常见肛周疾病commonanorectal.ppt

*Nelson RL et al Diseases of the Colon Rectum Apr 2000 Common Office Anorectal Problems Sandra J. Beck, M.D., FACS, FASCRS Associate Professor of Colon and Rectal Surgery University of Kentucky Medical Center Disclosures None Benign Anal Rectal Disease Anatomy of the anal canal and perianal spaces Benign Anal Rectal Disease Abscess and Fistula Fissure Hemorrhoids Overview of Anatomy Anatomy Pelvic and Perirectal Spaces Anatomy of Anal Canal Diagnosis and Treatment of Anorectal Abscess and Fistula-in-Ano Anorectal Abscess Etiology Cryptoglandular abscess Most common Infection in the glands at the dentate line Other causes Crohn’s and Ulcerative Colitis Tuberculosis and Actinomycoses Malignancy Foreign Bodies, Prostate Surgery or Radiation Fistula Description Clock description Does the anus tell time? Relies on description of patient’s position: supine, lateral, prone and relative landmarks Anatomic description: more consistent Pubic bone defines anterior Coccyx define posterior Right and left *If terms be incorrect, then statements do not accord with facts; and when statements and facts do not accord, then business is not properly executed. Confucius 1 There is an area of induration and erythema in the right posterior quadrant that is likely an abscess that has spontaneously drained Abscess Classification Four Types Based on Space Involved Perianal - 19-54% Intersphincteric - 20-40% Ischioanal - 40-60% Supralevator 2% or less Anorectal AbscessTreatment of Perianal and Ischiorectal Abscesses Diagnosis - usually straightforward Erythema and Pain over affected area Fluctuance Treatment Incision and Drainage +/- Excision of small amount of overlying skin Initial packing for hemostasis Drainage catheter (Pezzer) or pack wound Attention to good hygiene and control blood sugar Antibiotics if immunocompromised, obese or diabetic Small Radial incisionShort distance from anus – feel for soft spotPlace drain and trim – avoids packingFollow up in 7-10 days to remov