Goh Minghui, Chew Min-Hoe, Au-Yong Phui-Sze, Ong Choo-Eng, Tang Choong-Leong
Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
Singapore Med J. 2014 Dec;55(12):635-9. doi: 10.11622/smedj.2014176.
Severe perianal sepsis is often difficult to manage after surgical debridement due to faecal contamination. Diversion of the faecal stream has been attempted with faecal pouches and rectal tubes, and in some cases, a diverting stoma is created. However, reversal of the stoma may be delayed due to prolonged sepsis and this is not without risks. Herein, we review the use of a flexible faecal management system in patients with severe perianal sepsis.
We retrospectively evaluated 15 patients who made use of the ConvaTec Flexi-Seal® Fecal Management System (FMS) between 1 January 2007 and 31 December 2010. The demographics and comorbidities of the patients, as well as the treatment received, were recorded and reviewed.
None of the patients required the creation of a stoma to divert the faecal stream. Nursing requirements and wound care were found to be improved with the use of the Flexi-Seal® FMS (fewer changes were needed). No severe complications were observed in our series. Two deaths were encountered, but the cause of death was not directly due to the initial perianal sepsis. Overall, the wound healing rate was 80.0%, with one graft failure (11.1%).
The use of the Flexi-Seal® FMS in patients with perianal sepsis following extensive debridement is feasible and can be considered before stoma creation.
由于粪便污染，严重肛周脓毒症在手术清创后往往难以处理。人们尝试使用粪袋和直肠管来改道粪便流，在某些情况下，还会造一个分流造口。然而，由于脓毒症持续时间延长，造口回纳可能会延迟，而且这并非没有风险。在此，我们回顾了柔性粪便管理系统在严重肛周脓毒症患者中的应用。
我们回顾性评估了2007年1月1日至2010年12月31日期间使用康维德Flexi-Seal®粪便管理系统（FMS）的15例患者。记录并回顾了患者的人口统计学和合并症，以及所接受的治疗。
所有患者均无需造口来改道粪便流。使用Flexi-Seal® FMS后，护理需求和伤口护理得到改善（所需更换次数减少）。我们的系列研究中未观察到严重并发症。有2例死亡，但死亡原因并非直接由最初的肛周脓毒症导致。总体而言，伤口愈合率为80.0%，1例移植失败（11.1%）。
在广泛清创后的肛周脓毒症患者中使用Flexi-Seal® FMS是可行的，在造口之前可予以考虑。
