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Clinical Efficacy of Sphincter-retaining and Loose-seton Therapy in Treating Patients with High Perianal Abscess

目的　探讨保留括约肌虚挂线法治疗高位肛周脓肿的临床疗效。 方法　2009年10月－2010年10月采用随机对照试验，对52例高位肛周脓肿患者施行手术治疗，其中保留括约肌虚挂线法（治疗组）26例，切开挂线引流法（对照组）26例。对两组患者术后6个月肛瘘发生率、切口愈合时间、术后1～15 d每晚疼痛视觉模拟评分（VAS）和术后6个月痊愈患者肛门功能后遗症发生率进行比较。 结果　术后6个月，治疗组和对照组肛瘘发生率分别为4.0%和3.8%，差异无统计学意义（P＞0.05）。术后7～15 d治疗组VAS评分均低于对照组，差异有统计学意义（P＜0.05）。两组切口愈合时间分别为（19.05 ± 6.71）d和（21.42 ± 8.40）d，差异有统计学意义（P＜0.05）。术后6个月治疗组痊愈患者肛门功能全部正常，对照组后遗症发生率为12.0%，两组比较差异有统计学意义（P＜0.05）。 结论　保留括约肌虚挂线治疗在术后疼痛、切口愈合时间和保护肛门功能等方面明显优于切开挂线引流治疗，是一种治疗高位肛周脓肿较为理想的方法。

副肿瘤性天疱疮伴Castleman瘤患者肛周脓肿护理一例

Effect of Primary Surgery of Cutting with Thread Ligation in Combination with Drainage at Left and Right Side for High Perianal Abscess

目的　探讨一期后位切开挂线左右侧切开引流手术治疗高位马蹄型肛周脓肿的临床效果。方法　前瞻性纳入2008年10月至2010年10月期间庆阳市人民医院收治的60例高位马蹄型肛周脓肿患者，将其随机分成2组，其中观察组30例，行一期后位切开挂线左右侧切开引流术；对照组30例，行一期切开挂线术。比较2组患者的临床疗效。结果　临床疗效观察组为优11例（36.67%），良17例（56.66%），差2例（6.67%），优良率为93.33%（28/30）；对照组为优5例（16.67%），良16例（53.33%），差9例（30.00%），优良率为70.00%（21/30）。观察组的临床疗效优于对照组（P＜0.05）。观察组患者术后肛缘水肿、肛门前移和肛门内陷的发生率以及创面愈合时间均低于或短于对照组（P＜0.05）。2组患者术后均获访1年，均无复发，肛门功能均正常，无畸形。结论　一期后位切开挂线左右侧切开引流术治疗高位马蹄型肛周脓肿的临床疗效确切，患者术后恢复良好，值得临床推广应用。

Clinical Application of AQUACEL-Ag® HydrofiberTM Dressing in Wound Healing Following Anorectal Abscess Operation

目的　观察AQUACEL-Ag®亲水性纤维敷料对肛周脓肿患者术后创面愈合的作用。方法　将49例肛周脓肿术后患者按随机数字表法随机分为试验组（25例）和对照组（24例），分别予AQUACEL-Ag®亲水性纤维敷料换药（1 次/3d）和无菌凡士林纱布换药（1次/d），并观察2组患者的换药时创面疼痛程度、创面愈合时间、创面换药次数、创面愈合率及换药时创面分泌物培养结果。结果　试验组在创面疼痛、愈合时间、创面换药次数及换药时分泌物培养转阴时间方面均优于对照组（P＜0.05）；动态监测创面愈合率：第3d时2组间比较差异无统计学意义（P＞0.05），第9、15、21d时试验组创面愈合率明显高于对照组（P＜0.05）。结论　从本组有限的数据看，AQUACEL-Ag®亲水性纤维敷料对肛周脓肿患者术后创面愈合有重要作用。

Diagnosis and Treatment of Fournier Syndrome (Report of 6 Cases)

Objective To investigate the early diagnosis and effective treatment of Fournier syndrome. Methods The clinical data of 385 patients with perianal abscess in this hospital between 2006 and 2009 were retrospectively analyzed for screening the patients with complication of Fournier syndrome. Results Fournier syndrome was detected in 6 patients （1.56%）， who were all cured by treating with early incision and drainage, complete debridement, effective antibiotics, and supporting therapy. Conclusions Perianal abscess can induce Fournier syndrome of perineal, genital, and abdominal wall regions, which spreads rapidly and progressively, so early diagnosis and extensive surgical debridement play a decisive role on the prognosis.

硫酸吗啡栓用于肛周脓肿术后镇痛的临床观察

目的探讨硫酸吗啡栓对肛周脓肿术后患者的镇痛作用。 方法选择2013年1月－2014年5月住院行肛周脓肿手术患者66例，按随机数字表法分为治疗组与对照组，每组33例。两组患者均于术后6 h开始用药。治疗组给予硫酸吗啡栓 20 mg，纳肛，1次/d；对照组给予氨酚双氢可待因片40 mg口服，2次/d。3 d后，比较两组的镇痛效果。 结果治疗组术后3 d内用药后疼痛评分分值较对照组低，差异有统计学意义（P＜0.05）。治疗组2例切口轻度水肿，1例切口中度水肿，2例出现恶心、呕吐症状；对照组4例切口轻度水肿，3例切口中度水肿，3例出现胃痛反应；两组患者不良反应发生率差异无统计学意义（χ2=2.157，P=0.142）。 结论硫酸吗啡栓应用于肛周脓肿患者术后镇痛简单方便，安全有效，副作用小。

一期根治术与单纯切开引流治疗肛周脓肿的疗效比较

目的比较一期根治术与单纯切开引流术治疗肛周脓肿的疗效。 方法回顾性分析合肥市第二人民医院普外科自2007年6月至2013年6月期间收治的125例肛周脓肿患者的临床资料。根据接受的手术方式不同，将高位脓肿和低位脓肿患者分为一期根治组和切开引流组，分别比较2组患者的疗效。 结果所有患者的脓肿均愈合。在低位脓肿患者中，一期根治组的脓肿复发率和肛瘘发生率均较切开引流组低（P＜0.05）；2组患者均无肛门自控能力下降、肛门狭窄等并发症发生。在高位脓肿患者中，一期根治组的愈合时间和并发症发生率长于（高于）切开引流组（P＜0.05），但脓肿复发率和肛瘘发生率均低于切开引流组（P＜0.05）。 结论对于低位脓肿，首选一期根治术；对于高位脓肿，则应慎重选择手术方式。

Clinical Effectiveness of Sphincter Preservation Method of Improved Minimally Invasive Surgery to Primary Cure for Horseshoe-Shaped Perianal Abscess

ObjectiveTo evaluate clinical curative effect of sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess. MethodsOne hundred and twenty hospitalized patients diagnosed as horseshoe-shaped perianal abscess were analyzed by prospective, random, single-blind, parallel-group design method, and were randomly divided into two groups, one group of sphincter preservation method of improved minimally invasive surgery (observation group), another group of traditional method of hanging line drainage and multiple incisions of radian shape (control group). The cure rate, long-term recurrence, postoperative pain score within 9 d, hospitalization time, incision healing time, scar area after healing, postoperative anal function score and perioperative and long-term complications were compared in these two groups. ResultsAll the operations were successfully completed in these two groups. There were 56 cases of primary healing in the observation group and 55 cases of primary healing in the control group. Compared with the control group, the postoperative pain score on day 2-4 or on day 7-9 was lower (P < 0.05), the incision healing time was shorter (P < 0.05), and the postoperative anal function score was lower (P < 0.05) in the observation group. There was no incision infection and hemorrhoea in these two groups. The hospitalization time, scar area after healing, incidence rate of urinary retention, hepatic and renal dysfunction, and the total white blood cells > 10.0×109/L had no significant differences between these two groups (P > 0.05). There was no long-term recurrence, anal stenosis, and anal incontinence during following-up of 6 months in these two groups. ConclusionPreliminary research results show that sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess has a reliable clinical curative effect, fast healing, and less postoperative complications.

The clinical effect of VSD technology in the treatment of high perianal abscess

Objective To evaluate the clinical effect of vacuum sealing drainage (VSD) technology in the treatment of high perianal abscess. Methods A total of 38 cases of high perianal abscess who underwent surgery in our hospital from May. 2014 to Feb. 2016 were randomly divided into 2 groups: the VSD group (n=19) and the control group (n=19). The cases of VSD group were performed with closure of internal orifice+VSD technique, and the cases of control group were treated with radical operation of perianal abscess (low incision combined with high thread operation). The following indexes of cases in 2 groups were compared and analyzed, including postoperative pain score, wound healing time, postoperative anal function score, and prognosis. Results There were significant differences in pain score (3.53±0.70vs. 5.11±0.74), postoperative anal function score (0vs. 1), and wound healing time〔(27.58±4.95) dvs. (44.68±6.53) d〕between VSD group and control group,P<0.05. Compared with the control group, the pain score and anal function score of the VSD group were both lower, and the wound healing time was shorter. However, there was no statistically significant difference in incidence of fistula between the two groups〔5.3% (1/19)vs. 15.8% (3/19),P=0.60〕. Conclusion In the treatment of high perianal abscess, VSD technology can relieve pain in patients, shorten the wound healing time, protect the anal function, and the prognosis is as well as low incision combined with high thread operation, so VSD is a better treatment method for high perianal abscess.

146 例肛周脓肿脓液培养及药敏试验结果分析

目的 总结肛周脓肿相关致病菌的分布以及药敏特点，为其临床抗生素的应用提供依据。 方法 回顾性分析 2012 年 4 月至 2016 年 7 月期间于苏州高新区人民医院肛肠科行手术治疗的 146 例肛周脓肿患者的脓液细菌培养结果和药敏结果。 结果 146 例标本中检出病原菌 156 株，其中革兰阴性菌 137 株，占 87.8%；革兰阳性菌 19 株，占 12.2%。数量在前 3 位的细菌依次为大肠埃希菌 109 株（69.9%）、肺炎克雷伯菌 18 株（11.5%）和金黄色葡萄球菌 9 株（5.8%）。156 株细菌中检出产超广谱 β-内酰胺酶（ESBLs）细菌 34 株，占 21.8%，除 1 株为肺炎克雷伯菌外，其余均为大肠埃希菌。对革兰阴性菌，前 3 种敏感抗菌药物分别为阿米卡星、哌拉西林他唑巴坦及头孢西丁，前 3 位耐药的抗菌药物为哌拉西林、四环素及磺胺甲噁唑/甲氧苄啶；对革兰阳性菌，前 3 种敏感抗菌药物分别为左氧氟沙星、亚胺培南和庆大霉素；前 3 位耐药的抗菌药物为青霉素/氨苄西林舒巴坦（并列）、环丙沙星及四环素/阿莫西林/氨苄西林（并列）。 结论 肛周脓肿的病原菌以大肠埃希菌为主，且产 ESBLs 细菌主要为大肠埃希菌。