ObjectiveTo discuss the effectiveness of deep inferior epigastric artery perforator flap to repair perineal and perianal cicatricial contracture. MethodsBetween March 2007 and December 2013, 23 patients with perineal and perianal cicatricial contracture were treated with deep inferior epigastric artery perforator flap. There were 15 males and 8 females, aged from 21 to 62 years (mean, 42 years). Burn depth was III degree. The burning scars involved in the fascia, even deeper, which was rated as peripheral type (mild stenosis of the anal region and perianal cicatricial contracture) in 13 cases and as central type (severe stenosis of the anal region and anal canal with shift or defect of external genitalia) in 10 cases. All patients had limited hip abduction and squatting. Repair operation was performed at 3 months to 2 years (mean, 6 months) after wound healing. The size of soft tissue defects ranged from 10 cm×6 cm to 28 cm×13 cm after scar excision and release. The size of flaps ranged from 12 cm×7 cm to 30 cm×15 cm. The donor site was sutured directly in 16 cases and repaired by autograft of skin in 7 cases. ResultsThe flap had distal necrosis, distal cyanosis, and spotted necrosis in 1 case, 2 cases, and 1 case respectively, which were cured after symptomatic treatment;the other flaps survived and wound healed primarily. Twenty-one patients were followed up 6 months to 2 years (mean, 1 year). Nineteen patients had good appearance of the perinea and position of external genitalia, normal function of defecation function;stenosis of the anal region was relived, and the flaps had good texture and elasticity. Linear scar contracture was observed at the edge of flap in 2 cases, and the appearance of the perineum was restored after Z plasty. The hip abduction reached 30-40°. No abdominal hernia was found at donor site. ConclusionDeep inferior epigastric artery perforator flap has stable blood supply and flexible design, which is similar to the perianal and perineal tissues. The good effectiveness can be obtained to use this flap for repair of perineal and perianal cicatricial contracture.
目的 探討保留括約肌虛掛線法治療高位肛周膿腫的臨床療效。 方法 2009年10月－2010年10月采用隨機對照試驗，對52例高位肛周膿腫患者施行手術治療，其中保留括約肌虛掛線法（治療組）26例，切開掛線引流法（對照組）26例。對兩組患者術后6個月肛瘺發生率、切口愈合時間、術后1～15 d每晚疼痛視覺模擬評分（VAS）和術后6個月痊愈患者肛門功能后遺癥發生率進行比較。 結果 術后6個月，治療組和對照組肛瘺發生率分別為4.0%和3.8%，差異無統計學意義（P＞0.05）。術后7～15 d治療組VAS評分均低于對照組，差異有統計學意義（P＜0.05）。兩組切口愈合時間分別為（19.05 ± 6.71）d和（21.42 ± 8.40）d，差異有統計學意義（P＜0.05）。術后6個月治療組痊愈患者肛門功能全部正常，對照組后遺癥發生率為12.0%，兩組比較差異有統計學意義（P＜0.05）。 結論 保留括約肌虛掛線治療在術后疼痛、切口愈合時間和保護肛門功能等方面明顯優于切開掛線引流治療，是一種治療高位肛周膿腫較為理想的方法。
目的 探討一期后位切開掛線左右側切開引流手術治療高位馬蹄型肛周膿腫的臨床效果。方法 前瞻性納入2008年10月至2010年10月期間慶陽市人民醫院收治的60例高位馬蹄型肛周膿腫患者，將其隨機分成2組，其中觀察組30例，行一期后位切開掛線左右側切開引流術；對照組30例，行一期切開掛線術。比較2組患者的臨床療效。結果 臨床療效觀察組為優11例（36.67%），良17例（56.66%），差2例（6.67%），優良率為93.33%（28/30）；對照組為優5例（16.67%），良16例（53.33%），差9例（30.00%），優良率為70.00%（21/30）。觀察組的臨床療效優于對照組（P＜0.05）。觀察組患者術后肛緣水腫、肛門前移和肛門內陷的發生率以及創面愈合時間均低于或短于對照組（P＜0.05）。2組患者術后均獲訪1年，均無復發，肛門功能均正常，無畸形。結論 一期后位切開掛線左右側切開引流術治療高位馬蹄型肛周膿腫的臨床療效確切，患者術后恢復良好，值得臨床推廣應用。
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.
目的 觀察AQUACEL-Ag?親水性纖維敷料對肛周膿腫患者術后創面愈合的作用。方法 將49例肛周膿腫術后患者按隨機數字表法隨機分為試驗組（25例）和對照組（24例），分別予AQUACEL-Ag?親水性纖維敷料換藥（1 次/3d）和無菌凡士林紗布換藥（1次/d），并觀察2組患者的換藥時創面疼痛程度、創面愈合時間、創面換藥次數、創面愈合率及換藥時創面分泌物培養結果。結果 試驗組在創面疼痛、愈合時間、創面換藥次數及換藥時分泌物培養轉陰時間方面均優于對照組（P＜0.05）；動態監測創面愈合率：第3d時2組間比較差異無統計學意義（P＞0.05），第9、15、21d時試驗組創面愈合率明顯高于對照組（P＜0.05）。結論 從本組有限的數據看，AQUACEL-Ag?親水性纖維敷料對肛周膿腫患者術后創面愈合有重要作用。
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.