新生儿肛周脓肿的临床特点及治疗

Clinical characteristics and treatment of perianal abscess in neonates

目的探讨新生儿肛周脓肿的临床特点及治疗效果。方法对2008年1月至2015年12月滨州医学院附属医院儿外科收治的185例肛周脓肿新生儿进行回顾性分析，根据家长意愿分为切开引流组（136例）和保守治疗组（49例）。切开引流组在局麻下行脓肿切开引流，切口填塞碘仿纱条引流换药治疗；保守治疗组肛周外用1：5000高锰酸钾溶液坐浴，局部外涂红霉素眼膏。患儿形成肛瘘6个月后行肛瘘挂线术。所有患儿早期给予抗生素治疗。记录患儿年龄、性别、伴随疾病、脓肿数量和部位、处理方式、愈合时间、复发率，并行统计学处理及相关性分析。结果185例新生儿均为男性患儿，从最初发病到就诊时间为1～25d，平均7．5d；伴腹泻60例（32．4％），新生儿黄疸45例（24．3％）。单部位脓肿145例（78．4％），2个部位脓肿30例（16．2％），多部位脓肿10例（5．4％）。脓肿位于截石位9点钟方向115例（62．2％），3点钟方向65例（35．1％），1点钟方向3例（1．6％），6点钟方向2例（1．1％）。切开引流组中获得脓肿细菌培养123例（90．4％，123／136例），保守治疗组获得脓液细菌培养35例（71．4％，35／49例）。切开引流组愈合时间为（21±2）d（10-60d）；保守治疗组愈合时间为（36±3）d（9～90d）。切开引流组复发7例（5．1％，7／136例），再次给予脓肿扩创换药治愈，无肛瘘形成。保守治疗组复发10例（20．4％，10／49例），6例自行痊愈（12．2％，6／49例），4例形成肛瘘（8．1％，4／49例），6个月后均行挂线治疗痊愈。随访1年未见复发。2组在愈合时间（t=-6．707，P=0．000）、复发率（X^2=10．054，P=0．002）及肛瘘形成（X^2=11．347，P=0．001）方面差异均有统计学意义。结论新生儿肛周脓肿几乎都是单纯性肛周脓肿或肛瘘。脓肿早期切开引流治疗方法有效、安全，脓腔填塞纱条引流、保持引流通畅是减少肛周脓肿复发和肛瘘形成的关键。术后加强肛周护理及应用抗生素可促进肛周脓肿的愈合，缩短住院时间。

Objective To evaluate the clinical characteristics and the clinical outcomes of perianal abscess （PA） in neonates. Methods A retrospective review was performed on the collected data of 185 patients of PA in neo- nates prospectively admitted to Binzhou Medical University Hospital from January 2008 to December 2015. Patients were divided into 2 groups on the parents＇ intention：nonsurgical treatment and surgical treatment, the standard surgical treat- ment for PA was incision and drainage with the use of packing. The standard surgical treatment for PA was surgical inci- sion drainage of lower abscess under local anesthesia by the use of filling tamponade iodoform gauze, while the patients receiving conservative treatment took hip bath perianally with topical 1 ： 5 000 potassium permanganate, besmearing erythromycin eye ointment outside locally. Incision - thread - drawing procedure was recommended in fistula - in - ano （FIA） after 6 months. Antibiotics were administered in all patients in the early days. The clinical data of age, gender, accompanying diseases, abscess amount and location, treatment approach, healing time and recurrence rates were ana- lyzed with statistical method. Results All patients were boys, time of visiting hospital was 1 - 25 day, the average time 7.5 days ;60 cases （32.4%）had neonatal diarrhea,45 cases （24.3%）had neonatal jaundice, hut no patients had se- vere fever. A single skin lesion was present in 145 patients （ 78.4% ）, 2 lesions in 30 patients （ 16.2% ） , and 10 pa- tients had 3 lesions （5.4%）. The most commonly affected sites were at 9 o＇ clock clockwise direction with 115 （62.2%） lesions on lithotomy position ,followed by 3 o＇clock clockwise direction with 65 （35.1% ） lesions by 1 o＇clock clockwise direction with 3 （ 1.6% ） lesions and 6 o＇ clock clockwise direction with 2 （ 1.1% ） lesions. Bacteria cul- tures were obtained from 123 patients （90.4% , 123/136 cases） of surgical treatment and 35 patients （71.4% ,35/49 cases） of nonsurgieal treatment obtained the results of bacteria culture. The average healing time was （21±2） days （10-60 days） in the surgical treatment group,and （36±3） days （9 -90 days） in the nonsurgical treatment group,7 out of 136 （5.1% ）patients had a recurrence with surgical treatment, incision drainage was performed again with the use of packing, and FIA was not found, 10 out of 49 （20.4%） patients had a recurrence with nonsurgical treatment group, and 6 out of 49 （ 12.2% ） were spontaneously resolves within the first year of life,4 out of 49 （8.1% ） developed into FIA,incision - thread - drawing procedure was performed after 6 months. The significant difference was observed be- tween and nonsurgical treatment and surgical treatment in healing time （ t = - 6. 707, P = 0. 000） , recurrence （X^2 = 11. 347, P = 0. 001 ） and FIA formation rate （X^2 = 10.054,P = 0.002）. Conclusions PA is an entity in neonates. In- cision and drainage of PA is an effective and safe therapy in the early days. Surgery for PA may result in low recurrence rates, a low rate of evolution toward FIA, and a short healing time, which should be considered as the primary treatment. The key procedure is to keep the drainage unobstructed by the use of filling gauze drainage to prevent crissum abscess recurrence. Postoperative care with antibiotics is effective to shorten hospital stays.