经直肠超声引导下穿刺置管引流治疗高位肛周脓肿的临床观察

Clinical observation on transrectal ultrasound-guided puncture and cathetering drainage in treatment of high-position perianal abscess

目的观察经直肠超声引导下穿刺置管引流治疗高位肛周脓肿的临床效果。方法将2015年1月至2018年1月就诊于上海中医药大学附属曙光医院的80例高位肛周脓肿患者随机分为介入治疗组和手术治疗组,每组40例。介入治疗组患者接受经直肠超声引导下穿刺置管引流术治疗,手术治疗组患者接受传统切开引流术治疗。评定两组患者的临床疗效,并比较两组患者术前和术后第3天、第7天的疼痛、发热、渗出评分以及白细胞计数、C反应蛋白水平、脓腔最大截面面积、切口愈合时间。结果介入治疗组总有效率为87.5%(35/40),手术治疗组总有效率80%(32/40),两组总有效率差异无统计学意义(X^2=1.385,P=0.709)。术后第3天、第7天,介入治疗组患者的疼痛、渗出评分以及白细胞计数、C反应蛋白水平、脓腔最大截面面积方面均低于手术治疗组(P均<0.01)。介入治疗组直肠后间隙脓肿、高位括约肌间脓肿患者的切口愈合时间短于手术治疗组(P均<0.01)。结论与传统切开引流术相比,经直肠超声引导下穿刺置管引流术在治疗高位肛周脓肿中可减轻患者的疼痛和渗出,有效控制感染。

Objective To explore the clinical effect of transrectal ultrasound-guided puncture and cathetering drainage in the treatment of high-position perianal abscess.Methods Eighty patients with high-position perianal abscess,who admitted to Shuguang Hospital of Shanghai University of Traditional Chinese Medicine from Jan.of 2015 to 2018,were randomized into interventional therapy group and surgical treatment group,with 40 cases in each group.The patients in the interventional therapy group were treated with cathetering drainage guided by transrectal ultrasound,and the patients in the surgical treatment group were treated with traditional incision drainage.The clinical effect was evaluated in the two groups,and the pain,fever and exudation scores,white blood cell count,C-reactive protein level,maximal section area of abscess cavity,and wound healing time were compared between the two groups before operation and on 3 days and 7 days after operation.Results The total effective rates of the interventional therapy and surgical treatment groups were 87.5%(35/40)and 80%(32/40),respectively,and the difference was significant(χ2=1.385,P=0.709).On 3 days and 7 days after operation,the pain score,exudation score,white blood cell count,C-reactive protein level and maximum section area of the abscess cavity were significantly lower in the interventional therapy group than those in the the surgical treatment group(all P<0.01).The patients with retrorectal abscess or high intersphincteric abscess in the interventional therapy group had shorter wound healing time versus the patients in the surgical treatment group(both P<0.01).Conclusion Compared with traditional incision drainage,cathetering drainage guided by transrectal ultrasound can reduce pain and decrease exudation of the patients with high-position perianal abscess to effectively control infection.