三间隙引流术治疗肛周脓肿的可行性探讨

Feasibility investigation of three cavity clearance in treatment of perianal abscess

目的探讨三间隙引流术治疗肛周脓肿的可行性。方法收集2013年7月至2015年3月间南京中医药大学第三附属医院肛肠中心接受三间隙引流术（分别切开黏膜和内括约肌之间的黏膜下间隙、内括约肌和外括约肌间的括约肌间隙及外括约肌以外的括约肌外间隙并充分引流）的25例肛周脓肿患者的临床资料（三间隙引流组）。另选取同期行单纯脓肿切开引流术（单纯切开引流组）和切开挂线术（切开挂线组）的患者资料，依据年龄、性别及脓肿部位，与三间隙引流组患者进行1：1：1匹配，每组各25例，共75患者纳入本研究。比较3组患者术后首次排粪时和术后1周的疼痛视觉模拟评分（VAS）、创面愈合时间、肛瘘形成率及排粪失禁情况。结果切开挂线组术后1周的VAS为（6．5±1．3）分，明显高于三间隙引流组的（1．3±0．5）分和单纯切开引流组的（1．2±0．4）分（P〈0．01）；而3组术后首次排粪时VAS的差异无统计学意义（P〉0．05）。三间隙引流组、单纯切开引流组和切开挂线组创面的愈合时间分别为（45．8±19．9）d、（49．2±23．1）d和（53．5±24．1）d（P〉0．05）；单纯切开引流组的肛瘘形成率为48．0％（12／25），明显高于三间隙引流组（12．0％，3／25）和切开挂线组（12．O％，3／25），差异均有统计学意义（P〈0．01）。三间隙引流组和单纯切开引流组均无排粪失禁病例，而切开挂线组有2例（8．0％）出现肛门功能障碍。结论三间隙引流术治疗肛周脓肿可行，可降低术后肛瘘形成率，并具有术后疼痛轻及保护术后肛门功能的优点。

Objective To explore the feasibility of three-cavity clearance （TCC） in the treatment of perianal abscess. Methods A retrospective study of patients with perianal abscess in our center from July 2013 to March 2015 were carried out. Clinical data of 25 patients undergoing TCC （TCC group） were analyzed. At the same time, based on matched gender, age and location of abscess, 25 patients undergoing incision and drainage （incision group） and 25 undergoing cutting seton （seton group） were enrolled. Postoperative pain visual analogue scale （VAS） score （the first defecation, 1 week later）, rate of fistula formation, fecal incontinence （Wexner score） and wound healing were compared among groups. Results One week after operation, VAS score in seton group was 6.5 ± 1.3, which was significantly higher than 1.3 ± 0.5 in TCC group and 1.2 ±0.4 in incision group （P 〈 0.01 ）, while there were no significant differences of AS among groups at the first defecation（P 〉 0.05）. Time of wound healing was （45.8 ± 19.9）, （49.2± 23.1） and （53.5 ±24.1） days in TCC, incision and seton group respectively, without significant difference （P 〉 0.05）. Rate of fistula formation was 48.0% （12/25） in incision group, which was significantly higher than 12.0% （3/25） in TCC group and 12.0%（3/25） in seton group （all P 〈 0.01 ）. There was no patient with faecal incontinence in TCCgroup and incision group, while 2 patients with fecal incontinence were found in seton group. Conclusion Three-cavity clearance is feasible in treatment of perianal abscess, and can decrease the rate of fistula formation, ameliorate postoperative pain and protect anal function.