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  • Title: [Application of closed negative pressure irrigation and suction device in the treatment of high perianal abscess].
    Author: Chen SQ, Liu WC, Zhang ZZ, Lin LY, Chen SM, Huang GL, Lin CZ, Wang L.
    Journal: Zhonghua Wei Chang Wai Ke Za Zhi; 2019 Apr 25; 22(4):364-369. PubMed ID: 31054551.
    Abstract:
    Objective: To explore the efficacy of closed negative pressure irrigation and suction device (Patent number: Z200780013509.8) in the treatment of high perianal abscess. Methods: From January 2015 to December 2016, ≥18-year-old patients with primary high perianal abscess who were treated at our department were prospectively enrolled. Exclusion criteria: (1) recurrent perianal abscess; (2) complicated with anal fistula formation; (3) preoperative, intraoperative or postoperative physical therapy, and curettage treatment, negative pressure irrigation; (4) Crohn's disease-related perianal abscess; (5) with immunosuppressive status, such as transplant recipients; (6) co-existence of malignant tumors, such as leukemia; (7) with diabetes; (8) those who could not receive long-term follow-up and were not suitable to participate in this study. According to the random number table method, the patients were randomly divided into negative pressure irrigation and suction group and routine drainage group. All patients were clearly diagnosed and the location and size of the perianal abscess were marked before surgery. These two groups were treated as follows: (1) Negative pressure irrigation and suction group: the skin was incised at a diameter of 1-2 cm at the site where the abscess fluctuated most obviously. After the abscess was removed, a closed negative pressure irrigation and suction device was installed and the pressure of -200 to -100 mmHg (1 mmHg=0.133 kPa) was maintained to keep the abscess cavity collapsed. Generally, the irrigation was stopped 5 days later or when the drainage was clear. The closed vacuum suction was maintained for 2 additional days, before the wound was sutured. (2) Conventional drainage group: conventional incision and drainage was carried out. The skin was cut at a diameter of 8 to 10 cm at the site of abscess with most obvious fluctuation. After the abscess was removed, normal saline gauze was used for dressing. Dressing was changed regularly until the wound healed. The efficacy, operative time, intraoperative bleeding, incision length, frequency of dressing change, pain index (visual analogue score, VAS score), postoperative healing time, complications, recurrence rate of perianal abscess, anal fistula formation rate were observed. The t test and χ2 test were used for comparison between the 2 groups. Results: There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group. There were 28 males and 12 females in negative pressure irrigation and suction group with a mean age of (38.3±12.0) years and mean disease course of (6.6±2.1) days. The abscess in pelvic-rectal space accounted for 50.0% (20/40) and the mean diameter of abscess was (8.0±3.7) cm. There were 26 males and 14 females in the conventional drainage group with a mean age of (37.1±11.8) years and mean disease course of (6.4±2.5) days. The abscess in pelvic-rectal space accounted for 55.0% (22/40) and the diameter of abscess was (8.2±3.5) cm. The differences in baseline data between two groups were not statistically significant (all P>0.05). Both groups successfully completed the operation. There was no significant difference in operative time between two groups (P>0.05). As compared to conventional drainage group, intraoperative blood loss in negative pressure irrigation and suction group was less [(12.1±5.5) ml vs. (18.3±4.4) ml, t=5.606, P<0.001], incision length was shorter [(2.3±0.8) cm vs. (7.6±1.7) cm, t=17.741, P<0.001], postoperative VAS pain scores at 1-, 3-, 7-, and 14-day after operation were lower [3.7±1.4 vs. 7.6±1.8, t=10.816, P<0.001; 3.0±1.3 vs. 6.8±1.6, t=11.657, P<0.001; 2.7±0.9 vs. 5.1±1.1, t=10.679, P<0.001; 1.2±0.3 vs. 1.6±0.4, t=5.060, P=0.019], the dressing change within 7 days after operation was less (3.5±1.2 vs. 12.6±2.7, t=19.478, P<0.001), postoperative healing time was shorter [(10.4±3.0) d vs. (13.5±3.8) d, t=4.049, P<0.001] and postoperative complication rate was lower [17.5% (7/40) vs. 2.5% (1/40), χ2=5.000, P=0.025]. During follow-up of 12 to 36 (24±5) months, the recurrence rate of perianal abscess within 1 year after operation and anal fistula formation rate in negative pressure irrigation and suction group were lower than those in conventional drainage group [5.0% (2/40) vs. 20.0% (8/40), χ2=4.114, P=0.042 and 2.5% (1/40) vs. 17.5% (7/40), χ2=5.000, P=0.025, respectirely]. The one-time cure rate of negative pressure irrigation and suction group and conventional drainage group was 92.5% (37/40) and 62.5%(25/40), respectirely (χ2=10.323, P=0.001). Conclusions: The application of the negative pressure irrigation and suction device in the treatment of high perianal abscess can improve the efficiency of one-time cure, reduce postoperative pain, accelerate healing time, decrease the morbidity of postoperative complication and the rates of abscess recurrence and anal fistula formation, indicating an improvement of the treatment. 目的： 探讨封闭式负压冲吸装置（专利号：Z200780013509.8）治疗高位肛周脓肿的疗效。 方法： 前瞻性纳入2015年1月至2016年12月解放军联勤保障部队第九〇〇医院普通外科收治的、年龄≥18周岁、首发高位肛周脓肿患者，排除因素包括：（1）复发性肛周脓肿；（2）同时伴有肛瘘形成者；（3）术前、术中或术后同时行理疗、刮除术、负压冲洗等治疗者；（4）克罗恩病相关肛周脓肿；（5）伴免疫抑制状态如移植受体；（6）并存恶性肿瘤如白血病等；（7）伴糖尿病；（8）不能接受长期随访，或因其他因素不适宜参加本研究者。剔除标准：（1）失访；（2）误纳；（3）研究中因各种原因终止治疗或中途改用其他治疗者；（4）患者依从性差，不遵守研究的要求，明显违反本方案。按照随机数字表法把患者随机分为负压冲吸组（40例）和常规引流组（40例）进行随机对照研究，无剔除病例。两组患者均在术前诊断明确并标记肛周脓肿位置及大小，两组治疗方法分别如下：（1）负压冲吸组：在脓肿波动最明显处以直径1~2 cm切开皮肤，清除脓肿后安装封闭式负压冲吸装置，以-200~-100 mmHg（1 mmHg=0.133 kPa）的压力持续冲吸，使脓腔始终保持瘪陷状态；一般冲吸5 d或引流液清亮时停止冲洗，保持封闭式负压吸引2 d，缝闭创口。（2）常规引流组：采用常规切开引流术，在脓肿波动最明显处以直径8~10 cm切开皮肤，清除脓肿后给予生理盐水纱条填塞换药，及时更换敷料直至伤口创面愈合。分析比较两组手术时间、术中出血、切口长度、换药次数、疼痛指数（视觉模拟评分）、术后愈合时间、并发症情况、以及术后1年肛周脓肿复发率和肛瘘形成率情况，术后无脓肿复发或肛瘘形成定义为一次性治愈。采用t检验和χ2检验进行组间比较。 结果： 负压冲吸组男性28例，女性12例，年龄（38.3±12.0）岁，病程（6.6±2.1）d，骨盆直肠间隙脓肿占50.0%（20/40），脓肿直径为（8.0±3.7）cm；常规引流组男性26例，女性14例，年龄（37.1±11.8）岁，病程（6.4±2.5）d，骨盆直肠间隙脓肿占55.0%（22/40），脓肿直径为（8.2±3.5）cm。两组基线资料的差异均无统计意义（均P>0.05），具有可比性。两组患者均顺利完成手术，两组手术时间差异无统计学意义（P>0.05）。与常规引流组比较，负压冲吸组术中出血量少[（12.1±5.5）ml比（18.3±4.4）ml，t=5.606，P<0.001]；手术切口短[（2.3±0.8）cm比（7.6±1.7）cm，t=17.741，P<0.001]；术后疼痛指数低[术后1、3、7、14 d负压冲吸组和常规引流组的疼痛指数分别为3.7±1.4比7.6±1.8（t=10.816，P<0.001）、3.0±1.3比6.8±1.6（t=11.657，P<0.001）、2.7±0.9比5.1±1.1（t=10.679，P<0.001）和1.2±0.3比1.6±0.4（t=5.060，P=0.019）]；术后7 d内的换药次数少[（3.5±1.2）次比（12.6±2.7）次，t=19.478，P<0.001]；术后愈合时间短[（10.4±3.0）d比（13.5±3.8）d，t=4.049，P<0.001];术后并发症发生率少[2.5%（1/40）比17.5%（7/40），χ2=5.000，P=0.025]。随访12~36（24±5）个月，负压冲吸组术后1年的肛周脓肿复发率[5.0%（2/40）和20.0%（8/40），χ2=4.114，P=0.042]和肛瘘形成率[2.5%（1/40）比17.5%（7/40），χ2=5.000，P=0.025]均低于常规引流组；一次性治愈效率显著高于常规引流组[92.5%（37/40）和62.5%（25/40），χ2=10.323，P=0.001]。 结论： 应用封闭式负压冲吸装置治疗高位肛周脓肿，可以提高一次性治愈效率，减轻术后疼痛，加快愈合时间，减少术后并发症、降低脓肿复发率和肛瘘形成率，提高治疗效果。.
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