肛门直肠周围间隙发生急（）课件讲义.ppt

1、肛肛 痈痈肛门直肠周围间隙发生急、慢性化脓性感染而形成的脓肿西医称为肛门直肠周围脓肿属于祖国医学“脏毒”、“悬痈”、“坐马痈”、“跨马痈”等范畴灵枢痈疽篇谓“痈疽发于尻，名曰锐疽，其状赤坚大。”认为“营气不从，逆于肉理，乃生痈肿。”特点：发病急骤，主要为肛门周围剧烈疼痛，肿胀，伴有不同程度的全身症状，如高热，寒战等现代医学认为肛门直肠周围脓肿和肛瘘是一个疾病发展的两个阶段中医病因病机过食肥甘、辛辣、醇酒等物，湿热内生，下注大肠，蕴阻肛门肛门破损染毒，致经络阻塞，气血凝滞而成肺、脾、肾亏损，湿热乘虚下注西医病因肛腺感染肠源性细菌 大肠杆菌病病 理理 变变 化化感染物进入肛窦，形成炎症反应即肛窦炎

2、感染沿肛腺继续扩散，肛腺管水肿阻塞，肛腺发炎，扩延至肛门直肠周围形成肛周炎，为脓肿的前驱期炎症继续发展，由腺组织经血管淋巴管侵入周围组织，沿着括约肌各部的肌间隔蔓延，形成不同位置的脓肿，多发生在肛门直肠间隙的疏松脂肪组织中脓肿自行向皮肤或粘膜穿破，脓腔逐渐机化缩小，形成瘘道 诊诊 断断临床表现男性多于女性，多见于青壮年肛门周围疼痛、肿胀、有结块，伴有不同程度的发热、倦怠等全身症状根据脓肿部位和深浅肛提肌以上全身症状重，局部症状轻肛提肌以下全身症状轻，局部红、肿、热、痛较明显实验室和其他辅助检查肛提肌以下脓肿（低位脓肿）肛门旁皮下脓肿坐骨直肠间隙脓肿低位肌间脓肿肛管后间隙脓肿肛提肌以上脓肿（高位

3、脓肿）骨盆直肠间隙脓肿直肠后间隙脓肿直肠粘膜下脓肿高位肌间脓肿鉴别诊断肛周毛囊炎、疖肿骶骨前畸胎瘤继发感染骶髂关节结核性脓肿骶尾骨骨结核化脓性汗腺炎治治 疗疗以手术为主，注意预防肛漏的形成内治热毒蕴结证 治拟清热解毒仙方活命饮、黄连解毒汤加减有湿热之象，合用萆薢渗湿汤火毒炽盛证 治拟清热解毒透脓 透脓散加减阴虚毒恋证 治拟养阴清热，祛湿解毒 青蒿鳖甲汤合三妙丸加减外治初起 实证 金黄膏、黄连膏外敷、金黄散调糊灌肠虚证 冲和膏或阳和解凝膏外敷成脓 宜早期切开引流根据脓肿部位深浅和病情缓急选择手术方法溃后九一丹纱条引流脓尽用生肌散纱条日久成漏者，按肛漏处理手手 术术脓肿一次切开法适应证及操作方法一

4、次切开挂线法适应证及操作方法分次手术适应证及操作方法术后处理寻寻 找找 内内 口口肛镜下寻找内口脓肿切开前，注入染色剂寻找脓肿切开后，用探针寻找寻找时，避免暴力操作寻找准确率取决于对肛周脓肿扩散与括约肌关系的了解治治 疗疗 原原 则则肛门直肠周围脓肿很难自愈一旦诊断明确，应及时切开引流，不可拘于有无波动感，应参考疼痛的程度和发病时日决定治疗方案忌用抗生素保守治疗，否则非但不能根治，还易致局部硬块长久难以消散引流要彻底通畅对在肛提肌以下的低位脓肿，尽量找到内口，全身症状轻者，争取一次性手术处理，以防形成肛瘘对发生在肛提肌以上的脓肿，尚未找到可靠的内口或内口明显全身症状重者，宜先切开排脓，待形成肛

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