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題名 | 以即時瘻管切開術治療急性肛門直腸膿瘍 |
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作 者 | 劉漢邦; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 21:5 1988.09[民77.09] |
頁次 | 頁533-539 |
分類號 | 416.245 |
關鍵詞 | 即時瘻管切開術; 急性肛門直腸膿瘍; |
語文 | 中文(Chinese) |
中文摘要 | 急性肛門直腸膿瘍多數起因於肛門隱窩腺體感染,其治療一般習慣採用分期療法,先作切開引流,俟形成慢性瘻管後,再作根治性的瘻管切開或切除術。但有部分人則在切問引流的同時,嘗試找出病源腺體予以切除,即所謂瘻管即時切開術,企圖一次手術即達成根治的目標。1983年1月至1986年6月,三年半間共有84例由肛門腺體感染引起之初次發作的急性肛門直腸膿瘍患者在台中榮總住院治療。在盡可能作即時瘻管切開術的原則下,65例接受即時瘻管切開術,19例接受切開引流,結果前者五例發生瘻管,後者七例發生瘻管。12例發生瘻管者中,九例為坐骨直腸窩膿瘍,顯示坐骨直腸窩膿瘍不易以即時瘻管切開術達成一次手術即根治的目的。但佔肛門直腸膿瘍絕大多數的括約肌間及肛門周圍膿瘍以即時瘻管切開術治療,66例中只有三例發生瘻管,確有令人鼓舞的結果。除縮短病程之外,復可避免第二次手術,實為值得推廣的作法。 |
英文摘要 | Most anorectal abscesses originate from a cryptoglandular infection and are usually treated initially by incision and drainage. However, a fistula operation may be performed if a fistula develops weeks or months later. Several published papers from various Hospital have also pointed out that this disease entity can be successfully treated by a one-stage operation-primary fistulotomy. From January 1983 to June 1986, 84 cases with initial attacks of acute cryptoglandular anorectal abscesses were hospitalized and treated in the V. G. H. Taichung. Among them, there were 21 cases of the intersphincteric type, 45 of the perianal type, 15 of the ischiorectal type and three cases involving the supralevator space. In order to determine the source of infection, careful examination was carried out in the operating room under adequate anesthesia. A definite or at least a highly suspected offending crypt was found in 65 cases, all of whom were treated by primary fistulotomy. The remaining 19 cases whose offending crypts were undetectable, were treated by incision and drainage. Of the 65 cases treated with primary fistulotomy, five cases developed recurrent abscesses or fistulae. In the incision and drainage group, seven cases developed recurrences. Among the twelve cases of recurrence, nine were of the ischiorectal type. The authors proposed that acute anorectal abscess of the ischiorectal type was rarely cured by the one-stage primary fistulotomy operation. However, for the majority of perianal and intersphincteric abscesses, primary fistulotomy should be the first choice of management. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。