低位开窗旷置术和低位切开高位挂线术治疗高位肛周脓肿的疗效比较
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摘要
目的:比较低位开窗旷置术和低位切开高位挂线术治疗高位肛周脓肿的疗效差异。方法:选取2015年1月-2016年1月于本院就诊需行手术治疗的62例高位肛周脓肿患者,采用随机数字表法分为低位开窗旷置组(简称旷置组)和低位切开高位挂线组(简称挂线组),每组31例。两组患者分别采用低位开窗旷置术和低位切开高位挂线术治疗高位肛周脓肿,术后随访12个月。比较两组临床治疗效果、术后疼痛评分(VAS)、创面愈合时间和相关并发症(如脓肿复发率、肛瘘形成率以及肛门失禁等)。结果:旷置组和挂线组的治愈率分别为83.87%(26/31)和80.65%(25/31),术后1个月并发症发生率分别为25.81%(8/31)和22.58%(7/31),差异均无统计学意义(P>0.05);挂线组的脓肿复发率、肛瘘形成率均低于旷置组,旷置组的术后疼痛评分(VAS)、创面愈合时间和肛门失禁发生率显著低于挂线组,差异均有统计学意义(P<0.05)。结论:低位开窗旷置术和低位切开高位挂线术治疗高位肛周脓肿的总体疗效相似,低位开窗旷置术在缩短愈合时间、减轻术后疼痛和保留肛门功能等方面具有优势,而低位切开高位挂线术则能降低的肛周脓肿复发率和肛瘘发生率。
Objective:To compare the curative effects between low-incision exclusion therapy and lowincision high-seton therapy on patients with high perianal abscess.Method:From January 2015 to January 2016,62 patients in our hospital with high perianal abscess were randomly divided into low-incision therapy group(short for exclusion group)and low-incision high-seton therapy group(short for seton group)according to the random number table method,31 cases in each group.Exclusion group treated with low-incision exclusion therapy and seton group treated with low-incision high-seton therapy.The clinical curative effects,mean healing times,pain scores(Visual Analogue Score,VAS) and complications occurrence(such as abscess recurrence,anal fistula and fecal incontinence) of two groups were comparatively analyzed.Result:The clinical curative effects rate of exclusion group and seton group was 83.87% and 80.65% respectively,the complication occurrence rate of exclusion group and seton group were 25.81% and 22.58% respectively,there were no significant differences(P>0.05).The abscess recurrence rate and postoperative fistula occurrence rate of seton group were much lower than those of the exclusion group,the differences were statistically significant(P<0.05),the mean healing time,pain scores and the fecal incontinence occurrence rate of exclusion group were lower than those of seton group,the differences were statistically significant(P<0.05).Conclusion:The curative effects of low-incision exclusiontherapy and low-incision high-seton therapy are similar,low incision exclusion therapy has benefits in healing time,postoperative pain and anal function,while low-incision high-seton therapy has a lower rate of abscess recurrence and postoperative fistula.
Objective:To compare the curative effects between low-incision exclusion therapy and lowincision high-seton therapy on patients with high perianal abscess.Method:From January 2015 to January 2016,62 patients in our hospital with high perianal abscess were randomly divided into low-incision therapy group(short for exclusion group)and low-incision high-seton therapy group(short for seton group)according to the random number table method,31 cases in each group.Exclusion group treated with low-incision exclusion therapy and seton group treated with low-incision high-seton therapy.The clinical curative effects,mean healing times,pain scores(Visual Analogue Score,VAS) and complications occurrence(such as abscess recurrence,anal fistula and fecal incontinence) of two groups were comparatively analyzed.Result:The clinical curative effects rate of exclusion group and seton group was 83.87% and 80.65% respectively,the complication occurrence rate of exclusion group and seton group were 25.81% and 22.58% respectively,there were no significant differences(P>0.05).The abscess recurrence rate and postoperative fistula occurrence rate of seton group were much lower than those of the exclusion group,the differences were statistically significant(P<0.05),the mean healing time,pain scores and the fecal incontinence occurrence rate of exclusion group were lower than those of seton group,the differences were statistically significant(P<0.05).Conclusion:The curative effects of low-incision exclusiontherapy and low-incision high-seton therapy are similar,low incision exclusion therapy has benefits in healing time,postoperative pain and anal function,while low-incision high-seton therapy has a lower rate of abscess recurrence and postoperative fistula.
引文
[1]吴炯,王振宜,孙建华.肛周脓肿的外科治疗[J].世界华人消化杂志,2013,21(34):3842-3847.
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[3]张颂.挂线疗法治疗后高位肛瘘患者肛门功能的变化[J].按摩与康复医学,2015,6(7):74-75.
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[8]美国结直肠外科医师协会.2011版美国肛周脓肿和肛瘘治疗指南[J].中华胃肠外科杂志,2012,15(6):640-643.
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[10]Wang Y,Tian G B,Zhang R,et al.Prevalence,risk factors,outcomes,and molecular epidemiology of mcr-1-positive Enterobacteriaceae in patients and healthy adults from China:an epidemiological and clinical study[J].Lancet Infect Dis,2017,17(4):390.
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[12]张晔,邴卫平.一期根治术与单纯切开引流治疗肛周脓肿的疗效比较[J].中国普外基础与临床杂志,2015,22(6):722-724.
[13]谢永俊,常家聪.手术切开引流对肛周脓肿患者肛瘘形成的防治效果[J].中国普通外科杂志,2014,23(9):1299-1302.
[14]陈琴,王晓锋,李华山.挂线疗法治疗肛管直肠周围脓肿的应用进展[J].世界华人消化杂志,2013,11(1):82-86.
[15]陈朝晖,陈林,陈红霞,等.保留括约肌微创改良术一期根治蹄铁型肛周脓肿的疗效分析[J].中国普外基础与临床杂志,2016,23(8):948-952.
[16]赵建芳,姚一多.坐浴对肛周脓肿术后创面愈合作用的研究进展[J].结直肠肛门外科,2012,18(6):407-408.
[17]伍静,刘洪,杨春梅,等.保留括约肌虚挂线法治疗高位肛周脓肿[J].华西医学,2012,27(5):723-726.
[18]李华山,陈琴.肛管直肠周围脓肿的手术治疗研究进展[J].世界华人消化杂志,2012,20(7):580-584.
[19]邓大鹏,邓正明,郑玉金.邓正明主任高挂低切旷置引流术治疗高位复杂性肛瘘的临床研究[J].中外医疗,2016,35(34):4-7.
[2]张雅明.内外治结合治疗肛门直肠周围高位全马蹄形脓肿1例[J].上海中医药杂志,2012,46(1):27-28.
[3]张颂.挂线疗法治疗后高位肛瘘患者肛门功能的变化[J].按摩与康复医学,2015,6(7):74-75.
[4]丁曙晴,丁义江.肛周脓肿和肛瘘诊治策略--解读美国和德国指南[J].中华胃肠外科杂志,2012,15(12):1224-1226.
[5]吕艳锋,王建新,李涛,等.三维直肠腔内超声诊断肛周感染性疾病的临床应用[J].山东大学学报:医学版,2010,48(11):106-108.
[6]徐泉,王金萍,王宁新,等.高频超声诊断肛周脓肿、肛瘘的临床价值[J].中华全科医学,2010,8(6):774-775.
[7]刘艳荣.高频彩色多普勒超声诊断肛周脓肿及肛瘘的临床价值[J].中国肛肠病杂志,2012,32(9):12-13.
[8]美国结直肠外科医师协会.2011版美国肛周脓肿和肛瘘治疗指南[J].中华胃肠外科杂志,2012,15(6):640-643.
[9]Yano T,Asano M,Matsuda Y,et al.Prognostic factors for recurrence following the initial drainage of an anorectal abscess[J].Int J Colorectal Dis,2010,25(12):1495-1498.
[10]Wang Y,Tian G B,Zhang R,et al.Prevalence,risk factors,outcomes,and molecular epidemiology of mcr-1-positive Enterobacteriaceae in patients and healthy adults from China:an epidemiological and clinical study[J].Lancet Infect Dis,2017,17(4):390.
[11]何成华.微创术根治肛周深部多间隙脓肿40例临床观察[J].江苏中医药,2012,44(11):48-49.
[12]张晔,邴卫平.一期根治术与单纯切开引流治疗肛周脓肿的疗效比较[J].中国普外基础与临床杂志,2015,22(6):722-724.
[13]谢永俊,常家聪.手术切开引流对肛周脓肿患者肛瘘形成的防治效果[J].中国普通外科杂志,2014,23(9):1299-1302.
[14]陈琴,王晓锋,李华山.挂线疗法治疗肛管直肠周围脓肿的应用进展[J].世界华人消化杂志,2013,11(1):82-86.
[15]陈朝晖,陈林,陈红霞,等.保留括约肌微创改良术一期根治蹄铁型肛周脓肿的疗效分析[J].中国普外基础与临床杂志,2016,23(8):948-952.
[16]赵建芳,姚一多.坐浴对肛周脓肿术后创面愈合作用的研究进展[J].结直肠肛门外科,2012,18(6):407-408.
[17]伍静,刘洪,杨春梅,等.保留括约肌虚挂线法治疗高位肛周脓肿[J].华西医学,2012,27(5):723-726.
[18]李华山,陈琴.肛管直肠周围脓肿的手术治疗研究进展[J].世界华人消化杂志,2012,20(7):580-584.
[19]邓大鹏,邓正明,郑玉金.邓正明主任高挂低切旷置引流术治疗高位复杂性肛瘘的临床研究[J].中外医疗,2016,35(34):4-7.