括约肌间入路隧道式拖线置管引流术治疗后马蹄形肛周脓肿的临床研究

Efficacy of intersphincteric tunnel thread-drawing catheter drainage in the treatment of horseshoe perianal abscess

目的观察括约肌间入路隧道式拖线置管引流术治疗后马蹄形肛周脓肿的临床疗效。方法将2017年10月—2021年10月在复旦大学附属金山医院初次住院手术的后马蹄形肛周脓肿患者98例随机分为治疗组(52例)与对照组(46例),治疗组采用括约肌间入路隧道式拖线置管引流术治疗,对照组采用脓肿Ⅰ期根治术治疗,比较2组临床疗效、Ⅰ期治愈率、创面疼痛VAS评分、住院时间、创面愈合时间、术后1个月和术后6个月肛门功能情况。结果治疗组总有效率为96.15%(50/52),对照组为80.43%(37/46),治疗组明显高于对照组(P<0.05);治疗组Ⅰ期治愈率为94.23%(49/52),对照组为76.09%(35/46),治疗组明显高于对照组(P<0.05)。治疗组术后第1天、第3天、第4天、第5天、第7天VAS评分均明显低于同期对照组(P均<0.05);治疗组住院时间、创面愈合时间均明显短于对照组(P均<0.05)。治疗组术后1个月和6个月肛门功能评分均明显低于对照组(P均<0.05),术后脓肿复发率、肛瘘形成率均明显低于对照组(P均<0.05)。结论括约肌间入路隧道式拖线置管引流术治疗后马蹄形肛周脓肿,可以减轻术后疼痛,缩短创面愈合周期,有效保护肛门功能,降低脓肿复发率、肛瘘形成率。

Objective It is to observe the clinical efficacy of intersphincteric tunnel thread-drawing catheter drainage in the treatment of horseshoe perianal abscess.Methods A total of 98 patients with horseshoe perianal abscess who underwent primary inpatient surgery at Jinshan Hospital of Fudan University from October 2017 to October 2021 were randomly divided into treatment group(n=52)and control group(n=46).The treatment group was treated with tunnel thread-drawing catheter drainage via ntersphincteric approach,and the control group was treated with radical resection of abscess phase I.The clinical efficacy,phase I cure rate,wound pain score,length of hospital stay,wound healing time,anal anal function at 1 month and 6 months after operation were compared between the two groups.Results The total effective rate was 96.15%(50/52)in the treatment group and 80.43%(37/46)in the control group,the total effective rate in the treatment group was significantly higher than that in the control group(P<0.05);the phase I cure rate was 94.23%(49/52)in the treatment group and 76.09%(35/46)in the control group,and the treatment group was was significantly higher than the control group(P<0.05).The VAS pain score on postoperative d1,d3,d4,d5 and d7 in the treatment group was significantly lower than those in the control group(all P<0.05);the length of hospital stay and wound healing time in the treatment group were significantly shorter than those in the control group(all P<0.05).The anal function scores at 1 month and 6 months after operation of the treatment group were significantly lower that those of the control group(all P<0.05),and the abscess recurrence and anal fistula formation rate were significantly lower than those in the control group(all P<0.05).Conclusion Tunnel thread-drawing catheter drainage via intersphincteric approach can reduce postoperative pain,shorten wound healing cycle,effectively protect anal function,reduce abscess recurrence and anal fistula formation rate in the treatment of posterior horseshoe perianal abscess.