Gokce Feridun Suat, Gokce Aylin Hande
. Balıklı Rum Hospital, Department: General Surgery, İstanbul, Turkey.
. Istanbul Atlas University; Medical Faculty Department: General Surgery, İstanbul, Turkey.
Rev Assoc Med Bras (1992). 2020 Aug;66(8):1082-1086. doi: 10.1590/1806-9282.66.8.1082.
Perianal abscesses are frequently seen in clinical practice, and perianal fistulas develop in 30%-50% of cases after treatment. This study investigated whether the type of dressing applied after abscess drainage is correlated with fistula development. Prevention of fistula formation would reduce both the loss of work and healthcare costs.
The records of patients who underwent drainage of perianal abscesses between January 2015 and January 2018 were retrospectively reviewed. Patients with postoperative dressings changed with washing of the area in the hospital were included as Group 1. Patients with dressings changed at home and the area bathed in 10% povidone-iodine sitz bath were included as Group 2. The frequency and time of fistula formation, age, sex, cost, and workdays lost in the two groups were compared.
Between-group differences in age, sex, body mass index, and type of fistula that developed after months and 1 year of the abscess drainage were not statistically significant (p > 0.05). During follow-up, fistula development was significantly lower in Group 1 than in Group 2 (p < 0.001). The risk of perianal fistula development was significantly increased in those with a body mass index (BMI) > 30 (p = 0.004).
After perianal abscess drainage, in-hospital washing and dressing of the abscess area until abscess closure reduced the risk of perianal fistula, lost work time, and cost. The risk of perianal fistula development appeared to increase with BMI. A large, prospective study is needed for confirmation.
肛周脓肿在临床实践中较为常见，治疗后30%-50%的病例会发展为肛瘘。本研究调查了脓肿引流后所应用的敷料类型是否与肛瘘形成相关。预防肛瘘形成可减少工作损失和医疗费用。
回顾性分析2015年1月至2018年1月期间接受肛周脓肿引流的患者记录。术后在医院对脓肿区域进行冲洗并更换敷料的患者纳入第1组。在家中更换敷料并使用10%聚维酮碘坐浴的患者纳入第2组。比较两组肛瘘形成的频率和时间、年龄、性别、费用以及误工天数。
两组在年龄、性别、体重指数以及脓肿引流数月和1年后形成的肛瘘类型方面的组间差异无统计学意义（p>0.05）。随访期间，第1组的肛瘘形成率显著低于第2组（p<0.001）。体重指数（BMI）>30的患者发生肛周肛瘘的风险显著增加（p=0.004）。
肛周脓肿引流后，在医院对脓肿区域进行冲洗并更换敷料直至脓肿闭合，可降低肛周肛瘘风险、减少误工时间和费用。肛周肛瘘形成风险似乎随BMI增加而升高。需要开展一项大型前瞻性研究进行证实。
