简易肛门扩撑支具对会阴区烧伤后假性肛门狭窄的改善效果观察

Observation on the Improvement Effect of Simple Anal Expansion Brace on Pseudoanal Stenosis After Perineal Area Burn

目的:制作并观察简易肛门扩撑支具用于会阴区烧伤中改善假性肛门狭窄的临床效果。方法:选择2017年10月-2021年10月笔者医院收治的6例合并会阴区烧伤的患者,均于创面溶痂时开始使用简易肛门扩撑支具。该扩撑支具由无菌注射器及无菌手套修剪后制备而成,肛周创面愈合前使用无菌敷料及弹力绷带丁字包扎固定,创面愈合后使用弹力内裤固定,直至创面愈合后半年。结果:有2例患者肛周创面愈合后半年,肛门区瘢痕开始软化,其肛门狭窄未影响正常排便及便后清洁;有4例患者肛周创面愈合半年后因假性肛门狭窄的瘢痕假道较长,排便后大便滞留,要求行二期瘢痕整复手术。6例患者在治疗过程中均未行肛门改道、腹部乙状结肠暂时性造瘘,整个治疗过程均能顺利解大便。结论:简易肛门扩撑支具的使用在一定程度上具有改善假性肛门狭窄的作用,可以使患者在治疗过程中能完成排便的生理需要,并且可以为后期的瘢痕整形留出充足的时间。

Objective To observe the clinical effect of simple anal expansion brace in improving pseudo-anal stenosis in perineal burns.Methods Six patients with perineal burn admitted to the author's hospital from October 2017 to October 2021 were selected.All patients started to use simple anal expansion brace when wound eschar was removed.The brace was prepared by sterile syringe and sterile gloves after trimming.The perianal wound was fixed with sterile dressing and elastic bandage before healing,and fixed with elastic underwear after wound healing until half a year after wound healing.Results The scars in the anal area of two patients began to soften half a year after the healing of the perianal wound,and the anal stenosis did not affect the normal defecation and postdefecation cleaning.The four patients healed half a year after the perianal wound due to the long scar prosthesis of pseudoanal stenosis and stranded stool after defecation,and the second phase of scar recovery surgery was required.None of the six patients underwent anal diversion and temporary abdominal sigmoid colon fistula during the treatment process,and the whole treatment process could successfully defecate using toilets.Conclusion Using of simple anal expansion brace can improve pseudoanal stenosis to a certain extent,and can make patients complete the physiological needs of defecation in the process of treatment,leaving sufficient time for scar plastic surgery in the later stage.