置管引流联合负压吸引治疗高位复杂性肛瘘的临床效果研究
|
摘要
目的探讨置管引流联合负压吸引治疗高位复杂性肛瘘的临床效果。方法回顾性分析上海中医药大学附属龙华医院2015年7月至2018年6月采用置管引流联合负压吸引法治疗的43例高位复杂性肛瘘患者的治愈率、术后创面愈合时间、复发率及Williams肛门功能等级。结果 43例研究对象术后创面一期愈合率为72.09%(31/43),创面平均愈合时间(47.41±18.39) d。12例患者术后三个月仍未愈合行第二次手术治疗,其中7例愈合、5例好转,总体愈合率为88.37%(38/43)。术后随访6～36个月,创面愈合患者均无复发。术后Williams肛门功能评级A级40例、B级3例。结论高位复杂性肛瘘采用瘘管深部腔隙置管引流联合负压吸引治疗可有效清除深部感染灶,具有良好的临床治疗效果。
Objectives To investigate the clinical effect of catheter drainage plus vacuum aspiration in treating high complex fistula. Methods This was a retrospective analysis of 43 patients with high complex fistula who were treated with catheter drainage plus vacuum aspiration at Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between July 2015 and June 2018. We analyzed their cure rate, time to postoperative wound healing, recurrence rate and anal function evaluated by Williams Scoring and Grading. Results The proportion of achieving primary wound healing was 72.09%(31/43) and average time to wound healing was(47.41±18.39) d. There were 12 patients who could not achieve wound healing three months after the procedure and who received a second procedure, among whom seven achieved wound healing and five had improvement. Overall cure rate was 88.37%(38/43). Patients were followed-up for 6～36 months. No recurrence was found in patients who achieved healing. Forty patients had A grade and three B grade postoperative anal function according to Williams Scoring and Grading. Conclusion Deep catheter drainage plus vacuum aspiration could effectively clear deep infection site in treating high complex fistula and has satisfactory clinical effect.
Objectives To investigate the clinical effect of catheter drainage plus vacuum aspiration in treating high complex fistula. Methods This was a retrospective analysis of 43 patients with high complex fistula who were treated with catheter drainage plus vacuum aspiration at Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between July 2015 and June 2018. We analyzed their cure rate, time to postoperative wound healing, recurrence rate and anal function evaluated by Williams Scoring and Grading. Results The proportion of achieving primary wound healing was 72.09%(31/43) and average time to wound healing was(47.41±18.39) d. There were 12 patients who could not achieve wound healing three months after the procedure and who received a second procedure, among whom seven achieved wound healing and five had improvement. Overall cure rate was 88.37%(38/43). Patients were followed-up for 6～36 months. No recurrence was found in patients who achieved healing. Forty patients had A grade and three B grade postoperative anal function according to Williams Scoring and Grading. Conclusion Deep catheter drainage plus vacuum aspiration could effectively clear deep infection site in treating high complex fistula and has satisfactory clinical effect.
引文
[1]占煜,贺小婉,徐红.复杂性肛瘘治疗的回顾、进展与思考[J].中国普外基础与临床杂志.2017,24(1):124-128.
[2]GARG P.Understanding and treating supralevator fistula-in-Ano[J].Dis Colon Rectum,2018,61(5):612-621.
[3]上海市卫生局.上海市中医病证诊疗常规[M].上海:上海中医药大学出版社,2003:331-332.
[4]NANCY N,DAVID A,ANN C.Measuring fecal incontinence[J].Dis Colon Rectum,2003,46(12):1591-1605.
[5]孙平良,付军,黄艳,等.跳跃式开窗、主管改道外移、虚实结合挂线治疗高位复杂性肛瘘的临床观察[J].结直肠肛门外科,2013,19(5):325-326.
[6]ZHANG H,ZHOU Z,HU B,et al.Clinical significance of 2 deep posterior perianal spaces to complex cryptoglandular fistulas[J].Dis Colon Rectum,2016,59(8):766-774.
[7]GARCíA-GRANERO A,SANCHO-MURIEL J,SáNCHEZ-GUILLéN L,et al.simulation of supralevator abscesses and complex fistulas in cadavers[J].Dis Colon Rectum,2018,61(9):1102-1107.
[8]VAN ONKELEN R S,GOSSELINK M P,SCHOUTEN W R.Treatment of anal fistulas with high intersphincteric extension[J].Dis Colon Rectum,2013,56(8):987-991.
[9]GARCíA-GRANERO A,GRANERO-CASTRO P,FRASSON M,et al.The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin[J].Colorectal Dis,2014,16(9):0335-0338.
[10]裴景慧,王琛,黄河,等.顾氏外科“早期置管引流后期负压吸引”治疗深部肛周脓肿临床研究[J].世界中医药,2017,12(11):2651-2654.
[11]裴景慧,王琛.简易负压引流在肛肠良性疾病中的应用体会[J].中国中医急症,2015,24(12):2132-2134.
[12]王传思,谢贻祥,姚磊,等.高位肛周脓肿患者负压封闭引流前后血清TGF-β、EGF水平变化及意义[J].山东医药,2018,58(42):80-82.
[13]刘三风,刘志豪,戴志波.负压封闭引流技术(VSD)对各种复杂创面修复的临床研究[J].当代医学,2009,15(6):66-68.
[14]BRONCHARD R,DE VAUMAS C,LASOCKI S,et al.Vacuumassisted closure in the treatment of perineal necrotizing skin and soft tissue infections[J].Intensive Care Med,2008,34(7):1345-1347.
[2]GARG P.Understanding and treating supralevator fistula-in-Ano[J].Dis Colon Rectum,2018,61(5):612-621.
[3]上海市卫生局.上海市中医病证诊疗常规[M].上海:上海中医药大学出版社,2003:331-332.
[4]NANCY N,DAVID A,ANN C.Measuring fecal incontinence[J].Dis Colon Rectum,2003,46(12):1591-1605.
[5]孙平良,付军,黄艳,等.跳跃式开窗、主管改道外移、虚实结合挂线治疗高位复杂性肛瘘的临床观察[J].结直肠肛门外科,2013,19(5):325-326.
[6]ZHANG H,ZHOU Z,HU B,et al.Clinical significance of 2 deep posterior perianal spaces to complex cryptoglandular fistulas[J].Dis Colon Rectum,2016,59(8):766-774.
[7]GARCíA-GRANERO A,SANCHO-MURIEL J,SáNCHEZ-GUILLéN L,et al.simulation of supralevator abscesses and complex fistulas in cadavers[J].Dis Colon Rectum,2018,61(9):1102-1107.
[8]VAN ONKELEN R S,GOSSELINK M P,SCHOUTEN W R.Treatment of anal fistulas with high intersphincteric extension[J].Dis Colon Rectum,2013,56(8):987-991.
[9]GARCíA-GRANERO A,GRANERO-CASTRO P,FRASSON M,et al.The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin[J].Colorectal Dis,2014,16(9):0335-0338.
[10]裴景慧,王琛,黄河,等.顾氏外科“早期置管引流后期负压吸引”治疗深部肛周脓肿临床研究[J].世界中医药,2017,12(11):2651-2654.
[11]裴景慧,王琛.简易负压引流在肛肠良性疾病中的应用体会[J].中国中医急症,2015,24(12):2132-2134.
[12]王传思,谢贻祥,姚磊,等.高位肛周脓肿患者负压封闭引流前后血清TGF-β、EGF水平变化及意义[J].山东医药,2018,58(42):80-82.
[13]刘三风,刘志豪,戴志波.负压封闭引流技术(VSD)对各种复杂创面修复的临床研究[J].当代医学,2009,15(6):66-68.
[14]BRONCHARD R,DE VAUMAS C,LASOCKI S,et al.Vacuumassisted closure in the treatment of perineal necrotizing skin and soft tissue infections[J].Intensive Care Med,2008,34(7):1345-1347.