The Applied Study On Three Cavity Clearance (TCC) Treatment Of Perianal Abscess

Background:Perianal abscess is an infection disease, and research in the literature reported that anal gland infections accounted for about 95%, which developing and spreading along the perianal gap. Therefore, making sure a clear position of abscess and completing drainage become the key to treatment. But through drainage, there are still about 7% to 66% in patients[1] may occur with anal fistula; in order to reduce the rates of fistula formation, some scholars use a cutting or cutting seton to suspected fistula while draining, which called the "radical surgery". Incontinence and anus defects are more likely taking place; and still part of the patients after draining won’t become fistula. so for, all patients undergoing sphincter cutting is lack of theoretical basis. In order to protect the high perianal abscess drainage and anal function to achieve better level. According to the pathophysiology and development of perianal abscess, we have desinged a three cavity clearance(TCC) which draining submucosal gap, intersphincteric gap and outside gap of external sphincter at the same time, in order to achieve maximum protection to improve the quality of life in patients with anal function and form.Objectives:Traditional surgery of perianal abscess is bound to cause injury, may cause different degrees of anal incoutinence, affect the quality of life of patients. This topic based on pathophysiology and pathogenesis in western and Chinese medicine, proposes a three cavity clearance, with full drainage of potential infection gap and sphincter preservation, to reduce the anus injury,recrudescence, and fistula formation and so on, improve patient quality of life.Methods:Through the two aspects of retrospective and prospective study, discussing TCC in treatment of perianal abscess the value. A retrospective study of patients with perianal abcess in the the 3rd affiliated Hospital of Nanjing University of Traditional Chinese Medicine from July 2013 to March 2015 were carried out.Clinical data of 25 patients undered TCC were analyzed.At the same time,25 patients with the same gender,age and location of abcess undered Drainage alone and Drainage with cutting seton were analyzed.Rates of fistula formation, faecal incontinence (Wexner score),pain (VAS score)and wound healing were assessed. In prospective study,choose 59 with perianal abcess, on the basis of the patient’s wishes and condition, divided into TCC group with 18 cases and control group with 41 cases, which divided again into the group of Drainage alone with 21 cases and Drainage with cutting seton with 20 cases according to the complexity of abscesses and sphincter. Total efficacy of three groups of cases, pain index, voiding in the day of surgery, postoperative infections, wound healing, rates of fistula formation, anus defect, anus function evaluation index and so on were assessed.Result:In the retrospective study, rates of fistula formation:12/25(48%) in the group of Drainage alone,3/25 (12%) in the group of Drainage with cutting seton,3/25 (12%) in the group of TCC.There was no patient with faecal incontinence in the group of Drainage alone or in the group of TCC,but 2/25 (8%) with faecal incontinence to flatus and soiling in the group of Drainage with cutting seton.There were no statistically different (P> 0.05) in pain at first defecation between the three groups,while obvious pain occured after 1 week in the group of Drainage with cutting seton(P<0.01).In the prospective study,rates of fistula formation:6/21(28.57%) in the group of Drainage alone,1/20 (5.00%) in the group of Drainage with cutting seton,3/18 (16.67%) in the group of TCC.There was no patient with faecal incontinence in the group of Drainage with cutting seton or in the group of TCC,but 2/21 (9.52%) with faecal incontinence to flatus and soiling in the group of Drainage alone. Only pain in the day of surgery has statistically different between the group of Drainage alone and the group of TCC (P>0.05). There are no statistically different in others.Conclusion:Three Cavity Clearance (TCC) is a safe and effective sphincter-preserve procedure for perianal abcess.