对口引流加预期挂线治疗多间隙肛周脓肿

The treatment of More Spaces Perianal Abscess by the Method of Tunnel-style Dragging Thread and Anticipate Seton

目的:多间隙肛周脓肿的手术治疗比较复杂,大范围的切引创口引流虽然理想,但以后瘢痕收缩可导致肛门畸形,后果严重,切口过小则引流状况不佳。尽可能避免对肛门部正常组织结构的损伤,维护肛门正常功能和形态,又要保持良好的引流状况,是我们医务工作者寻求的目标。方法:采取I期多切口对口引流,即横向引流创口间采取纱条或多股丝线涂药(如九一丹等)拖线引流,每天拖线1次,配合高位脓肿腔顶或内口橡皮筋挂浮线,简称预期挂线。在炎症消退后渐加紧浮线,将横向的拖线去掉采取垫棉压迫使之闭合的方法,治疗多间隙肛周脓肿34例并与对照组34例II期低位切开高位挂线术进行比较。结果:治疗组一次治愈33例,复发1例,治愈率为97.1%,无失禁和肛门严重变形并发症发生,肛门功能正常;对照组34例均治愈,但在术后并发症、肛门形态、功能、疗程方面比较,有显著差异(P<0.01)。结论:本术式安全有效、科学合理,能达到I期治愈的目的,可维护肛门正常形态及功能,并可避免过早紧线使上方黏膜因牵拉而下移,影响创口引流及延期愈合的不良状况。

Objective：To-expiore a more effcctive therapy-of more spaces-perianal abscess ,by which the normal anal-rectal tissues and structures could be protected as soon as possible. Methods： Sixty-eight consecutive patients with diagnosed more spaces perianal abscess were received treatments in this trail. Thirty-four consecutive patients were treated by the method of primary tunnel-style dragging thread and anticipate seton of supra-levator abscess. To be compared, another thirty-four consecutive patients were treated by the method of primary incision and seton drainage treatment. In the trail, we compared with the two methods. Results ： In the experimental group, thirty-there patients of all thirty-four patients were cured, one patient developed recurrence, and the healing rates are 97.1%.There are no complications of anal incontinence or severe changed anal shape and the anal tunctions are normal. In the control group, all patients are cured, but it makes many differences in post procedure complications, anal structures, anal lunctions and course of treatment（P〈0.01）.Conclusion ： This procedure is sale, secure, sclentllacal and reasonable. It can reach the aim of primary healing, and it also protect the upper membrane from the prolapse because of thread-tightening ahead of time, which could make bad effects of wound drainage and healing.