挂线引流法治疗高位肛管直肠周围脓肿的临床观察

目的：研究挂线引流法治疗高位肛管直肠周围脓肿的临床疗效及其对术后疼痛、肛管缺损和肛门功能评分的影响。方法：对高位肛管直肠周围脓肿采用挂线引流疗法和一次性切开挂线疗法进行治疗，分别观察两组的疗效、创面愈合时间、术后疼痛、肛管缺损、肛门功能评分。结果：试验组和对照组的近期治愈率均为100％，经半年以上随访，试验组远期治愈率为96．2％（25/26），对照组远期治愈率为100％（23/23），但两组间并无显著性差异（χ2＝0．004， P＞0．05）；试验组创面愈合时间为（24．20±1．97）d，对照组创面愈合时间为（26．20±2．30） d。试验组显著短于对照组（ t＝4．667， P ＜0．01）；术后试验组疼痛积分平均为1．94±0．71，对照组疼痛积分平均为2．72±0．81，试验组积分明显优于对照组（t＝5．118，P＜0．01）；术后试验组患者均未发现明显漏气漏液和肛管锁眼畸形，对照组有16例患者出现肛管锁眼畸形，两组间有显著性差异（χ2＝51．515， P＜0．01）；按照Wexner的肛门功能评分法对患者术后肛门功能进行了评价，试验组的肛门功能评分为0．56±0．50，对照组的肛门功能评分为1．34±0．63，以试验组的肛门功能为优（ t＝6．935，P＜0．01）。结论：挂线引流法治疗高位肛管直肠周围脓肿与一次性切开挂线术的临床治愈率、疗程相近，但在术后疼痛、术后肛管缺损、肛门功能评分方面较一次性切开挂线组为优。

Clinical experience of treating superior anorectal abscess with thread drainage technique

Objective：To evaluate the clinical efficacy, postoperative pain,anal sphincter defects and scores of anal function in patients with superior anorectal abscess managed with thread drainage technique . Methods： One hundred patients with upper anorectal abscess were equal-ly allocated to two groups and treated with either thread drainage tech-nique or one step incision thread-drawing method.The two groups were observed regarding the curative effects,duration of wound healing,postop-erative pain,incidence of anal sphincter defects and scores of anal func-tion.Results： The short-term curative rates were 100% for both experi-mental and control groups.Follow-up over half a year time showed that the long-term curative rate was 96.2%（25/26） for the experimental group and 100%（23/23）for the controls,yet the two groups were not statistical-ly different（χ2 =0.004,P〉0.05）.The wound healing time was shorter and the average scores of postoperative pain was lower in the experimental group than the control group（24.20 ±1.97 d vs.26.20 ±2.30 d）（1.94 ±0.71 vs.2.72 ±0.81）（t=4.667,P〈0.01; t=5.118,P〈0.01,re-spectively） .No incidence of obvious leakage discharge and keyhole-like deformity occurred postoperatively in the experimental group ,yet such in-cidence was seen in the control group（ n=16） .The two groups were sig-nificantly different（χ2 =51.515,P〈0.01）.By Wexner scale for postop-erative anal incontinence,the score was 0.56 ±0.50 for the experimental group and 1.34 ±0.63 for the controls （ t =6.935, P 〈0.01 ）. Conclusion： The two approaches to upper anorectal abscess are compara-ble concerning the curative effects and course of treatment ,yet the postop-erative pain,incidence of anal sphincter defects and anal function scores seem superior in application of thread drainage to one step incision thread-drawing method.