括约肌间引流术治疗肛周脓肿的临床观察

Clinical observation on intersphincter drainage in treatment of perianal abscess

目的:比较括约肌间引流术与单纯切开引流术治疗肛周脓肿的有效性、安全性与卫生经济学指标。方法:纳入90例肛周脓肿患者,随机分为研究组与对照组,每组各45例。研究组患者采用括约肌间引流术治疗,对照组患者采用单纯切开引流术治疗。术后随访3个月,比较两组患者的术后肛瘘形成率、肛周脓肿复发率与创面愈合时间;术后,评价两组患者的肛门疼痛、创面分泌物渗出情况、发热情况、首次排尿情况评分;术后3个月,评价两组患者的肛门功能评估表(Wexner)评分及肛门形态外观评分;比较两组患者的住院时间与住院费用。结果:①研究组患者的肛周脓肿复发率为0%、对照组为6.67%,两组患者的复发率比较,差异无统计学意义(P>0.05);研究组患者的肛瘘形成率为22.2%、对照组为48.9%,研究组患者的肛瘘形成率低于对照组(P<0.01);研究组患者的创面愈合时间较对照组明显缩短(P<0.01)。②术后第3、7天,两组患者的肛门疼痛视觉模拟量表(VAS)评分比较,差异有统计学意义(P<0.05,P<0.01),研究组患者的肛门疼痛情况优于对照组;术后第3天,两组患者的创面分泌物渗出情况评分比较,差异有统计学意义(P<0.05),研究组患者的创面分泌物渗出情况优于对照组;术后,两组患者的发热情况评分比较,差异均无统计学意义(P>0.05);两组患者的术后首次排尿情况评分比较,差异具有统计学意义(P<0.05),研究组患者的术后首次排尿情况优于对照组。③术后3个月,两组患者的Wexner评分、肛门形态外观评分比较,差异均无统计学意义(P>0.05)。④研究组患者的住院天数较对照组明显缩短(P<0.05),住院费用较对照组明显减少(P<0.01)。结论:与单纯切开引流术相比,括约肌间引流术治疗肛周脓肿具有较好的临床疗效与安全性,且术后并发症轻,卫生经济效益更好。

Objective:To compare the efficacy,safety and health economic indicators between intersphincteric drainage and simple incision drainage in the treatment of perianal abscess.Methods:A total of 90 patients with perianal abscess were included and randomly divided into the study group and the control group,45 cases in each group. The patients in the study group were treated with intersphincter drainage,and the patients in the control group were treated with simple incision drainage. Follow-up for 3 months after surgery,the formation rate of anal fistula,recurrence rate of perianal abscess and wound healing time were compared between the two groups. After surgery,the scores of anal pain,wound secretion exudation,fever and the first urination were evaluated. Three months after surgery,the scores of anal function assessment scale(Wexner)and anal appearance in the two groups were evaluated. The hospitalization time and cost were compared between the two groups.Results:①The recurrence rate of perianal abscess was 0% in the study group and 6.67% in the control group,and there was no statistically significant difference on the recurrence rate between the two groups(P>0.05). The formation rate of anal fistula was 22.2% in the study group and 48.9% in the control group,and the formation rate of anal fistula in the study group was lower than that in the control group(P<0.01). The wound healing time of the study group was significantly shorter than that of the control group(P<0.01).②On the 3rd and 7th days after surgery,there was statistically significant difference on the visual analogue scale(VAS)score of anal pain between the two groups(P<0.05,P<0.01),and the anal pain condition of the study group was superior to the control group. On the 3rd day after surgery,there was statistically significant difference on the score of wound secretion exudation between the two groups(P<0.05),and the wound secretion exudation condition of the study group was superior to the control group. After surgery,there was no statistically significant difference on the score of fever between the two groups(P>0.05). There was statistically significant difference on the score of postoperative first urination between the two groups(P<0.05),and the postoperative first urination condition of the study group was superior to the control group.③Three months after surgery,there were no statistically significant differences on the Wexner score and the anal appearance score between the two groups(P>0.05).④The hospitalization time of the study group was significantly shorter than that of the control group(P<0.05),and the hospitalization cost of the study group was significantly less than that of the control group(P<0.01).Conclusion:Compared with simple incision drainage,intersphincter drainage has better therapeutic effect and safety in the treatment of perianal abscess,and its postoperative complications is mild,the health economic benefits are better.