肛门直肠周围脓肿的中医抗感染治疗

目的研究肛门直肠周围脓肿的中西医结合抗感染疗效。方法选取2014年3月~2015年9月我院收治的直肠周围脓肿患62例者作为研究对象,按照数字法分为对照组和干预组,各31例。对照组进行单纯的西医治疗,干预组进行中西医结合抗感染治疗,对比两组患者的疗效以及并发率。结果对照组患者治疗有效率为83.87%,干预组患者治疗有效率为96.77%,差异有统计学意义(P0.05)。对照组患者复发3例,复发率为9.68%,干预组复发1例,复发率为3.23%,差异有统计学意义(P0.05)。结论应用中西医结合抗感染治疗肛门直肠周围脓肿疾病具有较好的疗效,使患者的预后得到有效的改善,并使疾病的复发率有效降低,使患者的愈合时间得到有效的缩短,具有较高的临床价值。     

一期根治术治疗肛门直肠周围脓肿250例临床观察

肛门直肠周围脓肿分为两大类:一类与肛隐窝感染有关,称为原发性急性隐窝腺肌间瘘管性脓肿,简称瘘管性脓肿。一类与肛隐窝及感染无关,称为急性非隐窝非瘘管性脓肿,简称非瘘管性脓肿。据临床统计,97%肛门直肠周围脓肿属于瘘管性脓肿。所     

一期根治术治疗肛门直肠周围脓肿82例疗效观察

1997年4月～2006年5月，我们采用一期根治术治疗肛门直，周围脓肿82例，疗效满意。现报告如下。     

肛管直肠周围脓肿的手术治疗研究进展

肛管直肠周围脓肿为肛肠科常见病之一,手术仍然是治疗该病最有效的方式.手术方式大体经历了以下3个标志性阶段的演变,即从最初的单纯切开引流,待形成肛瘘后行二期手术,发展到一期根治术,再到以强调保护肛门功能为主的保留括约肌术式.随着这些术式在临床的推广运用,不仅使脓肿复发率和肛瘘发生率逐渐减少,还从很大程度上保护了肛门的精细功能及外观的完整性,大大减轻了患者痛苦并提高了生活质量.     

挂线疗法治疗肛管直肠周围脓肿的应用进展

肛管直肠周围脓肿为临床常见多发病,其治疗主要以手术为主,以往大多采用分期手术,即一期先切开引流,待形成肛瘘后再行二期手术,这种术式明显的缺点在于患者需承受两次手术之苦,经济负担也较重.20世纪50年代起,国内开始倡导肛管直肠周围脓肿的根治术式,引入了挂线疗法,其作用机理为:(1)慢性勒割作用;(2)异物刺激作用;(3)引流作用;(4)标志作用.挂线疗法治疗肛管直肠周围脓肿归纳起来可以分为挂实线、挂虚线及挂线配合其他疗法.应用挂线疗法的关键要点为:正确寻找和处理内口(感染的肛腺);掌握挂实线和挂虚线的应用指征;注意紧线的问题.至今,该疗法在临床运用已30余年,与传统的单纯切开引流术相比,不仅大大减少了后遗肛瘘的发生,还极大程度地保护了肛门功能.     

一次性手术治疗小儿肛门周围脓肿36例分析

目的 探讨一次性手术治疗小儿肛门周围脓肿的可行性和临床注意事项.方法 对36例小儿肛门周围脓肿行一次性手术治疗的临床资料进行回顾性分析.结果 全组患儿均经一次性手术治愈,随访无复发,无严重并发症发生.结论 一次性手术治疗小儿肛门周围脓肿疗效确切,术前诊断、术中处理及术后局部护理等方面应加强认识和积极处理,可减少复发机会和并发症的发生.     

9例直肠、肛门周围结核病延误诊断分析

目的为减少直肠、肛门周围结核病(本文主要指直肠、肛门周围脓肿和肛瘘)的延误诊断。方法本文对9例直肠、肛门周围结核病例进行初步分析。结果直肠、肛门周围脓肿和肛瘘病人，常规内科治疗及外科手术治疗效果不佳。应考虑有结核病的可能，规律全身抗结核治疗及局部用药，可取得较好疗效。结论提高医生对结核病的认识，早期诊断,早期治疗以减轻病人的痛苦。     

直肠、肛门

541938 直肠癌淋巴转移的临床病理学研究/董新舒等//中华外科杂志.-1985,23(8).-463～4 对进展期直肠癌切除标本100例进行淋巴转移规律的临床病理学研究,为根治术时淋巴清除范围提出了确切依据。结果表明:进展期直肠癌淋巴结转移度为7.5％,转移率为47％,其中第一站为44％,第二站为18％,第三站为8％。有3％无第一站转移而发生第二站转移。因此在根治术时,不论原发灶的部位如何,上方淋巴结清除必须进行,且应达第三站,否则近1/10病例造成淋巴结转移癌的残留。同时原发灶于腹膜反折以下者有7例发生侧     

直肠、肛门

直肠中段癌经腹骶联合切除吻合术于1964年Localio首创,Localiol认为男性直肠癌离齿线7～11cm,女性直肠癌离齿线5.5～10cm者,最宜采取用经腹骶联合切除吻合的术式。切口特点:1.腹部切口:起自左髂前上棘与第十二肋联线中点,向下平行于腹股沟韧带并与该韧带相距1.5cm,止于耻骨联合上方越过中线约3cm。2.骶部切口.男性平骶尾关节作一横切口,长约10cm,     

Early reoperation for perirectal abscess

PURPOSE: The aim of this study was to analyze failures in the operative management of perirectal abscesses resulting in early reoperation. METHODS: This was a retrospective case study of 500 consecutive patients who underwent 627 drainage procedures for a perirectal abscess. RESULTS: Forty-eight patients (7.6 percent of all drainage procedures) required reoperation within ten days of the original procedure. The main factors leading to reoperation were incomplete drainage (23 patients), missed loculations within a drained abscess (15 patients), missed abscesses (4 patients), and postoperative bleeding (3 patients). Incomplete drainage was more common with simple perirectal abscesses, whereas most overlooked collections were located posteriorly. Horseshoe abscesses were associated with a particularly high rate (50 percent) of operative failures. Neither preexisting perianal pathology nor systemic immunosuppressive disease contributed to early failures. CONCLUSION: Surgical errors are the leading cause of early failures in the surgical treatment of perianal abscesses. These errors occur in a limited number of typical patterns and can therefore be identified and taught with an aim to decrease their occurrence.     

Perianal abscess and fistula-in-ano in children

The authors present a retrospective review of 40 pediatric patients with perianal abscess and/or fistula-in-ano. The total patient population could be divided clinically into 2 broad groups. The first group consisted of 22 infants younger than 2 years of age, all of whom were males, and 10 of whom presented with recurrences after previous incision and drainage. Of the 14 infants presenting with an abscess, in 12 (85.7 percent), a fistula-in-ano was discovered at surgery. In contrast, in the group of 18 children older than 2 years of age, there were 7 females and 11 males, and fistulas were identified in only 7 of 13 patients (54.8 percent) who presented with abscesses. Surgical treatment consisted of examination under anesthesia and a diligent search for a fistulous tract. Abscesses were primarily saucerized and fistulotomy and cryptotomy of the confluent crypt was performed if a fistulous tract was identified. The only recurrences with this form of treatment occurred in the two immunocompromised patients.Read at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

Perianal abscess in Crohn's disease

PURPOSE: Perianal disease is frequent in patients with Crohn's disease, and many of these patients will eventually have abscess formation. In a prospective follow-up study, we evaluated factors influencing the occurrence and recurrence of perianal abscesses. METHODS: Of 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic, 61 (48.4 percent) had at least one perianal abscess (mean follow-up, 32±17 months). In all, 110 episodes of an abscess with 145 anatomically distinct abscesses were documented. RESULTS: The occurrence of first abscesses was dependent on the type of anal fistula (ischiorectal, 73 percent; transsphincteric, 50 percent; superficial, 25 percent;P < 0.02). Surgical therapy consisted of seton drainage (34 percent), mushroom catheter drainage (49 percent), or incision and drainage (29 percent) and led to inactivation in all patients. Cumulative two-year recurrence rates after the first and second abscess were 54 and 62 percent, respectively. Abscess recurrence was less frequent in patients with a stoma (13 vs. 60 percent in patients without stoma after two years) and in patients with superficial anal fistulas (0 vs. 55 percent/56 percent in patients with transsphincteric/ischiorectal fistulas). Only two abscesses recurred within one year after removal of seton drainage, whereas 13 abscesses recurred with the seton still in place. Neither intestinal nor rectal activity of Crohn's disease significantly influenced the occurrence of an abscess. During the study period, only two patients developed partial stool incontinence. CONCLUSION: Development of perianal abscesses in Crohn's disease depends on the fecal stream and the anatomic type of anal fistula. Seton and catheter drainage are safe and highly effective in treatment. Long-term use of setons to prevent recurrent abscesses is not supported by our data.     

Perianal abscess due toEnterobius vermicularis

A case of recurrent perianal abscess caused byEnterobius vermicularis infestation of the anal canal and glands in an 11-year-old boy is reported.     

Primary pulmonary sporotrichosis complicated by perirectal abscess.

A 48-year old, retired mounted policeman was followed for 4 years through 4 hospitalizations for progression of his bilateral, cavitary lung disease. His sputum was always negative for acid-fast bacilli and fungi. Subsequently, a painful perianal swelling appeared that was incised and drained of purulent material. Five years after first seen, sputum and rectal drainage revealed Sporothrichum schenckii in many cultures. Serologic evidence of sporotrichosis was also present. With amphotericin B therapy, the patient showed marked clinical improvement. Unfortunately, he died from an episode of acute respiratory failure. Although most patients with primary cutaneous or primary pulmonary sporotrichosis are horticulturists, the writers believe that this disease should be considered in any undiagnosed, chronic, cavitary lung disease, even in the absence of this occupational history.     

Early reoperation for perirectal abscess: a preventable complication

PURPOSE: The aim of this study was to analyze failures in the operative management of perirectal abscesses resulting in early reoperation. METHODS: This was a retrospective case study of 500 consecutive patients who underwent 627 drainage procedures for a perirectal abscess. RESULTS: Forty-eight patients (7.6 percent of all drainage procedures) required reoperation within ten days of the original procedure. The main factors leading to reoperation were incomplete drainage (23 patients), missed loculations within a drained abscess (15 patients), missed abscesses (4 patients), and postoperative bleeding (3 patients). Incomplete drainage was more common with simple perirectal abscesses, whereas most overlooked collections were located posteriorly. Horseshoe abscesses were associated with a particularly high rate (50 percent) of operative failures. Neither preexisting perianal pathology nor systemic immunosuppressive disease contributed to early failures. CONCLUSION: Surgical errors are the leading cause of early failures in the surgical treatment of perianal abscesses. These errors occur in a limited number of typical patterns and can therefore be identified and taught with an aim to decrease their occurrence.     

Perianal abscess as a presenting sign of leukemia

Summary Two cases of leukemia, one of which presented as a perianal abscess and the other as a perianal infiltrate, are reported. It is advised that such perianal signs be accorded more attention. Should the diagnosis of leukemia be made, conservative treatment, not surgical intervention, is indicated.     

Perianal abscess caused by Actinomyces: report of a case

Most anal abscesses are caused by anal fistula and invasion of the surrounding tissues by a mixed colonic flora. The treatment comprises excision of the abscess and. if appropriate, fistulectomy. Primary anorectal actinomycosis and perianal actinomycosis are very rare and are caused by Actinomyces, which is a ubiquitous microaerophilic bacterium. Here we report a case of perianal actinomycosis. The patient had a short history of painless perineal induration without fever or leucocytosis with normal routine blood tests. After excision sulphur granules drained from the cavity and the pathological investigations were indicative of perianal actinomycosis. Appropriate surgery and antibiotic treatment healed the perianal infection. After elimination of other diagnoses, e.g. Crohn’s disease, tuberculosis and malignant growths, this rare case of perianal actinomycosis should be kept in mind in the differential diagnosis of a painless perianal mass.     

Perineal and perirectal sarcomas

PURPOSE: Perineal sarcomas are rare tumors that are typically of an extensive nature by the time of diagnosis. In this article, two case reports are followed by a brief review of different types of sarcomas that may occur in the perineal and perirectal region. STUDY PATIENTS: This study consists of two cases that are representative of the many types of perineal/perirectal sarcomas. PRINCIPLE CONCLUSIONS: Perineal and perirectal sarcomas are generally of poor prognosis mainly because of delayed diagnosis. Computed tomography and magnetic resonance imaging can be extremely useful to help assess these tumors. It is well known that the most important criterion for diagnosing leiomyosarcomas appears to be the presence of mitotic activity. Anorectal stromal tumors having five or more mitoses per 50 high powered fields are considered to be malignant. The mainstay of treatment is surgical excision with wide margins. Currently, chemotherapeutic and radiotherapy trials are under way.