作　　者： (曹林峰）; (潘友珍）; (常忠生）; (石伟）; (陈步强）; (王恒）; (梁兴旺）;

机构地区： 上海中医药大学附属第七人民医院肛肠科,上海200137

出　　处： 《医学综述》 2017年第17期3533-3536,共4页

摘　　要： 目的观察所罗门定律在肛周脓肿一次性根治术中的应用疗效。方法收集2014年2月至2016年12月上海中医药大学附属第七人民医院收治的287例肛周脓肿患者的临床资料,观察患者治愈率、复发率以及形成肛瘘率情况。患者采用局部麻醉或蛛网膜下腔阻滞麻醉,根据治疗肛瘘的所罗门定律(将肛门两侧的坐骨结节画一横线,称肛门横线。当瘘管外口在横线之前距肛缘4 cm以内,内口在齿状线处与外口相对,其管道多为直形;如外口在距肛缘4 cm以外,或外口在横线以后,内口多在后正中齿线处,其瘘管多为曲形或马蹄形)。寻找内口,单纯低位脓肿予切开内口及脓腔进行根治,高位或马蹄型脓肿切开内口后放置引流管或开窗用橡皮筋浮线引流,进行一次性根治术。结果 287例患者中284例患者治愈出院,治愈率为98.95%;术后有1例伴有强直性脊柱炎患者迁延不愈形成肛瘘,1例深部脓肿患者因换药不及时发生假性愈合,均经二次手术治愈,其余患者一次性治愈,且未发生肛门失禁等并发症。结论基于治疗肛瘘的所罗门定律理论,进行肛周脓肿一次性根治术大大提高了治愈率,并减少了复发,避免了二次手术,减轻了患者的痛苦。 Objective To observe the efficacy of Solomon＇s law in the treatment of perianal abscess. Methods A total of 287 hospitalized patients with perianal abscess were enrolled in the Seventh People＇s Hospital of Shanghai University of Traditional Chinese Medicine from Feb. 2014 to Dec. 2016 ,and the patient＇s cure rate ,recurrence rate,and the formation of anal fistula rate were observed. All of them were treated with local anesthesia or subarachnoid anesthesia. According to Solomon＇s law for treatment of anal fistula （ a horizontal line between the ischial tubercle of both sides of the anuswas drawn, called the anus horizontal line. When the fistula＇s external orifice was in front of the horizontal line within 4 cm away from the anal margin, the internal orifice in the dentate line was opposite to the external orifice, the channel is mostly straight;if the external orifice was 〉 4 cm from the anal margin, or the external orifice was outside the horizontal line, the internal oririce was mostly in the posterior median of the dentate line, the fistula was mostly curved or horseshoe-shaped）. After finding the internal orifice, simple low abscess was radically treated by cutting the internal orifice and abscess cavity, and for high or horseshoe-shaped abscess, after cutting the internal orifice, a drainage tube should be placed or a rubber band should be placed for drainage, as a radical surgery. Results Among 287 patients,284 were cured and the cure rate was 98.95% ;one patient with ankylosing spondylitis developed fistula, one patient with deep abscess due to improper wound dressing developed, re-snrgery were performed, and the remaining patients were cured once, and there were no complications such as anal incontinence. Conclusion Based on the theory of Solomon＇s law of anal fistula,radical surgery of perianal abscess greatly improves the cure rate and reduces the recurrence, avoids the re-surgery and relieves the pain of the patients.

关 键 词： 肛周脓肿 所罗门定律 根治术 切开引流术