脓肿切除根治术与单纯切开引流术治疗肛周脓肿的疗效比较

Effects of radical resection and incision drainage in treating patients with perianal abscess

目的比较脓肿切除根治术与切开引流术在肛周脓肿治疗肛周脓肿的疗效。方法回顾性分析2014年5月至2016年1月于本院接受手术治疗的94例肛周脓肿患者资临床资料,根据接受术式不同,分为根治组(n=50,行脓肿切除根治术)和切开组(n=44,行单纯切开引流术)。比较两组术后治疗总有效率、术后恢复、肛门功能、复发及肛瘘形成情况。结果根治组治疗总有效率为96.00%,切开组75.00%,差异有统计学意义(P<0.05)。根治组切口愈合时间为(18.94±1.65)d,感染控制时间为(2.94±1.21)d,均显著少于切开组,差异均有统计学意义(均P<0.05)。根治组术后肛周重度疼痛率为10.00%,切开组为36.36%,两组肛周重度疼痛率差异有统计学意义(P<0.05)。术后3月,两组肛门形态评分、肛门收缩功能评分和肛门失禁评分均较组内术前显著降低(均P<0.05),组间术前、术后差异均无统计学意义(均P>0.05)。术后随访3~6个月,根治组肛周脓肿复发率为4.00%、肛瘘并发率为4.00%,切开组则分别为25.00%和18.18%,,两组肛周脓肿复发率差异有统计学意义(P<0.05)。结论与单纯切口引流术相比,脓肿切除根治术治疗肛周脓肿的总体疗效更优,术后发生重度疼痛率及肛周脓肿复发率更低。

Objective To compare the effects of radical resection and incision drainage in treating patients with high and low perianal abscess. Methods Clinical data on 94 patients with anal abscess who underwent operation in our hospital between May 2014 and January 2016 were retrospectively analyzed. According to the different operation methods, the patients were divided into radical resection group（n = 50） and simple incision group（n = 44）. The treatment effect, infection control, healing time, pain, sphincter score, recurrence of abscess and incidence of complications were compared between the two groups. Results The total effective rate in radical resection group was 96%, while it was 75% in the simple incision group（P〈0.05）. The healing time of wound and infection control time in radical resection group were（18.94 ±1.65） d and（2.94 ±1.21） d, respectively, while they were（28.64 ±2.68） d and（5.46 ±1.52） d, respectively, in the simple incision group（P〈0.01）. The rates of severe pain, moderate pain, mild pain and no pain in radical resection group were 10%, 32%, 50% and 8%, respectively, while they were were 36.36%, 40.91%, 20.45% and 2.28%, respectively,in the simple incision group. There were significant differences between the two groups in proportions of severe pain and mild pain（P〈0.01）. The scores of anal form, anal contraction function and anal incontinence in the two groups decreased significantly after the surgery（P〈0.05） but there was no difference between the two groups before and after surgery（P〉0.05）. The recurrence rate of perianal abscess and incidence of anal fistula in radical resection group were 4% and 4%, respectively, while they were 25% and18.18%, respectively, in simple incision group（P〈0.05）. Conclusion The total effective rate of radical resection is higher than that of incision drainage in treating perianal abscess. The former has advantages of quick recovery and less pain. It can significantly reduce postoperative recurrence and the incidence of anal fistula.