婴儿肛周脓肿和肛瘘：一种不同的疾病？

Perianal abscess and fistula-in-ano in infants: a different entity?

作者信息

Serour Francis, Somekh Eli, Gorenstein Arkadi

机构信息

Department of Pediatric Surgery, The Edith Wolfson Medical Center, Halokhamim Street 62, 58100 Holon, Israel.

出版信息

Dis Colon Rectum. 2005 Feb;48(2):359-64. doi: 10.1007/s10350-004-0844-0.

DOI:10.1007/s10350-004-0844-0

PMID:15616754

Abstract

PURPOSE

The features of perianal abscess and fistula-in-ano in infants are different from those of older children, and there is controversy regarding their treatment. The aim of this study was to assess the efficacy of various methods used for their management.

METHODS

A retrospective analysis of the records was conducted for all infants younger than 24 months of age treated for perianal abscess, fistula-in-ano, or both from 1990 to 2002.

RESULTS

The study included 98 infants. Perianal abscess was found in 77 patients (75 males), and fistula-in-ano in 21. No infant had an underlying illness. Drainage was performed by needle aspiration in 47 patients and by incision and drainage in 5. Following drainage, 43 patients received antibiotics. Altogether, 6 infants were treated with antibiotics alone and 19 with local care alone. Twenty-eight boys (36.4 percent) had an evolution toward fistula-in-ano. Patients who received antibiotics following drainage were less likely to develop fistula-in-ano than were patients who underwent a drainage procedure alone (27.9 percent vs. 66.7 percent, P < 0.05). All patients with fistula-in-ano were male and had been previously treated for perianal abscess (21 patients elsewhere and 28 in our department). Spontaneous cure of fistula-in-ano occurred in 42.9 percent of them (average 3.2 months), and 57.1 percent underwent fistulectomy for persistent fistula-in-ano. Cryptotomy was added when an involved crypt was found (11 patients, 39.3 percent). No recurrence of fistula-in-ano was noted after fistulectomy.

CONCLUSIONS

Local treatment for perianal abscess during the early stage and drainage by needle aspiration during the progressive stage are effective. Antibiotics may be considered for patients undergoing drainage of perianal abscess. Fistula-in-ano can be managed conservatively for one to three months. For a persisting fistula, fistulectomy with cryptotomy (when abnormal anal crypts are found) is the preferred treatment.

摘要

目的

婴幼儿肛周脓肿和肛瘘的特征与大龄儿童不同，其治疗方法存在争议。本研究旨在评估用于其治疗的各种方法的疗效。

方法

对1990年至2002年间接受肛周脓肿、肛瘘或两者治疗的所有24个月以下婴儿的记录进行回顾性分析。

结果

该研究纳入了98名婴儿。77例患者（75名男性）发现肛周脓肿，21例发现肛瘘。无婴儿患有基础疾病。47例患者通过针吸引流，5例通过切开引流。引流后，43例患者接受了抗生素治疗。共有6例婴儿仅接受抗生素治疗，19例仅接受局部护理。28名男孩（36.4%）发展为肛瘘。引流后接受抗生素治疗的患者比仅接受引流手术的患者发生肛瘘的可能性更小（27.9%对66.7%，P<0.05）。所有肛瘘患者均为男性，且之前接受过肛周脓肿治疗（21例在其他地方治疗，28例在我科治疗）。其中42.9%的肛瘘患者自然愈合（平均3.2个月），57.1%因肛瘘持续存在而接受了瘘管切除术。发现相关肛隐窝时加做肛隐窝切开术（11例患者，39.3%）。瘘管切除术后未发现肛瘘复发。