Tang C L, Chew S P, Seow-Choen F
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Dis Colon Rectum. 1996 Dec;39(12):1415-7. doi: 10.1007/BF02054531.
Incision and drainage (I & D) with concurrent or delayed fistulotomy is the usual treatment for abscess-fistula with a demonstrated internal opening. We compared incision and drainage alone vs. with concurrent fistulotomy for perianal abscesses with a demonstrated internal opening.
Consecutive patients with acute perianal abscesses and a demonstrated internal opening were prospectively randomized into either the I & D group or drainage with concurrent fistulotomy group. They were followed up at one month, three months, and one year.
The I & D group had 21 patients, and the fistulotomy group had 24 patients. Thirteen patients had low intersphincteric abscess-fistula, and seven had low transsphincteric fistulas in the I & D group. The fistulotomy group had 9 intersphincteric abscess-fistula compared with 14 low transsphincteric ones. Median duration of surgery, hospital stay, and continence at final follow-up were the same in the two groups. Three had recurrent abscess-fistula in the I & D group compared with none in the fistulotomy group (P = 0.09).
I & D alone for acute anal abscess-fistula with demonstrated internal opening showed a tendency to recurrence that did not reach a statistically significant difference compared with concurrent fistulotomy. I & D, therefore, puts only a few patients at risk for recurrence.
对于已证实存在内口的脓肿 - 肛瘘，切开引流（I&D）联合同期或延期肛瘘切开术是常用的治疗方法。我们比较了单纯切开引流与同期肛瘘切开术治疗已证实存在内口的肛周脓肿的效果。
将连续的急性肛周脓肿且已证实存在内口的患者前瞻性随机分为切开引流组或同期肛瘘切开引流组。对他们进行1个月、3个月和1年的随访。
切开引流组有21例患者，肛瘘切开术组有24例患者。切开引流组中13例为低位括约肌间脓肿 - 肛瘘，7例为低位经括约肌肛瘘。肛瘘切开术组有9例括约肌间脓肿 - 肛瘘，14例低位经括约肌肛瘘。两组手术的中位持续时间、住院时间和末次随访时的控便能力相同。切开引流组有3例脓肿 - 肛瘘复发，而肛瘘切开术组无复发（P = 0.09）。
对于已证实存在内口的急性肛门脓肿 - 肛瘘，单纯切开引流有复发倾向，但与同期肛瘘切开术相比，差异无统计学意义。因此，单纯切开引流仅使少数患者有复发风险。
