清创术联合VSD引流术治疗肛周坏死性筋膜炎的临床研究

Effect of debridement combined with VSD drainage in the treatment of perianal necrotizing fasciitis

目的研究清创术联合负压封闭引流(VSD)术治疗肛周坏死性筋膜炎的临床价值。方法纳入本院2014年5月至2016年5月60例肛周坏死性筋膜炎患者为研究对象,随机分为观察组(行清创术联合负压封闭引流术)与对照组(行单纯清创术),每组各30例。对比两组手术相关指标(手术时间、术中出血量、清创次数、体温恢复至正常时间、创面愈合时间、住院时间)、肛门功能,术后随访1年,观察患者预后。结果两组手术时间、术中出血量差异均无统计学意义(均P>0.05)。观察组清创次数(1.96±0.87)次,少于对照组(均P>0.05),观察组体温恢复至正常时间(11.39±3.26)d、创面愈合时间(53.12±9.65)d、住院时间(59.87±6.52)d,均短于对照组(均P<0.05)。两组手术前后肛管静息压、肛管最大收缩压差异均无统计学意义(均P>0.05)。两组并发症发生率及死亡率差异均无统计学意义(P>0.05)。结论清创术联合VSD引流术与单纯清创术治疗肛周坏死性筋膜炎均不影响患者肛门功能,在改善预后方面效果相当,但前者可明显缩短体温恢复至正常时间、创面愈合时间、住院时间,减少清创次数,有利于促进患者恢复,有一定应用价值。

Objective To investigate the clinical effect of debridement combined with negative pressure closed drainage（VSD） in the treatment of perianal necrotizing fasciitis. Methods 60 patients of perianal necrotizing fasciitis in our hospital were randomly assigned to treatment group（debridement combined VSD） and control group（simple debridement）. The operative indices（operation time, intraoperative blood loss, debridement times, time to body temperature returned to normal, wound healing time, hospital stays） and anal function were compared between the two groups. The prognosis was observed after 1-year follow-up. Results There was no significant difference between the two groups in operation time and intraoperative blood loss（P〉0.05）. Debridement times in the treatment group was（1.96±0.87） times less than in the control group. Time to body temperature returned to normal [（11.39±3.26） d], wound healing time[（53.12±9.65） d], hospitalization time[（59.87±6.52） d] in the treatment group were shorter than in the control group（P〈0.05）.There was no significant difference in anal rest pressure and anal maximum systolic pressure between the two groups（P〉0.05）. The complication rate and mortality rate did not differ between the two groups（P〉0.05）. Conclusion Debridement combined with VSD drainage and simple operation in the treatment of perianal necrotizing fasciitis did not affect the anal function, and had comparable effect in improving prognosis. But Debridement combined with VSD drainage can significantly shorten the time body temperature returned to normal, the wound healing time, hospitalization time, and reduce the number of debridement. It can help to promote the recovery of patients and has value for clinical application.