婴幼儿肛周脓肿及肛瘘诊治进展
张强 陆金根 梁宏涛
上海中医药大学附属龙华医院肛肠科,上海 200032
Advance of the diagnosis and treatment of anal abscess and anal fistula of infants
ZHANG Qiang LU Jingen LIANG Hongtao
Department of Anorectal, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
摘要 婴幼儿(出生后0~3岁)肛周脓肿和肛瘘发病率逐年上升。目前临床主要存在保守治疗和手术治疗两种截然相反的观点。医师及家属盲目追求保守治疗,直接导致患儿长期遭受病情反复发作带来的影响,甚至病灶扩大,病情加重,给患儿带来痛苦,也给患儿家属带来身体、工作、心理的压力和经济负担,成为不容忽视的现象。手术治疗虽然会快速缓解不适症状,改善体征,但是一味地切开引流,不寻求根治也会增加患儿痛苦。因此,临床急需有效的治疗婴幼儿肛周脓肿和肛瘘的方法。笔者通过回顾近10年来国内外婴幼儿肛周脓肿及肛瘘的文献,从疾病特点、病因学、治疗及预后五个方面对婴幼儿肛周脓肿及肛瘘进行阐述,以期寻找一种合适的治疗婴幼儿肛周脓肿和肛瘘的方法。
关键词 :
婴幼儿 ,
肛周脓肿 ,
肛瘘 ,
保守治疗 ,
手术治疗
Abstract :More and more infants (0-3 years old) with diseases of anal abscess and anal fistula are identified, and the incidence is increasing year by year. There are two opposite viewpoints about the treatment: conservative treatment and operation. The unwisely pursuits of conservative treatment by some doctors and the infants′ parents directly causes the infants′ suffering from repeated attacks of the disease for a long time, even the enlargement of the focus, the aggravation of the disease, and more pain, what′s more, and brought physical, work, psychological and economic pressure on parents, which can not be ignored either. Operation will relieve symptoms and improve physical stress quickly, but cutting and draining alone, not seeking a cure method would also increase the pain of children. Therefore, there is an urgent need for effective treatment of perianal abscess and anal fistula in infants. This article reviews the literature about the diseases last decade, studying the commonly clinical characteristics, the etiology, the treatment and the prognosis of these diseases, looking forward to find a better treatment to treat them.
Key words :
Infants
Anal abscess
Anal fistula
Conservative treatment
Operation
基金资助: “十二五”国家科技支撑计划项目(2015BAI04B00)。
通讯作者:
陆金根(1947.12-),男,主任医师;研究方向:良性肛肠疾病的中西医结合治疗。
作者简介 : 张强(1981.3-),男,硕士;研究方向:良性肛肠疾病的中西医结合治疗。
[1] 王语,金先庆,向丽,等.新生儿外科感染性疾病的治疗[J].中国新生儿科杂志,2015,30(3):200-203.
[2] 黄乃健.中国肛肠病学[M].济南:山东科学技术出版社,1996.
[3] 耿少民,曹军锋.婴儿肛周脓肿82例发病特点及与母乳喂养关系分析[J].陕西医学杂志,2016,45(11):1535-1536.
[4] 李春雨,张优生.实用肛门手术[M].沈阳:辽宁科学技术出版社,2005.
[5] 张有生,李春雨.实用肛肠外科学[M].北京:人民军医出版社,2009.
[6] 梁珣,金先庆,向丽,等.雄激素在婴儿肛周脓肿发病中的作用及机制探讨[J].中华小儿外科杂志,2013,34(12):893-895.
[7] 马木提江.婴幼儿脓肿性肛瘘的特点及治疗[J].医学研究生报,2010,23(5):495.
[8] 冯杰雄,郑珊.小儿外科学[M].2版.北京:人民卫生出版社,2014:162.
[9] 林晶.4种用药方案治疗小儿肛周脓肿的成本效果分析[J].中国药房,2016,27(35):4904-4906.
[10] 陆坚,徐照秀,吴帅军,等.近3年肛周脓肿及肛瘘感染病原菌分布及耐药性分析[J].国际检验医学杂志,2015,36(21):3189-3191.
[11] 王语,金先庆,李晓庆,等.儿童胃肠外科重症感染的抗菌药物治疗[J].重庆医学,2014,43(9):1066-1068.
[12] 贝绍生,徐蕾,黄乃健.小儿肛瘘与肠道微生态失调相关性研究[J].中国中西医结合外科杂志,2006,12(2):112-114.
[13] 江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015.
[14] 张东铭,王玉成,李恒爽,等.盆底肛直肠外科理论与临床[M].北京:人民军医出版社,2011.
[15] 林芝芳.1例婴幼儿肛周脓肿致感染中毒性休克的护理[J].中国生育健康杂志,2013,19(3):266-268.
[16] 孟晓锐.1例小儿肛门直肠异物致肛周脓肿的治疗和护理[J].全科护理,2014,12(24):2303-2303.
[17] 李如燕.小儿肛门直肠异物合并肛周脓肿的治疗和护理[J].中国临床实用医学,2015,9(3):73-74.
[18] 夏泽华,张雅明,柏连松.柏连松教授辨证治疗小儿肛瘘[J].吉林中医药,2015,35(3):248-250.
[19] Watanabe Y,Todani T,Yamamoto S. Conservative management of fistula in ano in infants [J]. Pediatr Surg Int,1998,13(4):274-276.
[20] 李慧,石兰辛,刘同明.复方黄柏液薰洗联合抗生素治疗小儿早期肛周脓肿的临床效果观察[J].当代临床医刊,2016,29(2):2051-2052.
[21] Christisonlagay ER,Hall JF,Wales PW,et al. Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation [J]. Pediatrics,2007,120(3):e548-e552.
[22] Chang HK,Ryu JG,Oh JT .Clinical characteristics and treatment of perianal abscess and fistula-in-ano in infants [J]. J Pediatr Surg,2010,45(9):1832-1836.
[23] Oh JT,Han A,Han SJ,et al. Fistula-in-Ano in Infants:is nonoperative management effective?[J]. J Pediatr Surg,2001,36(9):1367-1369.
[24] Ezer SS,O uzkurt P,Ince E,et al. Perianal abscess and fistula-in-ano in children:aetiology,management and outcome [J]. J Paediatr Child Health,2010,46(3):92-95.
[25] 朱益民,许傅英.三个月以下婴儿肛周脓肿病原菌特点及治疗效果分析[J].温州医科大学学报,2016,46(3):226-228.
[26] 肖兰福,胡家珍,李俊忠.小儿肛周脓肿33例治疗体会[J].中华小儿外科杂志,2008,29(12):766.
[27] 吴炯,王振宜,孙建华.肛周脓肿的外科治疗[J].世界华人消化杂志,2013,21(34):3842-3847.
[28] Afsarlar CE,Karaman A,Tan?覦r G,et al. Perianal abscess and fistula-in-ano in children:clinical characteristic,management and outcome [J]. Pediatr Surg Int,2011,27(10):1063-1068.
[29] 肖剑.新生儿肛周脓肿手术方法疗效比较[J].中国现代医生,2012,50(27):140-141.
[30] 宋新江,张利萍,严水根,等.肛周脓肿切口感染原因分析及预防对策[J].中华医院感染学杂志,2012,22(21):4785.
[31] Buddicom E,Jamieson A,Beasley S,et al. Perianal abscess in children:aiming for optimal managementans [J]. ANZ J Surg,2012,82(1-2):60-62.
[32] 陈亚军.小儿肛门直肠周围常见感染相关性疾病的处理[J].国际外科学杂志,2015,42(8):508-510.
[33] 付树华.V型内口缝合切缝术治疗婴幼儿肛瘘28例报告[J].结直肠肛门外科,2009,15(1):54.
[34] 陶云平.切开挂线法治疗婴幼儿肛瘘24例临床分析[J].承德医学院学报,2012,29(1):29-30.
[35] 梁宏涛,陆金根.陆金根运用拖线法治疗复杂性肛瘘经验[J].陕西中医,2015,36(9):1222-1223.
[36] 王琛,姚一博,董青军,等.拖线疗法在肛瘘治疗中的应用与发展[J].中华胃肠外科杂志,2015,18(12):1203-1206.
[37] 王明华,唐一多,郭修田,等.拖线法治疗婴幼儿低位单纯性肛瘘21例[J].中西医结合杂志,2005,3(3):231-232.
[38] Osman MA,Elsharkawy MA,Othman MH. Repair of fistulae in-ano in children using image guided Histoacryl injection after failure of conservative treatment [J]. J Pediatr Surg,2013,48(3):614-618.
[39] 马新生,赵贤峰,张风华,等.脱细胞异体真皮基质填塞治疗小儿肛瘘31例[J].临床小儿外科杂志,2013,12(6):514-515.
[40] 裘法祖,孟承伟.实用外科学[M].7版.北京:人民卫生出版社,2010.
[41] Cioli VM,Gagliardi G,Pescatori M,et al. Psychological stress in patients with anal fistula [J]. Int J Colorectal Dis,2015,30(8):1123-1129.
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