Hämäläinen K P, Sainio A P
Fourth Department of Surgery, Helsinki University Central Hospital, Finland.
Dis Colon Rectum. 1998 Nov;41(11):1357-61; discussion 1361-2. doi: 10.1007/BF02237048.
The aim of this study was to assess the incidence of anal fistulas and factors related to this incidence after incision and drainage of acute cryptoglandular anorectal abscesses.
Of 170 patients without previous anal fistulas, 146 were followed up for an average of 99 (range, 22-187) months after abscess drainage or until a fistula appeared.
Fifty-four (37 percent) patients developed a fistula, and 15 (10 percent) patients developed a recurrent abscess. The incidence of fistulas was higher in females than in males (50 vs. 31 percent; P = 0.0403), especially regarding anterior abscesses (88 vs. 33 percent). Abscesses growing Escherichia coli were more prone to fistula formation than those growing other bacteria (46 vs. 27 percent; P = 0.0368).
Incision and drainage alone of acute anorectal abscesses is recommended, because an unnecessary primary fistulotomy can be avoided in more than half of the patients by this approach. For superficial anterior abscesses in females, however, primary fistulotomy may be considered.
本研究旨在评估急性隐窝腺性肛管直肠脓肿切开引流术后肛瘘的发生率及与此发生率相关的因素。
在170例既往无肛瘘的患者中，146例在脓肿引流后平均随访99个月（范围22 - 187个月），直至肛瘘出现。
54例（37%）患者发生肛瘘，15例（10%）患者发生复发性脓肿。女性肛瘘发生率高于男性（50%对31%；P = 0.0403），尤其是前位脓肿（88%对33%）。培养出大肠杆菌的脓肿比培养出其他细菌的脓肿更易形成肛瘘（46%对27%；P = 0.0368）。
建议仅对急性肛管直肠脓肿进行切开引流，因为通过这种方法可避免超过半数患者进行不必要的一期肛瘘切开术。然而，对于女性的表浅前位脓肿，可考虑一期肛瘘切开术。
