| Objective:Perianal abscess is a kind of acute suppurative infection in soft tissues around the rectum and anus and the surrounding clearance, it is one of the common and frequently-occurring diseases in anorectal surgery; according to the scope and depth of the pus cavity, those involved anal levator or above are clinically defined as high-position crissum abscesses, which are characterized by large range and deep invasion, and they are one of the severe and emergency cases in anorectum section. Timely treatment do not achieve often due to the inconspicuous disease symptoms such as local inflamed hot swelling is not obvious, abscess could spread to a wide range and the infection is very severe when the patient visit hospital, some even has the life-threatening septicopyemia and sepsis. Surgery operation has long been regarded as the most effective means of treatment for high perianal abscess, there are many clinical operation methods at present, each surgical has its advantages. But some problems are still faced such as wide surgical wound, seriously destroyed crissum anatomical structures, common postoperative symptoms like anal incontinence and anal malaise, slowly healing postoperative wound, long hospital stay, postoperative wound pain during treatment, tremendous physical and mental pain and economic burden. Therefore, we do our best effort to further perfect the operation method to improve patients postoperative wound healing, reduce the length of hospital stay and postoperative complications and reduce the pain, in the meantime guarantee cure rate. Vacuum sealing drainage(VSD) technology is an arisen new technology in recent years to promote the of wound repair, which is considered safe and reliable, and has been widely used in all sorts of traumatic wound treatment, andhas achieved good effect. We apply the VSD technique to the treatment of high-position crissum abscess, and observe the postoperative clinical curative effect through detecting the content of tumor necrosis factor-a(TNF-a) and epidermal growth factor(EGF) in postoperative wound and discuss the feasibility of VSD technique in high-position crissum abscess.Methods:40 cases of high-position crissum abscess who met the inclusion criteria were selected and were randomly divided into research group and the control group, each included 20 cases. The research group accepted the VSD technique treatment and control group adopted open hanging line drainage. The two groups were comparable in the general information(gender, age, type of abscess)(P > 0.05). The content of tumor necrosis factor-a(TNF-a) and epidermal growth factor(EGF) on the operative day and postoperative day 7 in the two groups were detected and the data obtained were analyzed, and the treatment conditions in the two groups in postoperative week 3,the pain degree from postoperative day 2 to day 7, ultimately healing time, postoperative 3, the anus incontinence score in post operative month 3 and month 6 and the outcome of postoperative half year were observed and recorded, therapeutic effect of the two groups was analyzed and compared.Results:1 The two groups’ postoperative serum content compare of tumor necrosis factor-a(TNF- a) and epidermal growth factor(EGF)Two groups’ serum TNF-a content comparison between groups on the day of surgery, the study group had average of 7.48 ± 0.27 ug/L, the control group has average 7.50 ± 0.24 ug/L, there was no statistically significant difference(P>0.05); After 7d inter-group comparing, ithadpost operative obviously decrease, the difference was statistically significant(P<0.05); After 7d comparison between groups, content ofserum TNF-a in the research group was 5.32 ± 0.19 ug/L, the control group average 6.56 ± 0.19 ug/L by t test, significantly lower than the control group, the difference was statistically significant(P<0.01).Serum EGF content of the two groups comparing on the day of surgery, the research team average of 0.69 ± 0.04 ug/L, the control group average 0.70 ± 0.04 ug/L, there was no statistically significant difference(P>0.05); After 7d comparison between groups again, the research group’s serum EGF content was 2.18 ± 0.04 ug/L, control group average 1.78 ± 0.08 ug/L by t test, the research group is significantly higher than the control group, the difference was statistically significant(P<0.01).Two groups on the day of surgery and postoperative 7d inter-group comparison, the content of serum TNF-a before and after difference value was 2.16 ± 0.40 ug/L, by the paired t test, the preoperative was significantly lower than the postoperative, the difference was statistically significant(P<0.01).Two groups’ on the day of surgery and postoperative 7d inter-group comparison, Serum EGF content before and after difference value was-1.48 ± 0.04 ug/L, by the paired t test, the postoperative was significantly higher than the preoperative, the difference was statistically significant(P<0.01).2 Two groups’ 4 weeks postoperative total effective rate compareThe study group in 4 weeks after surgery had the total effective rate of 100%, 15 cases were cured, 5 cases were markedly effective, 0 case not healed; The control group 4 weeks the total effective rate after surgery was 70.00%, 4 cases were cured, improvement in 10 cases, 6 cases were not cured; By Fisher’s exact probability method, P=0.020, the efficient rate postoperative one month between the two groups was statistically significant, the research treatment effect better than the control group.3 Two groups’ pain situation compare in postoperative 2-7 daysTake the two groups of patients with postoperative 2-7 days pain VAS mean score, the standard deviation, the research group average 3.61 ± 0.61 points; The control groupaverage 5.22 ± 0.57 points. Using t test, t=0.86, P<0.01, the compare was statistically significant, the pain group was significantly lower than the control group.4 Two groups’ postoperative 6 months Wexner anal incontinence scores compareThere were 3 cases of 1 point, and 1 case of 2 points in the research group; There were 4 cases of 1 point, 3 cases of 2 points, 3 cases of 3 points in the control group; Data was tested in median(Interquartile range), the research group score of 0(0,0), the control group score of 0.50(0,2.00), rank sum test Z=2.19, P=0.029, comparing with statistically significant, the anus incontinence of the research group was better than that of control group.5 The comparison of two groups’ ultimate healing timeTeam eventually healing time averaged 26.15 ± 5.26 days; The control group’s final healing time was 43.00 ± 9.82 days on average. Using t test, t=6.67, P<0.01, compared statistically significant, the research healing time needed significantly less than the control group.6 Postoperative six months inter-cavity B ultrasound recheck, record the recurrence rate of fistulaThere are 1 case of recurrence in the research group, the control group has 3 cases recurrence, 5 cases forming fistula. Two groups’ postoperative 6 months recurrence and fistulization rate comparison between groups, Fisher’s exact probability method is used, P=0.020, two groups’ postoperative 1 month recurrence rate was statistically significant different, the research group’s outcome is better than that of the control group.Conclusion:The VSD technique can significantly reduce patients’ postoperative serum TNF-a content, and can significantly increase serum EGF levels, it is beneficial topostoperative wound recovery, improve the efficient of operation, effectively relieve patients’ postoperative pain, effectively protect the anal function, reduce postoperative anal incontinence, it can accelerate the postoperative wound healing, shorten the duration of symptoms obviously, reduce the postoperative recurrence rate and fistulization rate, being safe and effective, which is worth promoting. |
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