中西医结合治疗肛周脓肿140例.docVIP

中西医结合治疗肛周脓肿140例【摘要】:目的:观察中西医结合治疗肛管直肠周围脓肿的临床疗效。方法:以一期切开引流根治手术治疗为主,术后口服以五味消毒饮为基本方的中药为辅。结果:该病140例,一期痊愈132例,占94.3%;行二次手术8例,仅占5.7%。结论:采用中西医结合治疗方法,不仅明显缩短了治疗时间,而且避免了病人多次手术的痛苦,减少了复发的可能性,节约了医疗成本,提高了住院期间的效费比,值得临床推广、应用。 【关键词】:中西医结合疗法;肛周脓肿 【中图分类号】R2-031【文献标识码】A【文章编号】1007-8517(2010)08-116-1 TCM Treatment of 140 cases of perianal abscess Yan Bin Sichuan Chinese Medicine Hospital in Guangyuan City,Sichuan Guangyuan 628,000 [Abstract]: Objective To observe the combined Chinese and Western medicine treatment of perianal abscess in clinical efficacy. Way to a radical surgical incision and drainage mainly to Qingrejiedu Tang after oral administration of the basic side,supplemented by traditional Chinese medicine. The results of 140 cases of the disease,a cure rate of 94.3%, line second surgery patients accounted for only 5.7%. Conclusions The combination of Chinese and Western medicine treatment methods,not only significantly reduced the treatment time and avoid the pain of patients with multiple operations,reducing the possibility of recurrence,saving the health care costs,improve the hospital’s cost-effective,worthy to be popularized and applied. [Keywords]: TCM-WM therapy ;perianal abscess 1资料与方法 1.1一般资料:本组共140例,男107例,女33例;其中,肛门直肠周围脓肿137例,直肠壁脓肿3例,直肠尿生殖隔间脓肿2例;继发高位复杂肛瘘86例,低位肛瘘41例;年龄最小30天,最大76岁。 1.2手术方法: 1.2.1病例选择:本组病例均为急性感染性脓肿。 1.2.2术前准备:手术当天适度进食少渣软食,备皮,术前2小时清洁灌肠,至排泄物无粪渣为止。 1.2.3麻醉方式:成年人采用腰俞麻醉,必要时加局麻;婴幼儿采用氯胺酮麻醉。 1.2.4手术:病人在腰俞麻醉下取左侧或右侧卧位,用碘伏和0.1%新洁尔灭局部常规消毒,铺无菌巾。首先,采用视、触、牵拉、注射器抽吸等方法,确定脓肿的大小、范围、深浅,然后在适当的部位(脓肿的中央、肿块突出明显的部位、脓肿已经破溃处)做放射状切口,排除所有脓性和血性分泌液,用食指或组织钳彻底清除腔内纤维纵膈和腐烂组织;其次,用探针沿脓腔走向由浅入深、渐次探查与肠壁相通的内口。肛管直肠环以下的内口,直接“V”字型放射状切开引流;肛管直肠环以上的内口,采用低位放射状切开、高位橡皮筋挂线;对于波及多个间隙的脓肿,采用低切高挂对口引流的手术方法;直肠壁脓肿直接切开引流;直肠尿生殖隔间脓肿,采用经肛周皮下沿会阴浅、深筋膜层锐、钝性交替分离组织行低位切开、高位旷置引流术。 1.2.5术后处理及换药方法:(1)术后长效止痛液封闭各切口;必要时口服止痛剂。(2)术后进少渣软食,控制大便2-3天。(3)口服中药清热解毒、健脾除湿、化腐排脓生肌。药物组成:金银花18g黄柏18g丹皮15g茯苓30g野菊花18g蒲公英30g紫花地丁18g败酱草18g半枝莲18g山药24g薏苡仁30g苍术15g栀子15g甘草9g。或静滴氨苄青霉素、替硝唑、甲硝唑等抗生素抗炎、预防感染。(4)便后加减