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Treatment of Anorectal Abscess with Identified Anal Fistula: One-stage or Two-stage Operation

肛門直腸膿瘍合併確認之肛門廔管治療:一階段或是兩階段手術

摘要


目的 在引流膿瘍時是否需同時處理潛在的肛門廔管仍有爭議。我們由回朔性病歷分析臨床因素評估廔管切除治療的預後。 方法 我們藉由一個回朔性的研究來闡明初級廔管切除術在處理肛門直腸膿瘍合併確認之肛門廔管是否需要施行,而手術方式的選擇是視外科醫生個人偏好來決定。有一組病患族群接受引流術及初級廔管切除術,而另外一組病人一開始接受切開引流術及次級廔管切除術。分析預後的因子包括廔管切除術後的復發或是持續、肛門功能的影響、傷口癒合時間、住院天數、平均術後傷口疼痛指數及併發症。 結果 37位肛門直腸膿瘍合併確認之肛門廔管病患管接受一階段同時切開引流及初級廔管切除術(組群Ⅰ),另外27位病患接受兩階段切開引流及廔管切除術的治療(組群Ⅱ)。在組群Ⅰ的病人接受手術的平均時間爲42.41分鐘,而在組群Ⅱ的爲56.44分鐘,兩者的差別在統計學上有意義(p=0.004)。兩組病人在住院天數、傷口癒合時間、平均術後傷口疼痛指數、復發及術後併發症之間統計上並無顯著差異。 結論 肛門直腸膿瘍合併確認之肛門廔管病患可以一階段手術處理,而這種方式和兩階段手術比較上並無差異。此外,一階段手術的施行方式比兩階段手術方式節省手術總時間。肛門直腸膿瘍病患可以嘗試尋找肛門廔管的內口,且同時接受一階段初級廔管切除術而避免再次住院。

並列摘要


Background. Whether the underlying fistula of anorectal abscess should be treated when the abscess is drained remains controversial. Aretrospective chart review was undertaken to assess the treatment outcomes of fistulectomy in terms of the clinical parameters. Methods. We used a retrospective study to clarify whether primary fistu-lectomy can be performed in the management of patients with anorectal abscess with an identified anal fistula. The choice of the surgery was dependent on surgeon preference. One patient group underwent drainage and a primary fistulectomy and the other group underwent incision and drainage initially, followed by a secondary fistulectomy. The outcome variables analyzed were postoperative recurrence and persistence, anal function disturbance, wound-healing time, hospital stay, mean postoperative pain score, and complications. Results. Thirty-seven patients with an anorectal abscess with an identified anal fistula underwent incision and drainage with a primary fistulectomy (group Ⅰ), and 27 patients were treated with a two-stage fistulectomy (group Ⅱ). The operation times were 42.41 minutes for group I and 56.44 minutes for group Ⅱ, which are significantly different (p=0.004). There was no significant difference in the hospital stays, wound-healing times, mean postoperative pain scores, recurrences, postoperative complications of the two groups. Conclusion. Anorectal abscess with identified anal fistula can be managed with a one-stage operation, and this treatment did not differ from the two-stage operation. The one-stage operation required less time than the two-stage operation. Patients with anorectal abscess could try to locate the internal opening of the anal fistula, and underwent a one-stage operation of primary fistulectomy without another admission.

被引用紀錄


Hsiao, M. C., Cheng, L. C., Tian, Y. F., & Chou, C. L. (2016). Managements of an Anorectal Emergency: Experience from a Single Institution. 中華民國大腸直腸外科醫學會雜誌, 27(4), 179-186. https://doi.org/10.6312%2fSCRSTW.2016.27(4).10515

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