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Clinical Effectiveness of Sphincter Preservation Method of Improved Minimally Invasive Surgery to Primary Cure for Horseshoe-Shaped Perianal Abscess

ObjectiveTo evaluate clinical curative effect of sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess. MethodsOne hundred and twenty hospitalized patients diagnosed as horseshoe-shaped perianal abscess were analyzed by prospective, random, single-blind, parallel-group design method, and were randomly divided into two groups, one group of sphincter preservation method of improved minimally invasive surgery (observation group), another group of traditional method of hanging line drainage and multiple incisions of radian shape (control group). The cure rate, long-term recurrence, postoperative pain score within 9 d, hospitalization time, incision healing time, scar area after healing, postoperative anal function score and perioperative and long-term complications were compared in these two groups. ResultsAll the operations were successfully completed in these two groups. There were 56 cases of primary healing in the observation group and 55 cases of primary healing in the control group. Compared with the control group, the postoperative pain score on day 2-4 or on day 7-9 was lower (P < 0.05), the incision healing time was shorter (P < 0.05), and the postoperative anal function score was lower (P < 0.05) in the observation group. There was no incision infection and hemorrhoea in these two groups. The hospitalization time, scar area after healing, incidence rate of urinary retention, hepatic and renal dysfunction, and the total white blood cells > 10.0×109/L had no significant differences between these two groups (P > 0.05). There was no long-term recurrence, anal stenosis, and anal incontinence during following-up of 6 months in these two groups. ConclusionPreliminary research results show that sphincter preservation method of improved minimally invasive surgery to primary cure for horseshoe-shaped perianal abscess has a reliable clinical curative effect, fast healing, and less postoperative complications.

Effect of Primary Surgery of Cutting with Thread Ligation in Combination with Drainage at Left and Right Side for High Perianal Abscess

目的　探讨一期后位切开挂线左右侧切开引流手术治疗高位马蹄型肛周脓肿的临床效果。方法　前瞻性纳入2008年10月至2010年10月期间庆阳市人民医院收治的60例高位马蹄型肛周脓肿患者，将其随机分成2组，其中观察组30例，行一期后位切开挂线左右侧切开引流术；对照组30例，行一期切开挂线术。比较2组患者的临床疗效。结果　临床疗效观察组为优11例（36.67%），良17例（56.66%），差2例（6.67%），优良率为93.33%（28/30）；对照组为优5例（16.67%），良16例（53.33%），差9例（30.00%），优良率为70.00%（21/30）。观察组的临床疗效优于对照组（P＜0.05）。观察组患者术后肛缘水肿、肛门前移和肛门内陷的发生率以及创面愈合时间均低于或短于对照组（P＜0.05）。2组患者术后均获访1年，均无复发，肛门功能均正常，无畸形。结论　一期后位切开挂线左右侧切开引流术治疗高位马蹄型肛周脓肿的临床疗效确切，患者术后恢复良好，值得临床推广应用。

副肿瘤性天疱疮伴Castleman瘤患者肛周脓肿护理一例

Clinical Application of AQUACEL-Ag® HydrofiberTM Dressing in Wound Healing Following Anorectal Abscess Operation

目的　观察AQUACEL-Ag®亲水性纤维敷料对肛周脓肿患者术后创面愈合的作用。方法　将49例肛周脓肿术后患者按随机数字表法随机分为试验组（25例）和对照组（24例），分别予AQUACEL-Ag®亲水性纤维敷料换药（1 次/3d）和无菌凡士林纱布换药（1次/d），并观察2组患者的换药时创面疼痛程度、创面愈合时间、创面换药次数、创面愈合率及换药时创面分泌物培养结果。结果　试验组在创面疼痛、愈合时间、创面换药次数及换药时分泌物培养转阴时间方面均优于对照组（P＜0.05）；动态监测创面愈合率：第3d时2组间比较差异无统计学意义（P＞0.05），第9、15、21d时试验组创面愈合率明显高于对照组（P＜0.05）。结论　从本组有限的数据看，AQUACEL-Ag®亲水性纤维敷料对肛周脓肿患者术后创面愈合有重要作用。

CURATIVE EFFECTS OF BASIC FIBROBLAST GROWTH FACTOR ON ANUS WOUND HEALING

OBJECTIVE: To observe the curative effects of basic fibroblast growth factor (bFGF) on anus wound healing. METHODS: From April 1996 to December 2000, out of 109 patients with anus trauma, hemorrhoidectomy or fistula resection, 68 were treated with bFGF as the experimental group, while 41 were treated routinely as the control group. The healing of the wound, the general and local reaction were observed. RESULTS: The healing time of the experimental group was(17.00 +/- 1.54) days while that of the control group was(20.00 +/- 1.16) days (P lt; 0.01). Three weeks after operation, the healing rates of the experimental and control groups were 97.1% and 87.8%, respectively (P lt; 0.01). No general or local detrimental reactions were found in two groups. CONCLUSION: Local application of bFGF can accelerate the healing of anus wound, and the patients have little pain.

肛周化脓性汗腺炎13例临床分析

目的总结肛周化脓性汗腺炎的临床特点、诊断及治疗方法。 方法回顾性分析我院肛肠外科2013年1月至2015年12月期间收治的13例肛周化脓性汗腺炎患者的临床资料。 结果全部病例均行外科手术治疗，术中切开所有瘘管，彻底清除瘘管壁，术后给予抗炎、换药等治疗。手术时间（50±6）min，住院时间平均16.3 d，伤口愈合时间平均45.6 d。随访半年，1例患者4个月后局部复发再次入院，以同样手术方式治疗后治愈。其余患者均治愈，未复发，无失禁，愈合后肛周切口形成瘢痕，无感染。 结论肛周化脓性汗腺炎诊断主要依据临床表现及病理学检查，误诊率高，治疗以手术为主。早期诊断，及时治疗，手术彻底，是治愈肛周化脓性汗腺炎、降低复发的关键。

Clinical Efficacy of Sphincter-retaining and Loose-seton Therapy in Treating Patients with High Perianal Abscess

目的　探讨保留括约肌虚挂线法治疗高位肛周脓肿的临床疗效。 方法　2009年10月－2010年10月采用随机对照试验，对52例高位肛周脓肿患者施行手术治疗，其中保留括约肌虚挂线法（治疗组）26例，切开挂线引流法（对照组）26例。对两组患者术后6个月肛瘘发生率、切口愈合时间、术后1～15 d每晚疼痛视觉模拟评分（VAS）和术后6个月痊愈患者肛门功能后遗症发生率进行比较。 结果　术后6个月，治疗组和对照组肛瘘发生率分别为4.0%和3.8%，差异无统计学意义（P＞0.05）。术后7～15 d治疗组VAS评分均低于对照组，差异有统计学意义（P＜0.05）。两组切口愈合时间分别为（19.05 ± 6.71）d和（21.42 ± 8.40）d，差异有统计学意义（P＜0.05）。术后6个月治疗组痊愈患者肛门功能全部正常，对照组后遗症发生率为12.0%，两组比较差异有统计学意义（P＜0.05）。 结论　保留括约肌虚挂线治疗在术后疼痛、切口愈合时间和保护肛门功能等方面明显优于切开挂线引流治疗，是一种治疗高位肛周脓肿较为理想的方法。

Diagnosis and Treatment of Fournier Syndrome (Report of 6 Cases)

Objective To investigate the early diagnosis and effective treatment of Fournier syndrome. Methods The clinical data of 385 patients with perianal abscess in this hospital between 2006 and 2009 were retrospectively analyzed for screening the patients with complication of Fournier syndrome. Results Fournier syndrome was detected in 6 patients （1.56%）， who were all cured by treating with early incision and drainage, complete debridement, effective antibiotics, and supporting therapy. Conclusions Perianal abscess can induce Fournier syndrome of perineal, genital, and abdominal wall regions, which spreads rapidly and progressively, so early diagnosis and extensive surgical debridement play a decisive role on the prognosis.

Exploration of clinical pathway for perianal day surgery based on enhanced recovery after surgery concept

Objective To explore the application effect of the clinical pathway for perianal day surgery based on enhanced recovery after surgery (ERAS) concept. Methods The case data of patients who underwent perianal surgery in the Department of Anorectal Surgery of Gansu Provincial Hospital between January and October 2023 and patients who underwent perianal day surgery based on the ERAS clinical pathway in the Ambulatory Surgery & Chemotherapy Centre of Gansu Provincial Hospital were retrospectively collected. The patients in the Department of Anorectal Surgery were defined as the control group, while the patients in the Ambulatory Surgery & Chemotherapy Centre were defined as the pathway group. The differences in indicators such as hospitalization cost, average hospitalization time, preoperative hospitalization time, surgical time, intraoperative bleeding, patient satisfaction, and postoperative follow-up between the two groups of patients were analyzed. Results A total of 400 patients were included, with 200 in each group. The differences between the two groups in gender and age were not statistically significant (P>0.05), the Visual Analogue Scale of the pathway group was lower than that of the control group (P<0.05), and the Kolcaba Comfort Scale score was higher than that of the control group (P<0.05). The hospitalization cost, average hospitalization time, preoperative hospitalization time, and surgical time of the pathway group were all lower than those of the control group (P<0.05), and there was no statistically significant difference in intraoperative bleeding between the two groups (P>0.05). The satisfaction rates of the pathway group and the control group were 90.5% and 86.0%, respectively, and there was no statistically significant difference between the two groups (P>0.05). The follow-up results showed that perianal day surgery did not increase the discomfort of patients after discharge. Conclusions The clinical pathway for day surgery based on ERAS concept is more conducive to the postoperative recovery of patients undergoing day surgery, reducing medical costs, improving medical quality, and increasing patient satisfaction. It is worthy of clinical promotion and application.

保留括约肌挂线引流术联合英夫利昔单抗治疗肛周瘘管型克罗恩病的短期临床疗效

目的 总结保留括约肌挂线引流术联合英夫利昔单抗（infliximab，IFX）治疗肛周瘘管型克罗恩病（Crohn disease，CD）的短期临床疗效。 方法 回顾性分析江苏省中医院肛肠科于 2010 年 3 月至 2011 年 6 月期间收治的接受保留括约肌挂线引流术联合 IFX 治疗的 20 例肛周瘘管型 CD 患者的临床资料，治疗方案为降阶梯治疗。在第 0、2 及 6 周分别给予 5 mg/kg IFX 静脉注射诱导治疗，随后给予每 8 周 1 次、共 3 次的 IFX 维持治疗（5 mg/kg），共计 6 次。于治疗前和第 0、6 及 30 周治疗后评估克罗恩病活动指数（CDAI）、肛周克罗恩病活动指数（PCDAI）、治疗效果及瘘管闭合情况，并开展实验室检测。 结果 ① CDAI 和 PCDAI：与治疗前比较，第 0、6 及 30 周的 CDAI 和 PCDAI 均较低（P<0.05）。② 瘘管闭合：第 0 周时，18 例瘘管部分闭合，2 例无效；第6 周时，16 例瘘管完全闭合，4 例部分闭合；第 30 周时，16 例瘘管完全闭合，1 例部分闭合，3 例复发。③ 实验室检查：与治疗前比较，第 0、6 及 30 周的 C-反应蛋白（CRP）水平、红细胞沉降率（ESR）、血小板计数、中性粒细胞百分比及白细胞计数均较低（P<0.05），第 6 周和第 30 周的血红蛋白水平较高（P<0.05）。④ 不良反应：治疗过程中 3 例次发生不良反应。 结论 保留括约肌挂线引流术联合 IFX 降阶梯治疗对肛周瘘管型 CD 有效。