摘要
目的探讨三间隙引流术在腺源性肛周脓肿治疗中的安全性和有效性。方法采用多中心随机、平行、对照的方法,选取南京中医药大学第二附属医院、江苏省如皋市中医院、江苏省连云港市中医院、江苏省常熟市中医院、江苏省沭阳县中医院肛肠科收治的肛周脓肿患者,随机分为三间隙引流组和单纯切开引流组,比较两组患者的肛瘘形成率、脓肿复发及肛门失禁情况、术后疼痛视觉模拟量表(visual analogue scale,VAS)评分、住院时间和创面愈合时间等。结果2018年9月至2019年9月共纳入334例患者,其中三间隙引流组162例,单纯切开引流组172例。两组年龄、性别、脓肿部位比较差异无显著性(P>0.05)。术后3d三间隙引流组VAS评分低于单纯切开引流组,差异有显著性(P=0.002),而手术当天及术后1、2、7d两组VAS评分差异无显著性(P>0.05)。三间隙引流组住院时间为(9.0±5.4)d,低于单纯切开引流组的(10.4±6.1)d,差异有显著性(P=0.049);创面愈合时间为(27.1±16.4)d,与单纯切开引流组的(28.2±14.1)d比较差异无显著性(P=0.764);肛瘘形成率和脓肿复发率分别为6.2%和1.9%,低于单纯切开引流组的18.0%和8.1%,差异有显著性(P=0.001,P=0.009)。两组术后均未出现肛门失禁。结论三间隙引流术可降低腺源性肛周脓肿术后的肛瘘形成率,减少脓肿复发,减轻术后疼痛,且无肛门括约肌损伤,是一种安全有效的手术方法。
Objective To evaluate the safety and efficacy of three-cavity clearance(TCC)in management of cryptoglandular perianal abscess.Method A multicenter,randomized,parallel and controlled study was carried out in the department of colorectal surgery of the second affiliated hospital of Nanjing University of Traditional Chinese Medicine,Rugao TCM hospital,Lianyungang TCM hospital,Changshu TCM hospital and Shuyang TCM hospital.All enrolled cases were randomizedly divided into three-cavity clearance group(TCC group)and simple incision and drainage group(control group).Anal fistula formation rate,anal incontinence(Wexner score),abscess recurrence,postoperative pain visual analogue scale(VAS)score,wound healing time and hospitalization time were compared between the two groups.Result From Sept.2018 to Sept.2019,334 patients were included in this study.162 cases were divided in TCC group and 172 cases were divided in control group.The mean age was 41.9±13.3yrs in TCC group and 39.1±13.1ysr in control group(P=0.082).The defference of the absecss position betweent TCC group and Control group was not significant(P=0.067).The postoperative VAS score in day 3 in TCC group was lower than that of control group,with statistically significant difference(P=0.002).There was no significant difference in the postoperative VAS score between the two groups in the day,day 1,day 2 and day 7(P=0.949,P=0.114,P=0.178,P=0.205).The hospitalization time was 9.0±5.4 days in TCC group and 10.4±6.1days in control group(P=0.049).The wound healing time was 27.1±16.4days in TCC group and 28.2±14.1days in control group(P=0.764).The anal fistula formation rate and abscess recurrence rate in TCC group were 6.2%and 1.9%respectively,while they were 18.0%and 8.1%respectively in control group(P=0.001 and P=0.009).None of the patients in TCC group and control group suffered fecal incontinence.Conclusion The RCT study showed that three-cavity clearance for perianal abscess charaterized by reduced postoperative anal fistula formation rate,reduced abscess recurrence,no anal sphincter injure and reduced postoperative pain.It is a safe and effective method for management of cryptoglandular perianal abscess.
作者
张心怡
陈诚
韦平
王玉瑶
季利江
张琼
张春霞
金黑鹰
Zhang Xinyi;Chen Cheng;Wei Ping;Wang Yuyao;Ji Lijiang;Zhang Qiong;Zhang Chunxia;Jin Heiying(Nanjing University of Chinese Medicine,Jiangsu Nanjing 210029,China;Rugao Hospital of Traditional Chinese Medicine,Jiangsu Rugao 226500,China;Lianyungang Hospital of Traditional Chinese Medicine,Jiangsu Lianyungang 222001,China;Changshu Hospital of Traditional Chinese Medicine,Jiangsu Changshu 215500,China;Shuyang Hospital of Traditional Chinese Medicine,Jiangsu Suqian 223699,China;Department of Colorectal Surgery,Second Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Nanjing 210017,China)
出处
《中国医刊》
CAS
2020年第12期1320-1323,共4页
Chinese Journal of Medicine
关键词
肛周脓肿
三间隙引流术
单纯切开引流术
多中心随机对照研究
Perianal abscess
Three-cavity clearance
Simple incision and drainage
Multicenter randomized controlled study
