朱 吉, 呂 川, 趙 輝, 王宇翀, 孫夢(mèng)妍, 武 鎧, 邢 新, 薛春雨

作者單位：200433 上海，上海長(zhǎng)海醫(yī)院 整形外科

巴氏腺膿腫造瘺術(shù)式的臨床觀察

朱 吉, 呂 川, 趙 輝, 王宇翀, 孫夢(mèng)妍, 武 鎧, 邢 新, 薛春雨

作者單位：200433 上海，上海長(zhǎng)海醫(yī)院 整形外科

目的 尋找一種治療巴氏腺膿腫的簡(jiǎn)單有效方法。方法 自2011年1月至2012年6月，我們對(duì)12例會(huì)陰部巴氏腺膿腫患者采用造瘺術(shù)進(jìn)行治療。局部麻醉下，于巴氏腺開口及其上方分別設(shè)計(jì)2個(gè)切口,排除腔內(nèi)膿液，橡膠半管貫穿兩切口留置腔內(nèi)，端端縫合成環(huán)狀。術(shù)后每天換藥至無膿性分泌物。結(jié)果 12例患者置管期間均無不適主訴。4周后無困難取出環(huán)狀導(dǎo)管，巴氏腺膿腫愈合，產(chǎn)生2個(gè)上皮化的竇道。隨訪2年以上，膿腫無復(fù)發(fā)。結(jié)論 造瘺術(shù)是治療巴氏腺膿腫的一種簡(jiǎn)單、安全、有效的方法，可作為巴氏腺膿腫的治療方法之一。

巴氏腺膿腫; 造瘺術(shù)； 會(huì)陰部

前庭大腺，又名巴氏腺，位于陰道口兩側(cè)。前庭大腺分腺體和導(dǎo)管兩部分，導(dǎo)管是1條長(zhǎng)約2.0 cm的細(xì)長(zhǎng)管道，專門輸送前庭大腺分泌的黏液，開口于小陰唇和處女膜之間的溝內(nèi)，前庭大腺所分泌的黏液性物質(zhì)經(jīng)該管道輸送到陰道口起潤(rùn)滑作用。巴氏腺平時(shí)不可觸及。如果前庭大腺管阻塞，分泌物積聚而成前庭大腺囊腫。一旦感染即形成膿腫。目前常規(guī)方法是切開引流或造口術(shù)[1-3]，但引流管易脫落，膿腫易復(fù)發(fā)[4], 造口術(shù)則易造成愈合緩慢、血腫和感染[5]。自2011年1月至2012年6月，我們對(duì)會(huì)陰部巴氏腺膿腫的患者采用造瘺術(shù)進(jìn)行治療，取得了滿意的效果。現(xiàn)報(bào)道如下。

1 臨床資料

本組患者共12例。均為女性；年齡28～38歲，平均31歲。病程4～10 d，膿腫長(zhǎng)軸為3.0～5.0 cm，均有會(huì)陰部疼痛、紅腫，伴行走不適?；颊呔鶡o會(huì)陰部手術(shù)史，無性傳播疾病及婦科疾病。

2 手術(shù)方法

患者取截石位，常規(guī)消毒鋪巾，2%利多卡因局部麻醉，于巴氏腺開口處作長(zhǎng)約0.5 cm切口，于該切口上方2.0～3.0 cm處另設(shè)計(jì)一長(zhǎng)約0.5 cm切口，切開皮膚后，以血管鉗鈍性分離至巴氏腺膿腔內(nèi)，排除膿液，以雙氧水和洗必泰反復(fù)沖洗。將常規(guī)直徑約6.0 mm醫(yī)用橡膠管沿縱軸剪開，得到約6.0 cm 長(zhǎng)半管,一端自一個(gè)切口置入，經(jīng)過殘腔由另一切口穿出，端端縫合成環(huán)狀。術(shù)后每天予雙氧水和洗必泰腔內(nèi)沖洗，直至無膿性分泌物，之后每周至門診復(fù)診換藥1次，要求患者在家中每次如廁之后以洗必泰清洗。

3 結(jié)果

12例患者置管期間均無不適主訴，無留置管脫落。4周后無困難取出環(huán)狀導(dǎo)管，巴氏腺膿腫愈合，產(chǎn)生2個(gè)上皮化的竇道(圖1)。隨訪2年以上，均無復(fù)發(fā)。

4 討論

約有2%的女性會(huì)發(fā)生巴氏腺囊腫，35～50歲的女性相對(duì)高發(fā)，膿腫的發(fā)生率則是囊腫的3倍[6-7], 有癥狀的巴氏腺導(dǎo)管囊腫和巴氏腺膿腫均需要治療[8]。目前巴氏腺膿腫的治療方法主要有切開引流術(shù)和造口術(shù)[4，9-10]，國(guó)外常采用Word導(dǎo)管留置造口[11-12]，以上方法存在一些缺點(diǎn)，如局部炎性腫脹致引流不暢，引流管易滑脫，切口易粘連閉合，術(shù)后易復(fù)發(fā)[13-14]。其他治療方法包括腔內(nèi)注射高滲乙醇、碘酊、硝酸銀棒、激光和微波破壞囊壁，這些方法則易造成前庭大腺功能破壞。

我們?cè)谇叭说幕A(chǔ)上加以改進(jìn)[15]，具有以下優(yōu)勢(shì)：⑴使用材料為醫(yī)用橡膠管，有彈性，質(zhì)較軟，長(zhǎng)期留置患者無明顯不適，不影響患者的日常生活；⑵環(huán)狀縫合，留置半管不易滑脫； ⑶較長(zhǎng)的留置時(shí)間足夠形成的管道上皮化，不易再次閉塞，降低復(fù)發(fā)率；⑷形成的2個(gè)管道將管道閉塞造成巴氏腺囊腫或膿腫的復(fù)發(fā)概率下降了50%；⑸保留腺體功能。為達(dá)到充分的效果，術(shù)中需要注意以下方面：⑴留置半管的大小約為醫(yī)用橡膠導(dǎo)管(管徑約6.0 mm)1/3周徑；本組中有1例曾留置頭皮針管，22個(gè)月后復(fù)發(fā)，我們分析是管道太細(xì)不利于竇道上皮化，竇道閉塞，膿腫復(fù)發(fā)；⑵2個(gè)切口必須明確與巴氏腺膿腔相通，避免2個(gè)切口在皮下形成無效通道。本術(shù)式取材方便，操作簡(jiǎn)單易行，值得推廣。

圖1 左側(cè)巴氏腺膿腫行造瘺術(shù)治療前后對(duì)比 a.術(shù)前 b.術(shù)后即刻,膿腔內(nèi)放置環(huán)狀引流 c.術(shù)后4周拔除引流管后即刻,可見2個(gè)竇道口

Fig 1 Comparison between preview and postview of left bartholin gland abscess treated with fistulation. a. preview b. postview at once with a loop of tubing placed in the cavity. c. postview with two sinus tracts after drainage removal at 4 weeks.

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Clinical observation of fistulation for Bartholin gland abscess

ZHUJi,LYUChuan,ZHAOHui,etal.

(DepartmentofPlasticSurgery,ChanghaiHospital,SecondMilitaryMedicalUniversity,Shanghai200433,China)

Objective To explore a simple and effective method of treatment of a Bartholin gland abscess. Methods Between January 2011 and June 2012, 12 patients with Bartholin gland abscess were treated with fistulation in our department. Their clinical materials and follow-up results were retrospectively analyzed. Under local anesthetic, two incisions were made respectively in the area of the duct orifice and a loop of tubing was placed, allowing for drainage of the abscess. The abscess cavity was sterilized every day until there was no purulent secretion produced. Results The 12 patients with were with no complaints during the tube replacement. The Bartholin gland abscess healed with two epithelialized sinus tracts after the device was removed smoothly at 4 weeks postoperatively. There were no recurrences of Bartholin gland abscess after over 2 years following up. Conclusion Fistulation is a simple and effective method to treat Bartholin gland abscess.

Bartholin gland abscess; Fistulation; Perineum

朱 吉(1979-)，女，江蘇人，主治醫(yī)師，博士.

薛春雨，200433，上海長(zhǎng)海醫(yī)院 整形外科，電子信箱：xcyfun@sina.com

10.3969/j.issn.1673-7040.2015.07.010

R711.3

A

1673-7040(2015)07-0412-03

2015-04-10)