结直肠肛管疾病课件_2.ppt

Classification according to the level Low level fistula：fistula locate under deep of the external sphincter High level fistula：fistula locate above deep of the external sphincter according to the number of entrance Simple fistula Complicated fistula * according to the relationship between fistula and sphincter Inter-sphincter fistula Trans-sphincter fistula Supra-sphincter fistula Extro-sphincter fistula Clinical manifestation Acute chronic recurring abscess or chronic draining sinus over the sacrococcygeal or perianal region. Pain, tenderness, purulent,blood, mucinous excretion drainage,.general symptoms (fever, chill, weak). above sypmtoms repeated outbreak Anatomy anal canal: up is anorectal line, down is anus.1.5 to 2cm in length. the epithelium differ. the serrated dentate (or pectinate) line: demarcate rectum and anal canal (important anatomic landmarks) the importance show: upper is mucosa, autonomic nerve, no pain. below is skin, internal pudendal nerve, with keen pain. Anatomy blood supply differ: upper is superior rectal artery, inferior rectal artery. below is artery of anal canal. venous return differ: upper is superior rectal plexus→ superior rectal vein→ portal vein. below is inferior rectal plexus→ vein of anal canal→ inferior vena cava. lymphatic return differ: upper is aorta abdominalis nearby or the internal iliac lymph node. below is inguinal lymph node or external iliac node. white line: intermuscular groove. Anatomy rectum and anal canal musculature: the anal canal musculature with its sphincteric apparatus is the terminal muscular channel of the gastrointestinal tract. internal anal sphincter muscle is the continuation of the smooth circular layer of the rectum. external anal sphincter muscle is a continuous sheet of striated muscle constituting the pelvic floor. it divide into subcutaneous external anal sphincter muscle; superficial external anal sphincter muscle; deep external anal sphincter muscle. levator ani muscles: the