肛门直肠周围脓肿110例诊治分析

Diagnosis and Analysis of the Perianorectal Abscess(110 Cases Report)

目的总结肛门直肠周围脓肿的诊治经验。方法回顾性分析肛门直肠周围脓肿110例,根据肛门直肠周围脓肿类型采用单纯切开引流术、切开引流加挂线术与一次性切开根治术治疗,其中单纯脓腔者分别为5例、5例、22例;多个脓腔者分别为3例、7例、50例,高位脓腔者分别为2例、4例和12例。结果术后各组恢复顺利,无严重并发症。单纯切开引流组、切开引流加挂线组及一次性切开根治术组的肛门瘘管形成率在单个脓腔患者中分别为20.0%（1/5）,20.0%（1/5）和4.5%（1/22）;在多个脓腔患者中的66.7%（2/3）,28.6%（2/7）和2.0%（1/50）;在高位脓腔组为100.0%（2/2）,0和8.3%（1/12）。以上肛门瘘管形成者均进行了二次瘘管切除手术。均获随访,时间6-12个月。本组110例均无脓肿复发。肛门功能评价：单个脓肿和多个脓腔分别有1例和6例患者出现肛门畸形,肛周有便污,有排便感不易控制的情况。高位脓腔出现上述情况4例,出现肛门失禁1例。结论肛门直肠周围脓肿在切开引流术后肛瘘发生率高,尤其是高位脓肿,为减少肛门瘘管的发生,寻找潜在的内口是关键,同时要根据不同的肛门直肠周围脓肿类型选择相应手术方式,一次性切开根治术是可行的,可以减少二次手术的痛苦,同时也减轻患者的经济负担。

Objective To investigate the diagnosis and treatment effects of the perianorectal abscess.Methods The clinical date of the 110 cases of perianorectal abscess was retrospectively analyzed.In the 110 patients,there were 32 cases of the one abscess cavity group,60 cases of multiple cavity group,and 18 of the elevatus cavity group.Different surgical operations were undergone according to different appearances of the abscess.The number of the patients who recieved simple incision and drainage,discisson and seton operation,and one-stage radical resection was 5,5,22 cases in the one abscess cavity group,3,7,50 cases in the multiple cavity group,and 2,4,12 in the elevatus cavity group respectively.Results The anal fistula rate of the simple incision and drainage operation,the discisson and seton operation,and the one-stage radical resection was 20.0%（1/5）,20.0%（1/5） and 4.5%（1/22） in the simple abscess cavity group,was 66.7%（2/3）,28.6%（2/7） and 2.0%（1/50） in the multiple cavity group,and was 100.0%（2/2）,0 and 8.3%（1/12） in the elevatus cavity group respectively.All the cases were followed up for 6 to 12 months.There was one and six cases of anal dysfunction in the one cavity group and multiple cavity group respectively.And in the elevatus cavity group,4 suffered from the anal dysfunction,and one suffered from the anal incontinence.Conclusions The anal fistula rates were high after simple incision and drainage operation especially for the elevatus cavity group.It is the key point to find and resect the potential endostoma and to do different procedures according to different patterns of the abscess cavity.It is recommended of the one-stage radical resection for the anvantages of quicker recovery,less pain and less economic burden.