Two cases of complicated perianal abscess with systemic lupus erythematosus and literature review
-
摘要: 肛周脓肿并发系统性红斑狼疮的患者病情复杂，其脓肿范围大，易感染、易复发。本文回顾分析了2例伴有系统性红斑狼疮肛周脓肿患者的诊治过程，总结了手术方法、感染的预防和控制、术后换药及护理、营养调节、激素用药等方面的经验，并复习相关文献。Abstract: Patients with perianal abscess complicated by systemic lupus erythematosus have complex conditions, with a wide range of abscesses that are prone to infection and recurrence. This article reviews and analyzes the diagnosis and treatment process of two patients with perianal abscess and systemic lupus erythematosus, summarizes the experience in surgical methods, infection prevention and control, postoperative dressing and care, nutritional regulation, steroid treatment, and other aspects, and reviews relevant literature.
-
图 1 病例1于2016年5月CT检查
注：A为骶尾骨前方、直肠周围见不规则片状低密度；B为左侧股骨中上段内后方肌间见团块状密度稍低影。
Figure 1. Case 1 underwent a CT examination in May 2016
图 2 病例1行乙状结肠双腔造口远端封闭术
Figure 2. Case 1 underwent a distal closure procedure of the double-lumen sigmoid colostomy
-
[1] 陈飞云, 张雷. 肛周脓肿和肛瘘的病因学探究[J]. 中国肛肠病杂志, 2020, 40(12): 74-75. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202012036.htmCHEN F Y, ZHANG L. To probe into the pathogenesis of perianal abscess and fistula in ano[J]. Chinese Journal of Coloproctology, 2020, 40(12): 74-75. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202012036.htm [2] 谢敏珠, 靳政玺, 胡伟新. 系统性红斑狼疮相关肠道损伤的研究进展[J]. 肾脏病与透析肾移植杂志, 2021, 30(5): 480-484. doi: 10.3969/j.issn.1006-298X.2021.05.017XIE M Z, JIN Z X, HU W X. Intestinal injury in systemic lupus erythematosus[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2021, 30(5): 480-484. doi: 10.3969/j.issn.1006-298X.2021.05.017 [3] 中华医学会风湿病学分会, 国家皮肤与免疫疾病临床医学研究中心, 中国系统性红斑狼疮研究协作组. 2020中国系统性红斑狼疮诊疗指南[J]. 中华内科杂志, 2020, 59(3): 172-185.Chinese Rheumatology Association, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Systemic Lupus Erythematosus Treatment and Research Group, et al. 2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus[J]. Chinese Journal of Internal Medicine, 2020, 59(3): 172-185. [4] 中国医师协会肛肠医师分会指南工作委员会. 肛周脓肿临床诊治中国专家共识[J]. 中华胃肠外科杂志, 2018, 21(4): 456-457.Guide Working Committee of Anorectal Doctor Branch of Chinese Medical Doctor Association. Chinese expert consensus on the clinical diagnosis and treatment of perianal abscess[J]. Chinese Journal of Gastrointestinal Surgery, 2018, 21(4): 456-457. [5] 郭其乐, 姚向阳, 王琛. 肛周脓肿的术式选择及相应术后处理方法研究进展[J]. 中医临床研究, 2021, 13(33): 129-132, 135. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202133040.htmGUO Q L, YAO X Y, WANG C. Research progress of surgical selection and postoperative management of perianal abscess[J]. Clinical Journal Of Chinese Medicine, 2021, 13(33): 129-132, 135. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202133040.htm [6] 唐枭, 李欣奕, 何涛宏, 等. 肛周脓肿及肛瘘合并糖尿病的诊断及治疗进展[J]. 实用医学杂志, 2022, 38(16): 2100-2105. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202216022.htmTANG X, LI X Y, HE T H, et al. Advances in diagnosis and treatment of perianal abscess and anal fistulacombined with diabetes mellitus[J]. The Journal of Practical Medicine, 2022, 38(16): 2100-2105. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202216022.htm [7] 张义, 蔡晓芸. 一次性肛周脓肿根治术对患者肛周疼痛及肛门功能的影响分析[J]. 中国急救医学, 2018, 38(z1): 243.ZHANG Y, CAO X Y. Analysis of the Effect of One-Time Radical Cure Surgery for Perianal Abscess on Perianal Pain and Anal Function of Patients[J]. Chinese Journal of Critical Care Medicine, 2018, 38(z1): 243. [8] 楼征, 张卫. 肠造口的规范化实施及造口旁疝的预防策略[J]. 中国实用外科杂志, 2022, 42(7): 734-736, 742. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202207003.htmLOU Z, ZHANG W. Standardized ostomy and preventive strategy of parastomal hernia[J]. Chinese Journal of Practical Surgery, 2022, 42(7): 734-736, 742. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202207003.htm [9] 阮子培, 张景利, 张晓敏. 系统性红斑狼疮与感染关系的研究进展[J]. 牡丹江医学院学报, 2021, 42(2): 122-125. https://www.cnki.com.cn/Article/CJFDTOTAL-MDJB202102031.htmRUAN Z P, ZHANG J L, ZHANG X M. Research Progress on the Relationship between Systemic Lupus Erythematosus and Infection[J]. Journal of Mudanjiang Medical University, 2021, 42(2): 122-125. https://www.cnki.com.cn/Article/CJFDTOTAL-MDJB202102031.htm [10] AMATO A, BOTTINI C, DE NARDI P, et al. Evaluation and management of perianal abscess and anal fistula: SICCR position statement[J]. Tech Coloproctol, 2020, 24(2): 127-143. doi: 10.1007/s10151-019-02144-1 [11] ZHAN Z P, LAO M X, SU F, et al. Hospital-acquired infection in patients with systemic lupus erythematosus: a case-control study in a southern Chinese population[J]. Clin Rheumatol, 2018, 37(3): 709-717. doi: 10.1007/s10067-017-3919-8 [12] 刘楚. 系统性红斑狼疮并发感染的临床研究[D]. 苏州: 苏州大学, 2019.LIU C. Clinical study on systemic lupus erythematosus complicated with infection[D]. Suzhou: Suzhou University, 2019. [13] 刘莹, 贺荔枝. 肛周脓肿患者病原菌感染特点及多重耐药性分析[J]. 实用临床医药杂志, 2022, 26(16): 18-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202216004.htmLIU Y, HE L Z. Analysis in characteristics of pathogen infection and multidrug resistance in patients with perianal abscess[J]. Journal of Clinical Medicine in Practice, 2022, 26(16): 18-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202216004.htm [14] 胡建生, 王雯, 孙林梅. 不同术式治疗肛周脓肿后肛瘘形成的影响因素分析[J]. 中国中西医结合外科杂志, 2023, 29(1): 24-28. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202301005.htmHU J S, WANG W, SUN L M. Analysis of influencing factors of anal fistula formation after perianal abscess operation with different operation methods[J]. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, 2023, 29(1): 24-28. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202301005.htm [15] 刁硕. 探讨系统性红斑狼疮患者发生医院感染的临床特点及危险因素[J]. 世界最新医学信息文摘, 2019, 19(68): 56-57. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201968038.htmDIAO S. Clinical characteristics and risk factors of hospital-acquired infections in patients with systemic lupus erythematosus[J]. World Latest Medicine Information, 2019, 19(68): 56-57. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201968038.htm [16] 胡霞, 安海燕, 陈彦, 等. 重症监护病房单间与非单间医院感染率研究[J]. 中华医院感染学杂志, 2020, 30(6): 935-939. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202006030.htmHU X, AN H Y, CHEN Y, et al. Study on incidence of nosocomial infection between single and non-single wards in ICU[J]. Chinese Journal of Nosocomiology, 2020, 30(6): 935-939. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202006030.htm [17] 闫晔岚, 姬永辉, 孙晓倩, 等. 呋喃西林联合制霉菌素交替漱口用于预防系统性红斑狼疮患者口腔及肺部感染的效果评价[J]. 医学理论与实践, 2022, 35(6): 1043-1045. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202206065.htmYAN Y L, JI Y H, SUN X Q, et al. Effect evaluation of alternating mouthwash of furacilin and nystatin for prevention of oral and pulmonary infections in patients with systemic lupus erythematosus[J]. The Journal of Medical Theory and Practice, 2022, 35(6): 1043-1045. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202206065.htm [18] 杜仲代, 蒋应祥, 徐利, 等. 肛周脓肿临床诊治经验交流[J]. 中国中西医结合外科杂志, 2020, 26(6): 1174-1176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202006035.htmDU Z D, JIANG Y X, XU L. Clinical diagnosis and treatment experience exchange for perianal abscess[J]. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, 2020, 26(6): 1174-1176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202006035.htm [19] 林潮炫, 刘毓, 张雄辉, 等. 创伤后伤口感染的病原学分析及中药熏洗治疗的效果观察[J]. 海南医学, 2019, 30(9): 1155-1157. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201909020.htmLIN C X, LIU Y, ZHANG X H, et al. Pathogenic analysis of wound infection after trauma and observation of the effect of traditional Chinese medicine fumigation and washing[J]. Hainan Medical Journal, 2019, 30(9): 1155-1157. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201909020.htm [20] 陈兴华, 孟凡宇, 张磊, 等. 补托坐浴方促进肛周脓肿术后创面愈合的临床研究[J]. 中国中医急症, 2020, 29(5): 813-816. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202005017.htmCHEN X H, MENG F Y, ZHANG L, et al. Clinical study on supplemental sitting bath decoction to promote wound healing after perianal abscess[J]. Journal of Emergency in Traditional Chinese Medicine, 2020, 29(5): 813-816. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202005017.htm [21] 张国兴. 基于"清托法"理论研究黄芨汤保留灌肠对肛周脓肿术后血清IL-1β、IL-6、TNF-α表达的相关性研究[D]. 福州: 福建中医药大学, 2022.ZHANG G X. Study on the correlation between the expression of serum IL-1β, IL-6, TNF-α and the retention enema of Huangji decoction based on the theory of "qingtuo" in the treatment of perianal abscess after operation[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2022. [22] 谢宛廷, 江琼, 樊文彬, 等. 肛周脓肿术后外治法研究进展[J]. 中国肛肠病杂志, 2022, 42(6): 66-68. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202309027.htmXIE W Y, JIANG Q, FAN W B, et al. Current external treating perianal abscess after surgery[J]. Chinese Journal of Coloproctology, 2022, 42(6): 66-68. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202309027.htm [23] 侯庆元. 中药灌肠结合负压封闭引流术治疗肛周深部脓肿的疗效[J]. 临床研究, 2020, 28(12): 136-137. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN202012070.htmHOU Q Y. Efficacy of traditional Chinese medicine enema combined with negative pressure drainage in the treatment of deep perianal abscess[J]. Clinical Research, 2020, 28(12): 136-137. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN202012070.htm [24] 郎二秀, 郭建桃, 杨敏. 直肠癌术后造瘘口的护理进展[J]. 世界最新医学信息文摘, 2018, 18(12): 30-31. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201812017.htmLANG E X, GUO J T, YANG M. Progress in nursing care of stoma after rectal cancer surgery[J]. World Latest Medicine Information, 2018, 18(12): 30-31. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201812017.htm [25] 刘全丽, 张婕, 张静, 等. 思维导图式健康教育对肠造口患者术后自我护理能力的影响[J]. 中华全科医学, 2022, 20(9): 1615-1619, 1630. doi: 10.16766/j.cnki.issn.1674-4152.002662LIU Q L, ZHANG J, ZHANG J, et al. The influence of mind mapping schema health education on postoperative self-care ability of patients with enterostomy[J]. Chinese Journal of General Practice, 2022, 20(9): 1615-1619, 1630. doi: 10.16766/j.cnki.issn.1674-4152.002662 [26] 郑丹, 李廷玉. 营养与系统性红斑狼疮的相关性研究进展[J]. 儿科药学杂志, 2021, 27(8): 54-58. https://www.cnki.com.cn/Article/CJFDTOTAL-EKYX202108017.htmZHENG D, LI T Y. Progress of Correlation between Nutrition and Systemic Lupus Erythematosus[J]. Journal of Pediatric Pharmacy, 2021, 27(8): 54-58. https://www.cnki.com.cn/Article/CJFDTOTAL-EKYX202108017.htm [27] ABAD T O, SARNI R O, DA SILVA S G, et al. Nutritional intervention in patients with juvenile systemic lupus erythematosus: protective effect against the increase in fat mass[J]. Rheumatol Int, 2018, 38(6): 985-992. [28] ANDERSE C J. Impact of dietary cholesterol on the pathophysiology of infectious and autoimmune disease[J]. Nutrients, 2018, 10(6): 764. [29] 王秀娇, 左晓霞, 谢晓韵, 等. 系统性红斑狼疮住院患者合并严重感染的危险因素[J]. 中南大学学报(医学版), 2021, 46(7): 704-710. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD202107006.htmWANG X J, ZUO X X, XIE X Y, et al. Risk factors for serious infections in inpatients with systemic lupus erythematosus[J]. Journal of Central South University : Medical Science, 2021, 46(7): 704-710. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD202107006.htm [30] 郭佳, 李祥, 张理涛. 系统性红斑狼疮的用药进展[J]. 中国中西医结合皮肤性病学杂志, 2021, 20(5): 525-528. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYD202105036.htmGUO J, LI X, ZHANG L T. Progress in the Treatment of Systemic Lupus Erythematosus[J]. Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine, 2021, 20(5): 525-528. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYD202105036.htm [31] 李子龙, 张芸娇. 系统性红斑狼疮的免疫学研究进展[J]. 中国当代医药, 2022, 29(21): 27-30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202221006.htmLI Z L, ZHANG Y J. Advances in immunological research of systemic lupus erythematosus[J]. China Modern Medicine, 2022, 29(21): 27-30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202221006.htm [32] 朱琪. 大剂量免疫球蛋白对系统性红斑狼疮患者的临床疗效及安全性探讨[J]. 基层医学论坛, 2020, 24(17): 2511-2512. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT202017100.htmZHU Q. The clinical efficacy and safety of high-dose immunoglobulin in patients with systemic lupus erythematosus[J]. The Medical Forum, 2020, 24(17): 2511-2512. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT202017100.htm [33] 陈希, 周春燕. 大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮的疗效[J]. 中国现代医生, 2020, 58(3): 130-132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202003035.htmCHEN X, ZHOU C Y. Therapeutic effect of large dose intravenous infusion of immunoglobulin on systemic lupus erythematosus[J]. China Modern Doctor, 2020, 58(3): 130-132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202003035.htm [34] 王雪, 曾佳, 贾雪松, 等. 人免疫球蛋白与糖皮质激素对系统性红斑狼疮患者炎性因子、免疫指标及生活质量的改善作用观察[J]. 中国处方药, 2023, 21(2): 123-125. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF202302036.htmWANG X, ZENG J, JIA X S, et al. Observation on the improvement of inflammatory factors, immune indicators, and quality of life in patients with systemic lupus erythematosus treated with human immunoglobulin and glucocorticoids[J]. Journal of China Prescription Drug, 2023, 21(2): 123-125. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF202302036.htm [35] 王彬彬, 赵志玲, 聂晓寒. 系统性红斑狼疮患者心理护理现状及研究进展[J]. 心理月刊, 2022, 17(21): 235-237. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202221071.htmWANG B B, ZHAO Z L, NIE X H. Current status and research progress of psychological nursing in patients with systemic lupus erythematosus[J]. Psychol Mon, 2022, 17(21): 235-237. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202221071.htm [36] 张梅, 朱勤, 王建凤. 系统性红斑狼疮使用精细化管理的护理进展分析[J]. 世界最新医学信息文摘, 2018, 18(13): 32-33. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201813016.htmZHANG M, ZHU Q, WANG J F. Analysis of the nursing progress of fine management in systemic lupus erythematosus[J]. World Latest Medicine Information, 2018, 18(13): 32-33. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201813016.htm -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 134
- HTML全文浏览量: 46
- PDF下载量: 10
- 被引次数: 0
