以即時瘻管切開術治療急性肛門直腸膿瘍之經驗

Experience on the Treatment of Acute Anorectal Abscess with Primary Fistulotomy

吳九龍(Chiu-Lung Wu)

《The Kaohsiung Journal of Medical Sciences》 6卷5期 (1990/05) Pp. 218-223

https://doi.org/10.6452/KJMS.199005.0218

摘要

1985年8月至1989年7月，四年間共有72例由肛門腺體感染引起之初次發作的急性肛門直腸膿患者在光田綜合醫院住院治療，其中男性62例，女性10例，年齡分布18歲至63歲，平均39歲，追蹤期間由八個月至53個月，平均24個月。急性肛門直腸膿瘍多數起因於肛門隱窩腺體感染，其治療方式一般均先作切開引流，等形成慢性瘻管後，再入院作瘻管切開或切除術。但部分外科醫師主張在切開引流的同時，嘗試找出病源腺體予以切除，即所謂瘻管即時切開術。本院大腸直腸外科在處理急性肛門直腸膿瘍患者，在原則上，均盡可能作即時瘻管切開術，72例中52例接受即時瘻管切開術，15例接受切開引流，結果前四例發生瘻管，後者五例發生瘻管。九例發生瘻管者中，五例為坐骨直腸窩膿瘍，顯示坐骨直腸冏膿瘍不易以即時瘻管切開術，達成一次手術即根治的目的。但佔肛門直腸膿瘍絕大多數的肛門周圍膿瘍及括約肌間膿瘍，以即時瘻管切開術，51例中僅有二例發生瘻管。因其復發率低，且可避免第二次手術，故此種手術方式值得推廣。

並列摘要

From August 1985 to July 1989, 72 cases with initial attacks of acute cryptoglandular anorectal abscesses were hospitalized and treated in Kuang Tien General Hospital. Among them were 52 cases of the perianal type, 8 of the intersphincteric type, 11 of the ischiorectal type and one case involving the supralevator space.
Included were 62 males and 10 females (sex ratio 6:1) with a mean age of 39 years (range, 18 to 63). The mean duration of the follow-up was 24 months.
Most anorectal abscesses originate from a crytoglandular infection and are usually treated initially by incision and drainage. However, a fistula operation may be required if a fistula operation may be required if a fistula develops weeks or months later. Several published papers from various hospitals have also pointed out that this disease condition can be successfully treated by a one-stage operation-primary fistulotomy.
In order to determine the source infection, careful examination was carried out in the operating room under adequate anesthesia. A definite or at least a highly suspected offending crypt was found in 57 cases, all of whom were treated by primary fistulotomy. The remaining 15 cases whose offending crypts were undetectable, were treated by incision and drainage.
Of the 57 cases treated with primary fistulotomy, four cases developed recurrent abscesses or fistulas. In the incision and drainage group, five cases developed recurrences. Among the nine cases of recurrence, five were of the ischiorectal type.
The author surmises that acute anorectal abscess of the one-stage primary fistulotomy of perianal and intersphincteric abscesses, primary fistulotomy should be the first choice of management.

並列關鍵字

primary fistulotomy ； anorectal absecess ； incision and drainage