改良负压封闭引流术治疗肛周坏死性筋膜炎的临床疗效观察

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英文篇名：Clinical efficacy of modified vacuum-sealing drainage in treatment of perianal necrotizing fasciitis 作者：付焱 ; 王自兵 ; 张冰 ; 陈秋菊 ; 李慧 ; 李恒 英文作者：Fu Yan;Wang Zibing;Zhang Bing;Chen Qiuju;Li Hui;Li Heng;Department of General Surgical, Taihe Hospital, Hubei University of Medicine,Shiyan;Department of General Surgical, Economic Development Zone People′s Hospital of Shiyan City; 关键词：肛管 ; 脓肿 ; 肛周坏死性筋膜炎 ; 改良负压封闭引流术 ; 临床效果 英文关键词：Anal canal;;Abscess;;Perianal necrotizing fasciitis;;Modified vacuum-sealing drainage;;Clinic efficacy 中文刊名：ZHZC 英文刊名：Chinese Journal of Colorectal Diseases(Electronic Edition) 机构：十堰市太和医院(湖北医药学院附属医院)普外科;十堰市经济开发区人民医院普外科; 出版日期：2019-02-18 出版单位：中华结直肠疾病电子杂志 年：2019 期：v.8 基金：湖北省十堰市科技局指导项目(No.16Y09) 语种：中文; 页：ZHZC201901011 页数：4 CN：01 ISSN：11-9324/R 分类号：60-63

摘要

目的探讨应用改良负压封闭引流术(VSD)在肛周坏死性筋膜炎中临床疗效。方法选取十堰市太和医院2010年7月至2017年1月期间收治的60例肛周坏死性筋膜炎患者作为研究对象,按治疗方式分为观察组(30例)和对照组(30例),观察组辅助应用改良VSD,对照组应用常规外科清创换药治疗,收集两组患者的临床资料进行统计分析。结果所有患者经治疗后均治愈出院,两组均未发生肛门失禁及肛门狭窄等严重并发症。观察组清创换药次数(t=24.587,P=0.000),平均愈合时间(t=7.841,P=0.000),住院时间(t=-4.797,P=0.000)及费用(t=57.753,P=0.000)均低于对照组,差异有统计学意义;术后第3天(t=9.115,P=0.000),7天(t=7.174,P=0.000),14天(t=-3.415,P=0.002)VAS疼痛评分及术后第3天(t=2.036,P=0.046),7天(t=2.208,P=0.031),14天(t=-4.415,P=0.000)Fournier′s坏疽严重程度指数(FGSI)显著降低,差异有统计学意义,两组在术后脓肿复发率(χ2=0.472,P=0.642)及肛瘘形成率(χ2=1.041,P=0.323)差异无统计学意义。结论肛周坏死性筋膜炎清创术后辅助应用改良VSD是治疗该病的一种有效方法,值得临床推广应用。
        Objective To evaluate the clinical effects of modified vacuum-sealing drainage(VSD) technology in the treatment of perianal necrotizing fasciitis. Methods Sixty patients with perianal necrotizing fasciitis admitted to Shiyan Taihe Hospital from July 2010 to January 2017 were selected as the research subjects. Sixty patients were divided into the observation group and the control group randomly, each group has 30 patients. The observation group was treated by continuous modified VSD, and the control group was treated by conventional debridement. To compare the clinic efficacy of two group. Results Comparing with the control group, the average debridement times(t=24.587, P=0.000), the wound healing times(t=7.841, P=0.000), the hospitalization time(t=-4.797, P=0.000), the hospitalization expenses(t=57.753, P=0.000) were lower. The score of Visual Analogue Scale on 3 d(t=9.115, P=0.000), 7 d(t=7.174, P=0.000), 14 d(t=-3.415, P=0.002) and Fournier′s gangrene severity index(FGSI) on 3 d(t=2.036, P=0.046), 7 d(t=2.208, P=0.031), 14 d(t=-4.415, P=0.000) in the observation group decreased obviously. The difference between the experiment group and the control group had statistical significance(P < 0.05). There were no difference between the two group at the aspect of recurrence rate of pirianal abscess(χ2=0.472, P=0.642) and anal fistula(χ2=1.041, P=0.323). Conclusion The debridement combined with modified VSD is an effective method for the treatment of perianal necrotizing fasciitis and is worthy of clinical application.

引文

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