肛瘘MRI术前诊断价值与术中结果对照分析

【摘要】〓目的〓探讨术前磁共振(MRI)检查对肛瘘的定位、分型的临床指导意义。方法〓50例肛瘘患者行MRI检查,根据MRI所见,定位瘘道位置,依据窦道与肛门内外括约肌关系进行分型,并与术中所见结果相对照。结果〓手术证实50例患者中,30例为单纯性肛瘘,20例为复杂性肛瘘。括约肌间型20例,经括约肌型12例,括约肌上型6例,括约肌外型3例,表浅型9例。原发性瘘管72个,内口78个,外口77个,肛周脓肿17个。MRI诊断原发瘘管、内口、肛周脓肿的灵敏度分别为93.1%、96.2%、100%,特异度分别为91.5%、97.5%、91.3%。结论〓MRI可准确地判断肛瘘的分型、瘘管数量、走行、支管、内口的位置及有无肛周脓肿形成,为临床手术治疗提供重要指导信息。     

改良经括约肌间瘘管结扎术治疗括约肌间型及经括约肌型肛瘘的临床效果研究

目的：观察改良经括约肌瘘管结扎术（MLIFT）治疗括约肌间型肛瘘（ISAF）及经括约肌型肛瘘（TSAF）的疗效。方法：选取2016年1月1日—2020年12月31日上海市宝山区中西医结合医院肛肠科收治的190例TSAF和ISAF患者,随机分为治疗组（行MLIFT术）、对照组（行肛瘘切开挂线术）,术后常规清创、换药治疗;比较两组术后第1、3、7、14、21、30天的创面疼痛(VAS)、创面出血、肛门坠胀感、尿潴留及肛门控便能力(FISI)评分,比较两组治愈率及复发率情况,比较两组患者术前及术后1年的肛管静息压、肛管收缩压及肛管排便压的差异。结果：治疗组、对照组治愈率分别为87.37%、94.75%,差异无统计学意义(P>0.05);治疗组、对照组复发率分别为7.37%、2.11%,差异无统计学意义(P>0.05);术后第1、3、7天,治疗组VAS评分、创面出血和术后第14天创面出血评分均高于对照组(P <0.01);术后第1、7天,治疗组患者肛门坠胀评分和术后第1天尿潴留评分明显低于对照组(P <0.01);术后1年,治疗组患者肛管收缩压及肛管排便压明显高于对照组...     

Mucinous carcinoma of the anal canal arising from perianal fistula

Background

Anal carcinomas account for 1.5% of all gastrointestinal carcinomas. They may occur in the anal canal, perianal region (up to 5 cm) and surrounding skin. Squamous cell carcinoma (SCC) is the most frequent type (80%), while adenocarcinoma of the anal canal (ACC) accounts for 10% of all anal carcinomas. The remaining 5% includes neuroendocrine neoplasms, mesenchymal tumours, lymphomas, melanocyte tumours and secondary tumours. ACCs arise from chronic fistula or anal glands and they are very rare.

Methods

We report one case of rare adenocarcinoma that originated from perianal fistula. There is not definitive strategy about cure.

Conclusion

Inflammatory perianal tumour often causes late diagnosis or misdiagnosis of ACC, which is due to frequent perianal abscesses at the external perianal fistula opening. The presence of mucin may increase the index of suspicion for malignancy.

     

部分瘘管切开肛瘘栓填塞治疗括约肌上型肛瘘

目的探讨部分瘘管切开肛瘘栓填塞在括约肌上型肛瘘手术中的应用。方法对5例患者切开括约肌外侧瘘管,保留穿过括约肌的部分瘘管,清除瘘管内坏死组织,切除内口处黏膜组织,将肛瘘栓修剪后由内口拉入瘘管,近端用2-0可吸收线缝合,固定于内括约肌并用黏膜覆盖,远端缝合固定于外括约肌。结果 5例全部治愈,术后无肛瘘栓脱落,无伤口感染,肛门功能良好,随访3个月,无复发。结论部分瘘管切开肛瘘栓填塞治疗括约肌上型肛瘘对肛门括约肌无损伤,可避免脓腔残留,有助于提高手术成功率。     

Gastrosplenic fistula: etiologies, diagnostic studies, and surgical management

A gastrosplenic fistula is a rare event. Reported causes include a spontaneous malignant fistula, chemotherapy for gastric or splenic malignancies, peptic ulcer disease, Crohn disease, and trauma. We report a case of a gastrosplenic fistula discovered on abdominal computed tomography with contrast, performed in a patient with a history suspicious for malignancy. In this case, no etiology was identified prior to the surgical repair of the lesion despite extensive workup. Due to continued gastrointestinal blood loss requiring multiple transfusions, the patient was taken to surgery for splenectomy and partial gastrectomy. It was at that time that the diagnosis of a large B-cell lymphoma was made. Postoperative chemotherapy was initiated and led to remission of the malignancy. Though most cases require definitive surgical repair, the treatment plans for gastrosplenic fistulas depend largely on the etiology of the lesion.     

Significant presence of biofilm‐producing gut‐derived bacteria in anal fistula of chronic duration

Fistula‐in‐ano though not a life‐threatening condition, yet its symptoms often significantly impact patients'' social, intimate, and work lives. There is an established role of bacterial microflora in acute infections. However, we proposed that biofilm‐forming organisms might be present in the microflora of anal fistula of prolonged duration. This aspect has rarely been studied earlier. Therefore, the study describes the microbiology of anal fistula and the biofilm‐forming capacity of the isolated organisms. A total of 30 patients were included in the study as per the criteria. Anal fistula tissue sample, tissue fluid, and blood samples were collected from each individual. The collected specimens were detected for the presence of aerobic and anaerobic microflora through standard microbiological method and polymerase chain reaction. Furthermore, the role of biofilm formation by microtitre plate assay and serum matrix metalloproteinases‐9 was also studied. The result showed significant predominance of gut‐derived microflora with high‐to‐moderate biofilm‐producing ability in anal fistulas of prolonged duration. The study emphasises the presence of biofilm‐forming bacteria in chronic, non‐healing fistula.     

慢性肛瘘癌变：附6例临床分析

目的：了解慢性肛瘘癌变的临床病理特征。方法：回顾性总结1996—2005年收治的6例由慢性肛瘘演变而来的肛管癌的临床和病理资料。结果：男5例，女1 例;中位年龄55岁。有慢性肛瘘病史15～30年;反复发作的慢性炎症刺激为肛瘘癌变的主要诱因。肿瘤确诊依靠瘘管及周围肿块的病理学活检。其中3例伴有腹股沟淋巴结转移。所有患者均行腹会阴联合根治术, 3例同时行腹股沟淋巴结清扫, 术后均辅以化疗。3例患者生存期在5 年以上，1例已存活3年，1例存活1年， 1例手术1年后死于肺转移。结论：肛瘘继发癌变,病程发展慢,恶性程度相对较低,但易被漏诊。治疗应采用以腹会阴根治性切除术为主的综合治疗。     

肛瘘治疗的回顾和思考

肛瘘是一个＂恼人＂的病,对患者是难忍之疾、难言之痛,直接导致患者的生活质量下降.在临床上,复杂性肛瘘的治疗一直是一个严峻的挑战.一方面,如何提高肛瘘治疗成功率、减少复发和避免肛门功能损伤,令医生进退维谷;另一方面,＂百花齐放＂（西医外科疗法、传统医学疗法和新出现的生物治疗方法）的治疗方法在临床上的交织和互补,令人眼花缭乱.但是,从结果看,肛瘘的治疗效果还远不能令医生和患者满意,还需要更多地进行探索.     

慢性肛瘘演变的粘液腺癌四例临床分析

目的 了解慢性肛瘘演变为粘液腺癌的生物学特征,探讨其诊断和治疗。方法 回顾性总结１９８６～１９９７年我院收治的肛门直肠恶性肿瘤中,４例由慢性肛瘘演变而来的肛门粘液腺癌的临床和病理资料。结果 本组患者男３例,女１例,平均年龄５０岁。有长期肛周脓肿或肛瘘病史;肛瘘及其相关的肛腺是这种罕见肿瘤的原发部位,反复发作的慢性炎症刺激和瘢痕组织变异为诱发肛瘘癌变的主要原因。肿瘤确诊依靠瘘管及相关肿物的病理学活检。本组２例腹股沟淋巴结有转移。３例行Ｍｉｌｅｓ根治术的患者中,２例同时行腹股沟淋巴结清扫,并辅以化疗,生存期在５年以上;１例未行根治手术仅单纯化学药物治疗者３个月后死亡。结论 继发于肛瘘的粘液腺癌,与原发性肛管直肠粘液腺癌相比?病程发展慢,恶性程度相对较低,预后较好。