Chen S Q, Liu W C, Zhang Z Z, Lin L Y, Chen S M, Huang G L, Lin C Z, Wang L
Department of General Surgery, the 900th Hospital of The Joint Logistics Support Force of Chinese PLA, (Fuzhou General Hospital of Fujian Medical University, East Hospital Affiliated To Xiamen University), Fuzhou 350025, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Apr 25;22(4):364-369. doi: 10.3760/cma.j.issn.1671-0274.2019.04.009.
To explore the efficacy of closed negative pressure irrigation and suction device (Patent number: Z200780013509.8) in the treatment of high perianal abscess. From January 2015 to December 2016, ≥18-year-old patients with primary high perianal abscess who were treated at our department were prospectively enrolled. Exclusion criteria: (1) recurrent perianal abscess; (2) complicated with anal fistula formation; (3) preoperative, intraoperative or postoperative physical therapy, and curettage treatment, negative pressure irrigation; (4) Crohn's disease-related perianal abscess; (5) with immunosuppressive status, such as transplant recipients; (6) co-existence of malignant tumors, such as leukemia; (7) with diabetes; (8) those who could not receive long-term follow-up and were not suitable to participate in this study. According to the random number table method, the patients were randomly divided into negative pressure irrigation and suction group and routine drainage group. All patients were clearly diagnosed and the location and size of the perianal abscess were marked before surgery. These two groups were treated as follows: (1) Negative pressure irrigation and suction group: the skin was incised at a diameter of 1-2 cm at the site where the abscess fluctuated most obviously. After the abscess was removed, a closed negative pressure irrigation and suction device was installed and the pressure of -200 to -100 mmHg (1 mmHg=0.133 kPa) was maintained to keep the abscess cavity collapsed. Generally, the irrigation was stopped 5 days later or when the drainage was clear. The closed vacuum suction was maintained for 2 additional days, before the wound was sutured. (2) Conventional drainage group: conventional incision and drainage was carried out. The skin was cut at a diameter of 8 to 10 cm at the site of abscess with most obvious fluctuation. After the abscess was removed, normal saline gauze was used for dressing. Dressing was changed regularly until the wound healed. The efficacy, operative time, intraoperative bleeding, incision length, frequency of dressing change, pain index (visual analogue score, VAS score), postoperative healing time, complications, recurrence rate of perianal abscess, anal fistula formation rate were observed. The test and χ test were used for comparison between the 2 groups. There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group. There were 28 males and 12 females in negative pressure irrigation and suction group with a mean age of (38.3±12.0) years and mean disease course of (6.6±2.1) days. The abscess in pelvic-rectal space accounted for 50.0% (20/40) and the mean diameter of abscess was (8.0±3.7) cm. There were 26 males and 14 females in the conventional drainage group with a mean age of (37.1±11.8) years and mean disease course of (6.4±2.5) days. The abscess in pelvic-rectal space accounted for 55.0% (22/40) and the diameter of abscess was (8.2±3.5) cm. The differences in baseline data between two groups were not statistically significant (all >0.05). Both groups successfully completed the operation. There was no significant difference in operative time between two groups (>0.05). As compared to conventional drainage group, intraoperative blood loss in negative pressure irrigation and suction group was less [(12.1±5.5) ml vs. (18.3±4.4) ml, =5.606, <0.001], incision length was shorter [(2.3±0.8) cm vs. (7.6±1.7) cm, =17.741, <0.001], postoperative VAS pain scores at 1-, 3-, 7-, and 14-day after operation were lower [3.7±1.4 vs. 7.6±1.8, 10.816, <0.001; 3.0±1.3 vs. 6.8±1.6, =11.657, <0.001; 2.7±0.9 vs. 5.1±1.1, =10.679, <0.001; 1.2±0.3 vs. 1.6±0.4, =5.060, =0.019], the dressing change within 7 days after operation was less (3.5±1.2 vs. 12.6±2.7, =19.478, <0.001), postoperative healing time was shorter [(10.4±3.0) d vs. (13.5±3.8) d, 4.049, <0.001] and postoperative complication rate was lower [17.5% (7/40) vs. 2.5% (1/40), χ=5.000, =0.025]. During follow-up of 12 to 36 (24±5) months, the recurrence rate of perianal abscess within 1 year after operation and anal fistula formation rate in negative pressure irrigation and suction group were lower than those in conventional drainage group [5.0% (2/40) vs. 20.0% (8/40), χ=4.114, =0.042 and 2.5% (1/40) vs. 17.5% (7/40), χ=5.000, =0.025, respectirely]. The one-time cure rate of negative pressure irrigation and suction group and conventional drainage group was 92.5% (37/40) and 62.5%(25/40), respectirely (χ=10.323, =0.001). The application of the negative pressure irrigation and suction device in the treatment of high perianal abscess can improve the efficiency of one-time cure, reduce postoperative pain, accelerate healing time, decrease the morbidity of postoperative complication and the rates of abscess recurrence and anal fistula formation, indicating an improvement of the treatment.
探讨封闭式负压冲洗吸引装置（专利号：Z200780013509.8）治疗高位肛周脓肿的疗效。2015年1月至2016年12月，前瞻性纳入本科收治的年龄≥18岁的原发性高位肛周脓肿患者。排除标准：（1）复发性肛周脓肿；（2）合并肛瘘形成；（3）术前、术中或术后进行物理治疗及刮除术、负压冲洗；（4）克罗恩病相关肛周脓肿；（5）处于免疫抑制状态，如移植受者；（6）并存恶性肿瘤，如白血病；（7）患有糖尿病；（8）无法接受长期随访且不适合参与本研究。根据随机数字表法，将患者随机分为负压冲洗吸引组和常规引流组。所有患者术前均明确诊断，并标记肛周脓肿的位置和大小。两组治疗方法如下：（1）负压冲洗吸引组：在脓肿波动最明显处做直径1 - 2 cm的皮肤切口。清除脓肿后，安装封闭式负压冲洗吸引装置，维持-200至-100 mmHg（1 mmHg = 0.133 kPa）的压力，使脓肿腔塌陷。一般5天后或引流液清澈时停止冲洗。继续维持封闭式负压吸引2天，然后缝合伤口。（2）常规引流组：行常规切开引流。在脓肿波动最明显处做直径8 - 10 cm的皮肤切口。清除脓肿后，用生理盐水纱布换药。定期换药直至伤口愈合。观察两组的疗效、手术时间、术中出血量、切口长度、换药频率、疼痛指数（视觉模拟评分，VAS评分）、术后愈合时间、并发症、肛周脓肿复发率、肛瘘形成率。两组比较采用t检验和χ²检验。负压冲洗吸引组和常规引流组各40例患者。负压冲洗吸引组男28例，女12例，平均年龄（38.3±12.0）岁，平均病程（6.6±2.1）天。骨盆直肠间隙脓肿占50.0%（20/40），脓肿平均直径（8.0±3.7）cm。常规引流组男26例，女14例，平均年龄（37.1±11.8）岁，平均病程（6.4±2.5）天。骨盆直肠间隙脓肿占55.0%（22/40），脓肿直径（8.2±3.5）cm。两组基线资料差异无统计学意义（均P>0.05）。两组均成功完成手术。两组手术时间差异无统计学意义（P>0.05）。与常规引流组相比，负压冲洗吸引组术中出血量少[（12.1±5.5）ml对（18.3±4.4）ml，t = 5.606，P<0.001]，切口长度短[（2.3±0.8）cm对（7.6±1.7）cm,t = 17.741，P<0.001]，术后1、3、7、14天的VAS疼痛评分低[3.7±1.4对7.6±1.8，t = 10.816，P<0.001；3.0±1.3对6.8±1.6，t = 11.657，P<0.001；2.7±0.9对5.1±1.1，t = 10.679，P<0.001；1.2±0.3对1.6±0.4，t = 5.060，P = 0.019]，术后7天内换药次数少（3.5±1.2对12.6±2.7，t = 19.478，P<0.001），术后愈合时间短[（10.4±3.0）d对（13.5±3.8）d，t = 4.049，P<0.001]，术后并发症发生率低[17.5%（7/40）对2.5%（1/40），χ² = 5.000，P = 0.025]。随访12至36（24±5）个月，负压冲洗吸引组术后1年内肛周脓肿复发率及肛瘘形成率均低于常规引流组[5.0%（2/40）对20.0%（8/40），χ² = 4.114，P = 0.042；2.5%（1/40）对17.5%（7/40），χ² = 5.000，P = 0.025]。负压冲洗吸引组和常规引流组的一次性治愈率分别为92.5%（37/40）和62.5%（25/40）（χ² = 10.323，P = 0.001）。负压冲洗吸引装置应用于高位肛周脓肿的治疗可提高一次性治愈率，减轻术后疼痛，加速愈合时间，降低术后并发症发生率及脓肿复发率和肛瘘形成率，表明治疗效果得到改善。
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