Department of Anorectal Diseases, China-Japan Friendship Hospital, Beijing, China.
Ann Palliat Med. 2021 Sep;10(9):9830-9840. doi: 10.21037/apm-21-2229.
Surgery is the clinically preferred treatment for high perianal abscesses. Incision and seton drainage improve the cure rate and reduce recurrence. We aimed to systematically evaluate the clinical effect and safety of incision and seton drainage in the treatment of high perianal abscess.
China Knowledge Network (CNKI), WanFang database, VIP database, PubMed, and Cochrane Library were searched and all relevant Chinese and English language documents until July 2021were retrieved. All records that described randomized clinical trials (RCTs) of incision and seton drainage for the treatment of high perianal abscess were eligible. Documents that met the inclusion criteria were evaluated for bias using the Cochrane Collaboration Risk Evaluation Standard, and Revman5.4 software was used to analyze the data.
Fourteen RCTs were included. The results of nine studies showed that the clinical cure rate of the incision-seton group was higher than that of the incision-drainage group (P<0.05). Seven studies showed that the wound healing time of the incision-seton group was shorter than that of the incision-drainage group (P<0.05). Four studies showed that the visual analogue scale (VAS) score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Five studies showed that the Wexner score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Six studies showed that the formation rate of anal fistula in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Six studies demonstrated that the recurrence rate of abscess in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Seven studies showed that the incidence of adverse events in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Five studies demonstrated that the length of stay in the incision-seton group was shorter than that of the incision-drainage group (P<0.05).
The choice of surgical methods in clinical research has always been controversial. The incision-seton method can effectively and safely treat high perianal abscess. However, the results of this meta-analysis still leave some gaps in the evidence. More large-sample, high-quality, and multi-center RCTs are needed.
手术是治疗高位肛周脓肿的临床首选治疗方法。切开挂线引流可提高治愈率，降低复发率。我们旨在系统评价切开挂线引流治疗高位肛周脓肿的临床疗效和安全性。
检索中国知网（CNKI）、万方数据库、维普数据库、PubMed 和 Cochrane Library，检索时间截至 2021 年 7 月，收集所有描述切开挂线引流治疗高位肛周脓肿的随机对照临床试验（RCT）的中文和英文文献。纳入符合标准的文献，采用 Cochrane 协作风险评估标准评价偏倚风险，采用 RevMan5.4 软件进行数据分析。
共纳入 14 项 RCT。9 项研究结果显示，切开挂线组的临床治愈率高于切开引流组（P<0.05）。7 项研究结果显示，切开挂线组的创面愈合时间短于切开引流组（P<0.05）。4 项研究结果显示，切开挂线组的视觉模拟评分（VAS）低于切开引流组（P<0.05）。5 项研究结果显示，切开挂线组的 Wexner 评分低于切开引流组（P<0.05）。6 项研究结果显示，切开挂线组的肛瘘形成率低于切开引流组（P<0.05）。6 项研究结果显示，切开挂线组脓肿复发率低于切开引流组（P<0.05）。7 项研究结果显示，切开挂线组的不良反应发生率低于切开引流组（P<0.05）。5 项研究结果显示，切开挂线组的住院时间短于切开引流组（P<0.05）。
临床研究中手术方法的选择一直存在争议。切开挂线法能有效、安全地治疗高位肛周脓肿，但本研究的 Meta 分析结果仍存在一定证据缺口，需要更多大样本、高质量、多中心的 RCT 进一步验证。
