经括约肌间结扎联合拖线置管术治疗肛周脓肿的临床效果观察

Observation of the clinical efficacy of intersphincteric ligation combined with traction and catheterization in the treatment of anal abscess

目的观察经括约肌间结扎联合拖线置管术治疗肛周脓肿的临床效果。方法纳入2019年12月至2021年6月上海中医药大学附属龙华医院肛肠科确诊的80例肛周脓肿患者作为研究对象,随机分为治疗组(n=40,采用经括约肌间结扎联合拖线置管术治疗)与对照组(n=40,采用切开引流术治疗)。观察记录两组肛瘘形成情况,临床疗效,拖线、置管情况,术后第1、第3天并发症情况【包括创面疼痛程度(视觉模拟评分)、创面渗出物(创面渗出物评分)和发热情况(发热评分)】,肛门功能,创面愈合时间,住院费用,以及住院时间。结果治疗组的肛瘘形成率(25%vs.52.5%)低于对照组,置管患者比例高于对照组(67.5%vs.42.5%),肛管静息压【(62.9±8.9)mmHg vs.(49.2±9.5)mmHg】高于对照组,创面愈合时间短于对照组,差异有统计学意义(P<0.05);两组拖线患者比例、住院费用和住院时间比较差异无统计学意义(P>0.05)。两组总有效率均为100%,治疗组的临床疗效优于对照组(P<0.05)。术后第1天,两组视觉模拟评分、创面渗出物评分及发热评分比较差异无统计学意义(P>0.05)。术后第3天,两组创面渗出物评分及发热评分比较差异无统计学意义(P>0.05),治疗组的视觉模拟评分低于对照组(P<0.05)。结论经括约肌间结扎联合拖线置管术是一种治疗肛周脓肿的安全有效的全括约肌保留术式,能有效地降低术后肛瘘形成的概率,减少术后并发症,加速创面愈合,节省医疗资源,值得临床推广应用。

Objectives To observe the clinical efficacy of intersphincteric ligation combined with traction and catheterization in the treatment of anal abscess.Methods Total of eighty patients with anal abscess diagnosed in the Department of Anorectal Surgery,Longhua Hospital,Shanghai Traditional Chinese Medicine University from December 2019 to June 2021 were randomly divided into treatment group(n=40,treated with intersphincteric ligation combined with traction and catheterization)and control group(n=40,treated with incision and drainage).The anal fistula formation,clinical efficacy,traction and catheterization,complications that including wound pain degree[visual analogue scale(VAS)],wound exudate(wound exudate score),and fever(fever score)at postoperative day 1 and day 3,anal function,wound healing time,hospitalization cost,and hospital stay were observed and recorded.Results The anal fistula formation rate in the treatment group was lower than that in the control group(25%vs.52.5%),The proportion of patients with catheterization was higher in the treatment group than that in the control group(67.5%vs.42.5%),The anal resting pressure in the treatment group was higher than that in the control group[(62.9±8.9)mmHg vs.(49.2±9.5)mmHg],The wound healing time was shorter in the treatment group than that in the control group,with statistical significance(P<0.05).There were no significant differences in the proportion of patients with traction,hospitalization cost,and hospital stay between the two groups(P>0.05).The total effective rate was 100%in both groups,and the clinical efficacy of the treatment group was better than that of the control group(P<0.05).On postoperative day 1,there were no significant differences in VAS score,wound exudate score,and fever score between the two groups(P>0.05).On postoperative day 3,there were no significant differences in wound exudate score and fever score between the two groups(P>0.05),the VAS score was lower in the treatment group than that in the control group(P<0.05).Conclusion Intersphincteric ligation combined with traction and catheterization is a safe and effective sphincter-saving technique for the treatment of anal abscess.It can effectively reduce the probability of postoperative anal fistula formation, reduce postoperative complications,accelerate wound healing, save medical resources, and is worthy of clinical promotion and application to a certain extent.