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.     

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。     

应用环阵探头经直肠腔内超声检查诊断直肠肛管周围脓肿

应用环阵探头经直肠腔内超声检查直肠肛管周围脓肿,由于其扫查角度为360°,故可以取得较完整直肠肛管周围图像,有助于提高诊断的准确性。临床资料：收集我院普外科2010年10月～2011年4月初诊为直肠肛管周围脓肿患者37例,男21例、女16例,年龄32～59（41±2.4）岁。其中骨盆直肠间隙脓肿11例,     

基层医院急性期阑尾周围脓肿55例手术治疗体会

目的探讨基层医院急性期阑尾周围脓肿手术治疗方法及效果。方法回顾性分析55例阑尾周围脓肿的临床资料及治疗结果。结果 55例阑尾周围脓肿均于急性期行Ⅰ期手术切除痊愈。结论阑尾周围脓肿急性期Ⅰ期手术切除的优点是能及早解除病人的痛苦,减轻患者的经济负担,避免复发。     

原发性肛管直肠恶性黑色素瘤诊断与治疗

目的总结探讨原发性肛管直肠恶性黑色素瘤的临床特点。方法回顾分析我院收治的3例及文献报告131例肛管直肠恶性黑色素瘤临床资料，并复习文献。结果134例原发性肛管直肠恶性黑色素瘤中，术前诊断46例，占34．3％。结论肝管直肠恶性黑色素省表现为便血，肛门扪及肿物或肿物脱出，大便习惯改变或肛门不适，坠胀感等。与肛管直肠癌类似，极易误诊。病理活检是确诊的主要手段。     

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。     

骶管阻滞麻醉在肛管直肠手术中的应用

对330例实施手术治疗的肛管直肠疾病患者应用骶管阻滞麻醉,麻醉显效282例,有效35例,无效13例。认为要提高麻醉的成功率,准确定位是前提,认真操作为关键,出现麻醉反应时要重视,有镇痛不全时需积极处理。     

急诊手术治疗阑尾周围脓肿65例临床分析

目的探讨阑尾周围脓肿急诊手术的治疗效果。方法回顾性分析65例阑尾周围脓肿急诊切除阑尾及腹腔引流治疗的临床资料。结果 62例行阑尾一次性切除,腹腔冲洗加腹腔引流,其中3例因阑尾自溶无法找到阑尾而行坏死组织清除加脓肿引流,术后经联合抗感染及全身支持治疗,切口一期愈合61例,二期愈合4例,均全部治愈出院。无残端瘘、肠梗阻、腹腔脓肿等并发症发生。住院7～24 d。结论阑尾周围脓肿急诊行阑尾切除和腹腔引流是一种积极可靠而又安全的治疗方法,早期清除病灶,保持引流通畅,合理应用抗生素,可使阑尾周围脓肿病人得到一次性治愈。     

Fournier's gangrene following a perianal abscess

Fournier's disease is an uncommon form of gas gangrene involving the scrotum and perineum. Described by Fournier as an idiopathic condition it must be recognized as a synergistic gangrene secondary, in most cases, to a focus of perianal infection. Urinary tract infection and local trauma follow as possible causal factors. Five cases complicating a perianal abscess observed in a period of 11 years have been treated with urgent aggressive surgical debridement and intensive care support. Full-thickness skin grafts were required in three patients. Hospital mortality occurred in one case. Although combination antibiotic therapy and correct postoperative wound management are potentially successful, the mainstay of treatment is complete excision of all necrotic tissue. Colostomy and urinary diversion are not mandatory. Treatment with hyperbaric oxygen is controversial.     

肛旁脓肿的术式选择

肛周脓肿是肛门部最常见疾病,青年男性多见,发病率较高,多由肛腺感染引起,向肛周间隙蔓延,最终形成脓肿。还有一些全身性疾病引起的肛周脓肿,例如炎症性肠病,血液肿瘤等。肛周脓肿无论是原发于肛腺感染还是全身疾病导致局部脓肿,目前公认的治疗方案为肛周脓肿的切开引流,同时也符合外科感染的治疗原则。但切开引流术后肛瘘的形成率较高,肛门部脓肿常无固定,手术处理不当可能将潜在腔系残留,导致脓肿的复发及肛瘘形成。笔者根据肛门周围解剖结构的特点,采用"三间隙引流"对肛周脓肿行彻底的敞开引流,取得了一定的效果。本述评就肛周脓肿的术式选择展开论述。     

Modern surgical strategies for perianal Crohn's disease

One of the most challenging phenotypes of Crohn’s disease is perianal fistulizing disease (PFCD). It occurs in up to 50% of the patients who also have symptoms in other parts of the gastrointestinal tract, and in 5% of the cases it occurs as the first manifestation. It is associated with severe symptoms, such as pain, fecal incontinence, and a significant reduction in quality of life. The presence of perianal disease in conjunction with Crohn’s disease portends a significantly worse disease course. These patients require close monitoring to identify those at risk of worsening disease, suboptimal biological drug levels, and signs of developing neoplasm. The last 2 decades have seen significant advancements in the management of PFCD. More recently, newer biologics, cell-based therapies, and novel surgical techniques have been introduced in the hope of improved outcomes. However, in refractory cases, many patients face the decision of having a stoma made and/or a proctectomy performed. In this review, we describe modern surgical management and the most recent advances in the management of complex PFCD, which will likely impact clinical practice.     

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.     

The natural history of perianal Crohn''s disease

Perianal lesions are exceedingly common in Crohn's disease and many patients have more than one type of lesion. Skin tags, fissures and haemorrhoids may persist over time and are usually managed expectantly or with topical therapy. Perianal and rectovaginal fistulas and associated abscesses often require both local and systemic therapy, and recurrence is common. In general, the clinical course of Crohn's disease is more aggressive in patients with perianal involvement. Established risk factors for perianal disease include colonic disease and young age at disease onset. Classification schema now recognize perianal fistulas as distinct from other forms of penetrating Crohn's disease. Genetic susceptibility factors for perianal disease may exist, but they remain incompletely delineated at present. There is hope that immunosuppressive and biotechnology medications will influence the natural history of perianal disease by preventing invasive surgeries, disease complications and recurrence, but this needs to be confirmed. Cancer, a rare complication of perianal disease, must be suspected when lesions persist despite therapy.     

Endoanal ultrasound in perianal fistulas and abscesses

Anal ultrasound has demonstrated to be accurate in staging perianal cryptoglandular fistulae and fistulae in Crohn's disease. When there is an external fistula opening, H2O2 can be introduced with a plastic infusion catheter. The tract becomes then visible as a hyperechoic lesion ('white'). It has been shown that this corresponds excellent with surgical findings. It is equally sensitive as endoanal MRI. Because recurrent cryptoglandular fistulae are complex in about 50% and Crohn's fistula in 75%, it is mandatory to perform anal ultrasound preoperative in these patients to avoid missed tracks during surgery and subsequent recurrences. Anal ultrasound can also be used to monitor (medical) therapy in patients with Crohn's disease. Especially considering the easiness of performing and lesser costs then MRI, endoanal ultrasound merits more attention.     

Multidisciplinary and evidence-based management of fistulizing perianal Crohn's disease

Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.     

结核性肛周脓肿延误诊断临床分析(附5例报告)

2015年12月至2017年12月,航空总医院普外科收治的320例肛周脓肿患者中5例患者术后30d内切口未愈合,最终诊断为结核性肛周脓肿;其中3例并发肺结核,给予2R-H-E-Z/4R-H-E抗结核药物化疗方案治疗后,切口均愈合,平均愈合时间(25.5±3.6)d,无复发。分析延误诊断原因主要为:结核性肛周脓肿临床较少见,临床表现缺乏特异性,医务人员对此病的认识不足,未对患者病史进行详细分析,未进行脓液抗酸杆菌检查及肛周病变组织病理学检查。对于肛周脓肿的患者,应仔细询问患者病史,常规进行脓液分泌物抗酸杆菌检查、组织病理学检查。确诊为结核性肛周脓肿后应给予规范抗结核药物化疗方案治疗6个月至1年。