The Clinical Research Of Treatment Of Pelvirectal Abscess By Using Seton Technology Inside Rectum

ObjectTo search an operation method for treating pelvirectal abscess by minimally invasive way.Discussing clinical safety and efficacy of seton technology inside rectum and assessing its advantage in protecting the anal function、keeping a complete form of anus and so on,which compares to the incision and drainage by cutting setion.MethodBy use a prospective randomized controlled trial,40cases of patients were selected from the department of Colorectal Surgery in Guang’anmen Hospital of China Academy of Chinese Medical Science from January2011to December2012.Divide all the patients into the control group and the treatment group randomly, the former was treated with seton technology inside rectum,and the latter with incision and drainage by cutting setion,each had20patients.To compare the differences between two groups in the function of anus which including three aspects:digital examination by doctor、subject feeling in patient、anorectal manometry,and a complete form of anus, as well as the total effect、the overall recurrence rate、time of operation、 postoperation pain、the length of hospital stay,the results of follow up for6months to observe whether the anus has damp、defect、deformation、stenosis、part of incontinence or become into anal fistula.All the results adopt SPSS20.0for statistical analysis, bilateral test. In the therapeutic process of two groups,all the measurement datas used mean±standard deviation to statistical description while enumeration datas used constituent ratio.If the measurement data obey the normal distribution and variance together,by use two sample mean t-test.The comparison of two sample rate use PearsonX2-test,enumeration data use Fisher’s exact probability method or continuity correction X2-test or nonparametric rank and inspection. All the results are listed the exact P values,with P<0.05has the difference in statistically.Result1.The difference of digital examination result of postoperation between two groups (the anus of function normally;the anus of functional impairment;the anus has contraction reaction;the anus has no contraction reaction) was statistically significant(P=0.04<0.05). Subject feeling in patient after postoperation about the first week、the second and the third are respectly as follows(normally;incomplete incontinence;completely incontinence): P1=0.04<0.05,P2=0.000<0.05,P3=0.002<0.05;which has the difference in statistically. The result of anorectal manometry is:both the pre-operation anal resting pressure (P1=0.11>0.05)and anal squeeze pressure(P2=0.15>0.05) have no difference in statistically of two groups,while anal resting pressure(P3=0.004<0.05) and anal squeeze pressure (P4=0.000<0.05) after recovery have the difference in statistically. Estimate the result from three aspects that are digital examination、subject feeling in patient and anorectal manometry, the treatment group has the advantage over the contral group in protecting anal function.Through six months of follow-up after recovery,both two groups have no completely incontinence、anal stenosis and become into anal fistula,but in the anal damp、defect and deformation,that has the difference in statistically (P<0.05),while the incomplete incontinence has no difference in statistically (P>0.05). The result reflect that the treatment group has the advantage over the contral group in keeping a complete form of anus and reduce sequelae.2.The total effect(P=0.53>0.05) between two groups has no difference in statistically,which means the two groups have the same therapeutic effect.As to the overall recurrence rate (X2=4.80>3.84, P<0.05) has difference in statistically,that means the treatment grou has higher recurrence rate than the control group.The average operative time of treatment group is34.50±6.67minutes,while the control group is43.00±9.52minutes,whose result has no difference in statistically (P=0.002<0.05) by two sample mean t-test,that means the operation time of treatment group is shorter than the control group.As to the comparison of anus pain in post operation:the first day(P1=0.025<0.05). the seventh day (P2=0.011<0.05)and the fourteenth day(P3=0.044<0.05)after operation,whose differences have significant in statistically. But the twenty-first day(P4=0.298>0.05) has no differences in statistically, which means anus pain about the treatment group is less than the control group in most time after operation.The length of hospital stay of two groups is respectively as follows:the treatment group is23.75±4.90days and the control group is31.35±4.18days, which by t-test has differences in statistically (p=0.000<0.05),that means the treatment group has the hospital stays shorter than the control group.ConclusionSeton technology inside rectum is safe and effective in treating pelvirectal abscess. Compared to the incision and drainage by cutting setion,which has the obvious advantage in protecting the anal function and keeping a complete form of anus. It also largely reduce the sequel,such as the damp of anus、incomplete incontinence of anus and so on.The operation has three characteristics as follows:easy and simple to handle、patients with less pain、the soon recovery of postoperation, which conform to the modern concept of minimally invasive surgery.