高位肛周脓肿内口皮瓣推移封闭联合负压封闭引流疗效评价

doi:10.3877/cma.j.issn.1674-0793.2023.03.004

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 178 -181. doi: 10.3877/cma.j.issn.1674-0793.2023.03.004

论著

高位肛周脓肿内口皮瓣推移封闭联合负压封闭引流疗效评价

廖辉^†(

), 谢林峰, 王洁

610081　成都大学附属医院肛肠科

收稿日期:2022-10-27 出版日期:2023-06-01
通信作者: 廖辉

Clinical efficacy on the treatment of high perianal abscess with anal sinus suture combined with vacuum sealing drainage

Hui Liao^†(), Linfeng Xie, Jie Wang

Department of Anorectal Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China

Received:2022-10-27 Published:2023-06-01
Corresponding author: Hui Liao

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目的

评价高位肛周脓肿内口皮瓣推移封闭联合持续负压封闭引流技术（VSD）治疗的临床效果。

方法

采用非随机前瞻性研究方法，分析成都大学附属医院2015年1月至2019年12月60例高位肛周脓肿患者，其中观察组30例行直肠黏膜瓣推移内口修补封闭术联合VSD治疗，对照组30例采用肛周脓肿切开挂线引流术。统计分析两组患者创面愈合时间、换药时间、术后1个月疗效，随访1年观察术后肛门功能、肛瘘发生率及复发率。

结果

观察组创面愈合时间[（15.42±3.45）d vs（23.45±3.75）d]、术后换药时间[（10.56±2.23）d vs（16.78±2.65）d]均少于对照组（P<0.001），观察组治愈率优于对照组（96.67% vs 83.33%，χ²=9.325，P=0.021），术后第1、4、7天视觉模拟评分和术后1年肛门功能Wexner评分均低于对照组（P<0.001）。两组术后均无肛瘘发生，肛周脓肿复发率比较差异无统计学意义（3.57% vs 7.41%，χ²=0.622，P=0.776）。

结论

高位肛周脓肿内口皮瓣推移封闭联合VSD治愈率高，术后疼痛轻，愈合时间短，肛门失禁、肛瘘发生率及复发率低。

关键词: 高位肛周脓肿, 内口封闭, 持续负压引流

Objective

To evaluate the clinical efficacy of vacuum sealing drainage (VSD) treatment after the suture of the anal sinus for the high perianal abscess.

Methods

A non-randomized prospective study was conducted to analyze 60 patients with high perianal abscess in the Affiliated Hospital of Chengdu University from January 2015 to December 2019. Among them, 30 cases in the observation group underwent internal orifice flap closure combined with VSD treatment, and 30 cases in the control group were treated with perianal abscess incision and drainage. The wound healing time, dressing change time, and curative effect at 1 month after operation were statistically analyzed. The anal function, the incidence of anal fistula and the recurrence rate were observed after 1 year of follow-up.

Results

The wound healing time [(15.42±3.45) d vs (23.45±3.75) d] and dressing change time [(10.56±2.23) d vs (16.78±2.65) d] in the observation group were lower than those in the control group (both P<0.001). The healing rate of the observation group was better than that of the control group (96.67% vs 83.33%, χ²=9.325, P=0.021). The visual analogue score on the 1-, 4- and 7-day after operation and Wexner score for anal incontinence one year after operation were lower than those in the control group (P<0.001). No anal fistula occurred in the two groups, and there was no significant difference in the recurrence rate of perianal abscess between the two groups (3.57% vs 7.41%, χ²=0.622, P=0.776).

Conclusion

The treatment of high perianal abscess with internal orifice flap closure combined with VSD has a high healing rate, light postoperative pain, short healing time, and low postoperative anal discharge, anal fistula incidence and recurrence rate.

Key words: High perianal abscess, Anal sinus suture, Vacuum sealing drainage

表1 两组高位肛周脓肿患者的一般资料比较

组别	例数	性别[例(%)]		年龄(岁)^a	病程(d)^a	脓液量(ml)^a	脓肿面积(cm²)^a
组别	例数	男	女	年龄(岁)^a	病程(d)^a	脓液量(ml)^a	脓肿面积(cm²)^a
观察组	30	21(70.0)	9(30.0)	34.4±6.2	6.2±2.4	55.6±20.5	25.54±10.38
对照组	30	23(76.7)	7(23.3)	35.2±6.4	6.4±1.8	52.3±21.8	24.82±10.64
统计值		χ²=0.615		t=0.983	t=0.590	t=0.462	t=0.032
P值		0.741		0.748	0.961	0.626	0.759

表1 两组高位肛周脓肿患者的一般资料比较

组别	例数	性别[例(%)]		年龄(岁)^a	病程(d)^a	脓液量(ml)^a	脓肿面积(cm²)^a
组别	例数	男	女	年龄(岁)^a	病程(d)^a	脓液量(ml)^a	脓肿面积(cm²)^a
观察组	30	21(70.0)	9(30.0)	34.4±6.2	6.2±2.4	55.6±20.5	25.54±10.38
对照组	30	23(76.7)	7(23.3)	35.2±6.4	6.4±1.8	52.3±21.8	24.82±10.64
统计值		χ²=0.615		t=0.983	t=0.590	t=0.462	t=0.032
P值		0.741		0.748	0.961	0.626	0.759

图1 在主脓腔处作长约5 cm放射状切口

图2 组织缝合

图3 连接自动负压吸引装置

表2 两组高位肛周脓肿患者术后创面愈合时间和换药时间比较（d, ±s）

组别	例数	创面愈合时间	术后换药时间
观察组	30	15.42±3.45	10.56±2.23
对照组	30	23.45±3.75	16.78±2.65
t值		3.726	5.069
P值		<0.001	<0.001

表2 两组高位肛周脓肿患者术后创面愈合时间和换药时间比较（d, ±s）

组别	例数	创面愈合时间	术后换药时间
观察组	30	15.42±3.45	10.56±2.23
对照组	30	23.45±3.75	16.78±2.65
t值		3.726	5.069
P值		<0.001	<0.001

表3 两组高位肛周脓肿患者术后第1、4、7天VAS评分(分，±s)

组别	例数	第1天	第4天	第7天
观察组	30	3.98±1.51	3.04±0.89	1.15±0.39
对照组	30	6.15±1.92	5.89±2.02	4.88±1.77
t值		7.229	7.015	6.643
P值		<0.001	<0.001	<0.001

表3 两组高位肛周脓肿患者术后第1、4、7天VAS评分(分，±s)

组别	例数	第1天	第4天	第7天
观察组	30	3.98±1.51	3.04±0.89	1.15±0.39
对照组	30	6.15±1.92	5.89±2.02	4.88±1.77
t值		7.229	7.015	6.643
P值		<0.001	<0.001	<0.001

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