肛管直肠后间隙脓肿的诊断治疗:附93例报告

Diagnosis and treatment of postanorectal space abscess:a report of 93 cases

目的:探讨肛管直肠后间隙脓肿的诊断治疗。方法:回顾性分析93例肛管直肠后间隙脓肿的临床资料,其中马蹄形脓肿21例,半马蹄形脓肿45例,瘘管性肛管后间隙脓肿12例,肛管后间隙脓肿9例(采用保留肛尾韧带,在其两侧开窗置管引流结合挂线手术);直肠后间隙脓肿6例(采用开窗置管引流术)。结果:89例(95.7%)获临床治愈。随访6～24个月均无复发,无肛门狭窄、肛门失禁等并发症发生。4例(4.3%)术后肛瘘复发,主要是由于挂线时没有找到真正内口,引流管过早脱落使脓腔引流不畅而形成瘘管。3个月后经二次手术剔除瘘管到肛尾韧带,确认内口后刮除周围肉芽组织再挂线而治愈。结论:采用沿肛尾韧带两侧开窗置管引流结合选择性挂线术式,能够完整保护肛门的功能及形态,是治疗肛管直肠后间隙脓肿比较理想的方法。

Objective： To summarize the diagnosis and management ofpostanorectal space abscess. Methods： The clinical data of 93 patients with postanorectal space abscess were retrospectively analyzed. Of the patients, bilateral fenestrated catheter drainage （from both sides of the anococcygeal ligament） with the preservation of anococcygeal ligament plus thread-ligating method was performed in 21 cases of horseshoe abscess, 45 cases of semi-horseshoe abscess, 12 cases of fistulized postanal space abscess, and 9 cases of postanal space abscess; and fenestrated catheter drainage was performed in 6 cases ofpostrectal space abscess. Results： Clinical recovery was achieved in 89 cases （95.7%）. All patients were followed up for 6 to 24 months after surgery, and no recurrence or postoperative complications such as anal stricture or fecal incontinence occurred. Four cases （4.3%） had recurrence of anal fistula after surger~ This was mainly due to failure to find the true internal opening when performing thread-ligating procedure, and too early extraction of the drainage tube, which led to obstructed drainage and finally fistula formation. At a second operation 3 months later, the fistula and anococcygeal ligament of the patients were removed, the granulation tissues were eliminated and the thread-ligating procedure was performed again after confirmation of the internal opening, and the patients were cured. Conclusion： Fenestrated catheter drainage （from both sides of the anococcygeal ligament） combined with selective thread-ligating procedure can maintain the shape and function of the anus, and is an ideal treatment method for postanorectal space abscess.