经括约肌间双塞顿(TRISDS)治疗肛周脓肿的随机对照试验。

IF 4.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Gastroenterology Report Pub Date : 2025-09-30 eCollection Date: 2025-01-01 DOI:10.1093/gastro/goaf091
Leichang Zhang, Pan Shen, Xiao Yuan, Guanghua Chen, Wei Ge, Wu Liao, Xiaonan Zhang, Chen Wang, Lu Li
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引用次数: 0

摘要

背景:肛门周围脓肿的切开引流术与高瘘管形成率相关。我们的研究旨在评估一种新技术的有效性,即跨括约肌间双缝扎术(TRISDS),与I&D相比,该技术旨在保持肛门括约肌完整性并改善临床结果。方法:这项前瞻性、随机、非盲对照研究纳入了肛周脓肿位于肛提肌下方并有内部开口的成年患者。患者被随机分配到TRISDS组(n = 55)或I&D组(n = 51)。TRISDS技术涉及两个切口:括约肌间切口和引流切口,并放置两个松散的缝线。一套定位于保护肛门内括约肌,方便通过括约肌间隙引流,另一套定位于保护肛门外括约肌,确保全面引流。I&D组在不损伤肛门括约肌复合体的情况下进行常规I&D。主要观察指标为肛周脓肿治愈率,定义为伤口上皮化完全,术后12个月内无瘘或渗出,无复发。结果:TRISDS组的治愈率为78.2%(43/55),显著高于I&D组的41.2% (21/51)(P < 0.05)。结论:本研究强调了TRISDS在不影响肛门功能的情况下提高治愈率的有效性。TRISDS技术是治疗肛周脓肿的一种很有前途的方法。建议进一步的多中心研究来验证这些发现,并扩大TRISDS在不同患者群体中的应用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A randomized controlled trial of trans-intersphincteric double seton (TRISDS) for the treatment of perianal abscess.

Background: Incision and drainage (I&D) for perianal abscesses is associated with high rates of fistula formation. Our study aimed to evaluate the effectiveness of a novel technique, trans-intersphincteric double seton (TRISDS), designed to preserve anal sphincter integrity and improve clinical outcomes compared to I&D.

Methods: This prospective, randomized, non-blinded controlled study included adult patients with perianal abscesses located below the levator ani muscle with an internal opening. Patients were randomly assigned to either the TRISDS group (n = 55) or the I&D group (n = 51). The TRISDS technique involved two incisions: intersphincteric and drainage incisions with the placement of two loose setons. One seton was positioned to preserve the internal anal sphincter and facilitate drainage through the intersphincteric space, while the other seton aimed to protect the external anal sphincter to ensure comprehensive drainage. The I&D group underwent conventional I&D without damaging the anal sphincter complex. The primary outcome was the cure rate of perianal abscesses, which was defined as complete epithelialization of wounds without fistula or exudate and no recurrence within 12 months after surgery.

Results: The TRISDS group achieved a significantly higher cure rate of 78.2% (43/55) compared to 41.2% (21/51) in the I&D group (P < 0.05). There were no significant differences in anal function at 2 months postoperatively between the groups (median Wexner score, IQR: 1.0 [0.0-1.0] vs 1.0 [0.0-1.0], P > 0.05).

Conclusions: The study highlighted the effectiveness of TRISDS in improving cure rate without compromising anal function. The TRISDS technique represents a promising strategy for the treatment of perianal abscesses. Further multicenter studies are recommended to validate these findings and expand the application of TRISDS in diverse patient populations.

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来源期刊
Gastroenterology Report
Gastroenterology Report Medicine-Gastroenterology
CiteScore
4.60
自引率
2.80%
发文量
63
审稿时长
8 weeks
期刊介绍: Gastroenterology Report is an international fully open access (OA) online only journal, covering all areas related to gastrointestinal sciences, including studies of the alimentary tract, liver, biliary, pancreas, enteral nutrition and related fields. The journal aims to publish high quality research articles on both basic and clinical gastroenterology, authoritative reviews that bring together new advances in the field, as well as commentaries and highlight pieces that provide expert analysis of topical issues.
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