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9 例肛周会阴部坏死性筋膜炎的诊断和治疗分析

目的总结肛周和会阴部坏死性筋膜炎的临床诊断和治疗经验。方法回顾性分析 2014 年 9 月至 2019 年 9 月期间朝阳市中心医院结直肠肛门外科收治的 9 例肛周坏死性筋膜炎患者的临床资料。结果9 例患者中，包括 1 例肛周、会阴部和下腹部坏死性筋膜炎，2 例肛周和会阴部坏死性筋膜炎，6 例肛周坏死性筋膜炎，均采用早期手术清创引流、广谱抗炎药物治疗、术后加强全身营养支持、换药清创等综合治疗控制感染。9 例患者的肛周和会阴部坏死性筋膜炎均治愈。3 例阴囊部缺损通过二期转移皮瓣重建治疗，皮瓣无坏死，创面和皮瓣愈合良好。结论早期手术清创引流、使用广谱抗炎药物、加强术后全身营养支持、换药清创等综合治疗坏死性筋膜炎的疗效较好。阴囊皮肤缺损二期通过大腿根部皮瓣转移或直接缝合能缩短患者的创面愈合时间。

肛周坏死性筋膜炎12例诊治体会

目的总结肛周坏死性筋膜炎（PNF）的临床诊治体会。 方法对2008年11月至2015年3月期间我院诊治的12例PNF患者的临床资料进行回顾性分析。 结果本组12例患者平均住院时间35.6 d，经手术治疗后均痊愈，随访3个月均无复发。 结论早期诊断、及时有效的清创手术及合理使用抗生素是治愈PNF的关键。

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.

副肿瘤性天疱疮伴Castleman瘤患者肛周脓肿护理一例

Expressions and clinical significance of SDF-1 and CXCR4 in local tissues of perianal abscess

ObjectiveTo investigate the expressions of stromal cell-derived factor-1 (SDF-1) and chemokine receptor-4 (CXCR4) in local tissues of perianal abscess and their relationships with clinicopathological features and prognosis of patients.MethodsA total of 47 patients with perianal abscess (perianal abscess group) and 58 patients with mixed hemorrhoids (mixed hemorrhoids group) were selected for the study. The tissues were collected during the operation. Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expressions of SDF-1 mRNA and CXCR4 mRNA in local tissues of the two groups, the positive expressions of SDF-1 protein and CXCR4 protein in local tissues were detected by immunohistochemistry, and the relationships between the expressions of SDF-1 and CXCR4 protein and the clinical characteristics, prognosis of patients were analyzed.ResultsThe expression levels of SDF-1 mRNA and CXCR4 mRNA in the perianal abscess group were higher than those in the mixed hemorrhoids group, and the positive rates of SDF-1 protein and CXCR4 protein in the perianal abscess group were higher than those in the mixed hemorrhoids group too (P<0.05). The expressions of SDF-1 protein and CXCR4 protein in perianal abscess tissues were both not related to sex, age, location of abscess, and course of disease (P>0.05), but was related to abscess diameter, healing time, and anal fistula (P<0.05). The non-recurrence rates of SDF-1 protein-negative group and CXCR4 protein-negative group were lower than those of SDF-1 protein-positive group and CXCR4 protein-positive group respectively (P<0.05).ConclusionSDF-1 and CXCR4 molecular are up-regulated in the local tissues of perianal abscess, which are related to the size of abscess, healing time, anal fistula, and recurrence of patients.

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。

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.

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。

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。

146 例肛周脓肿脓液培养及药敏试验结果分析

目的 总结肛周脓肿相关致病菌的分布以及药敏特点，为其临床抗生素的应用提供依据。 方法 回顾性分析 2012 年 4 月至 2016 年 7 月期间于苏州高新区人民医院肛肠科行手术治疗的 146 例肛周脓肿患者的脓液细菌培养结果和药敏结果。 结果 146 例标本中检出病原菌 156 株，其中革兰阴性菌 137 株，占 87.8%；革兰阳性菌 19 株，占 12.2%。数量在前 3 位的细菌依次为大肠埃希菌 109 株（69.9%）、肺炎克雷伯菌 18 株（11.5%）和金黄色葡萄球菌 9 株（5.8%）。156 株细菌中检出产超广谱 β-内酰胺酶（ESBLs）细菌 34 株，占 21.8%，除 1 株为肺炎克雷伯菌外，其余均为大肠埃希菌。对革兰阴性菌，前 3 种敏感抗菌药物分别为阿米卡星、哌拉西林他唑巴坦及头孢西丁，前 3 位耐药的抗菌药物为哌拉西林、四环素及磺胺甲噁唑/甲氧苄啶；对革兰阳性菌，前 3 种敏感抗菌药物分别为左氧氟沙星、亚胺培南和庆大霉素；前 3 位耐药的抗菌药物为青霉素/氨苄西林舒巴坦（并列）、环丙沙星及四环素/阿莫西林/氨苄西林（并列）。 结论 肛周脓肿的病原菌以大肠埃希菌为主，且产 ESBLs 细菌主要为大肠埃希菌。