surgery.The clinical efficacy,operation time,intraoperative bleeding,abscess depth,postoperative VAS score,wound exudate,white blood cell count,C-reactive protein,calcitoninogen,postoperative dressing change time,wound healing time,complications,abscess recurrence rate,and anal fistula formation rate were analyzed and compared between the two groups using t test and x*test.Results:There were no statistically significant differences between the trans-external sphincter group and the trans intersphincter group in terms of healing rate.operative time,intraoperative bleeding。1-day postoperative pain score,C reactive protein,postoperative complications,abscess recurrence rate,and fistula formation rate(P>0.05),The trans external sphincter group was smaller than the trans-intersphincter group in terms of wound healing time,postoperative dressing change time,and number of days in hospital(P<0.05).The trans-sphincteric group was better than the trans external sphincter group in terms of postoperative 1-day trauma exudate volume,postoperative 3-day pain score,postoperative leukocyte count decrease,caleitoninogen level,and trauma scar length(all P<0.05).Conclusion:The trans external sphincter and trans-intersphincter surgical approaches have advantages and disadvantages in various intraoperative and postoperative factors,but both can effectively treat deep perianal space abscesses,reduce the rate of

关 键 词：肛周脓肿 深部间隙 括约肌间入路 疗效 

分 类 号：R657.15[医药卫生—外科学]