保留括约肌不成瘘术治疗肛周脓肿的临床观察

Effect of sphincter preserving incision and drainage in the treatment of perianal abscess

目的研究保留括约肌不成瘘术治疗肛周脓肿的临床效果。方法将本院86例肛周脓肿患者随机分为观察组与对照组,每组各43例,观察组采取保留括约肌不成瘘手术治疗,对照组采取一次性切开挂线术治疗。比较两组术后临床疗效、肛门疼痛、切口分泌物、创面愈合时间及术前术后肛管静息压、最大收缩压,另参考Vaizey肛门功能评分评价肛门自制功能。结果观察组与对照组总有效率分别为88.37%与81.40%,组间差异无统计学意义(P>0.05);观察组术后1 d、7 d肛门疼痛评分均显著低于对照组(均P<0.05),创面愈合时间显著短于对照组(P<0.05);观察组术后肛管静息压、肛管最大收缩压均显著高于对照组(均P<0.05);两组术后排便情况比较,干便、稀便差异均无统计学意义(均P>0.05),观察组气体发生率、借助衬垫及生活方式改变率均显著低于对照组(均P<0.05)。结论保留括约肌不成瘘手术治疗肛周脓肿对肛门功能影响小,可避免一次性切开挂线术对肛门括约肌的损伤,且可减轻术后疼痛并缩短创面愈合时间。

Objective To study the effect of sphincter preserving incision and drainage without fistula in the treatment of perianal abscess. Methods A total of 86 patients with perianal abscess who were treated in our hospital were randomly assigned to treatment group and control group,with 43 patients in each group. The treatment group received fistula-free sphincter preserving incision and drainage surgical treatment. The control group was treated with disposable incision and seton. The clinical efficacy,anal pain,incision secretion,wound healing time,anal canal resting pressure and maximum systolic pressure before and after operation were compared between the two groups. The Vaizey anal function score was used to evaluate anal continence. Results The total effective rate in the treatment group and the control group were 88.37% and 81.40%,respectively. There was no significant difference between the two groups（P 〉0.05）. The pain scores at 1 d and 7 d in the treatment group were significantly lower than those in the control group（P 〈0.05）. Wound healing time was significantly shorter in the treatment group than in the control group（P 〈0.05）. The anal rest pressure and anal maximum systolic pressure in the treatment group were significantly higher than those in the control group（P 〈0.05）. There was no significant difference in defecation between the two groups,and there was no significant difference in hard stools,loose stools and gases（P〉 0.05）. The change rate of the bed liner and lifestyle in the treatment group was significantly lower than that in the control group（P 〈0.05）. Conclusion Sphincter preserving incision and drainage has small influence on anal function in the treatment of perianal abscess. It can avoid the injury of anal sphincter by single incision and thread drawing. It can relieve postoperative pain and shorten wound healing time. It has a potential for clinical application.