肛門(mén)直腸周圍間隙發(fā)生急課件

肛癰肛門(mén)直腸周圍間隙發(fā)生急、慢性化膿性感染而形成的膿腫西醫(yī)稱為肛門(mén)直腸周圍膿腫屬于祖國(guó)醫(yī)學(xué)“臟毒”、“懸癰”、“坐馬癰”、“跨馬癰”等范疇《靈樞·癰疽篇》謂“癰疽發(fā)于尻，名曰銳疽，其狀赤堅(jiān)大。”認(rèn)為“營(yíng)氣不從，逆于肉理，乃生癰腫?！备匕b肛門(mén)直腸周圍間隙發(fā)生急、慢性化膿性感染而形成的膿腫1特點(diǎn)：發(fā)病急驟，主要為肛門(mén)周圍劇烈疼痛，腫脹，伴有不同程度的全身癥狀，如高熱，寒戰(zhàn)等現(xiàn)代醫(yī)學(xué)認(rèn)為肛門(mén)直腸周圍膿腫和肛瘺是一個(gè)疾病發(fā)展的兩個(gè)階段特點(diǎn)：發(fā)病急驟，主要為肛門(mén)周圍劇烈疼痛，腫脹，伴有不同程度的2中醫(yī)病因病機(jī)過(guò)食肥甘、辛辣、醇酒等物，濕熱內(nèi)生，下注大腸，蘊(yùn)阻肛門(mén)肛門(mén)破損染毒，致經(jīng)絡(luò)阻塞，氣血凝滯而成肺、脾、腎虧損，濕熱乘虛下注西醫(yī)病因肛腺感染腸源性細(xì)菌大腸桿菌中醫(yī)病因病機(jī)3病理變化感染物進(jìn)入肛竇，形成炎癥反應(yīng)即肛竇炎感染沿肛腺繼續(xù)擴(kuò)散，肛腺管水腫﹑阻塞，肛腺發(fā)炎，擴(kuò)延至肛門(mén)直腸周圍形成肛周炎，為膿腫的前驅(qū)期炎癥繼續(xù)發(fā)展，由腺組織經(jīng)血管﹑淋巴管侵入周圍組織，沿著括約肌各部的肌間隔蔓延，形成不同位置的膿腫，多發(fā)生在肛門(mén)直腸間隙的疏松脂肪組織中膿腫自行向皮膚或粘膜穿破，膿腔逐漸機(jī)化縮小，形成瘺道病理變化感染物進(jìn)入肛竇，形成炎癥反應(yīng)即肛竇炎4診斷臨床表現(xiàn)男性多于女性，多見(jiàn)于青壯年肛門(mén)周圍疼痛、腫脹、有結(jié)塊，伴有不同程度的發(fā)熱、倦怠等全身癥狀根據(jù)膿腫部位和深淺肛提肌以上－全身癥狀重，局部癥狀輕肛提肌以下－全身癥狀輕，局部紅、腫、熱、痛較明顯實(shí)驗(yàn)室和其他輔助檢查診斷臨床表現(xiàn)5肛提肌以下膿腫（低位膿腫）肛門(mén)旁皮下膿腫坐骨直腸間隙膿腫低位肌間膿腫肛管后間隙膿腫肛提肌以上膿腫（高位膿腫）骨盆直腸間隙膿腫直腸后間隙膿腫直腸粘膜下膿腫高位肌間膿腫肛提肌以下膿腫（低位膿腫）6鑒別診斷肛周毛囊炎、癤腫骶骨前畸胎瘤繼發(fā)感染骶髂關(guān)節(jié)結(jié)核性膿腫骶尾骨骨結(jié)核化膿性汗腺炎鑒別診斷肛周毛囊炎、癤腫7治療以手術(shù)為主，注意預(yù)防肛漏的形成內(nèi)治熱毒蘊(yùn)結(jié)證治擬清熱解毒仙方活命飲、黃連解毒湯加減有濕熱之象，合用萆薢滲濕湯火毒熾盛證治擬清熱解毒透膿透膿散加減治療以手術(shù)為主，注意預(yù)防肛漏的形成8陰虛毒戀證治擬養(yǎng)陰清熱，祛濕解毒青蒿鱉甲湯合三妙丸加減外治初起實(shí)證金黃膏、黃連膏外敷、金黃散調(diào)糊灌腸虛證沖和膏或陽(yáng)和解凝膏外敷陰虛毒戀證9成膿宜早期切開(kāi)引流根據(jù)膿腫部位深淺和病情緩急選擇手術(shù)方法潰后九一丹紗條引流膿盡用生肌散紗條日久成漏者，按肛漏處理成膿10手術(shù)膿腫一次切開(kāi)法適應(yīng)證及操作方法一次切開(kāi)掛線法適應(yīng)證及操作方法分次手術(shù)適應(yīng)證及操作方法術(shù)后處理手術(shù)膿腫一次切開(kāi)法11尋找內(nèi)口肛鏡下尋找內(nèi)口膿腫切開(kāi)前，注入染色劑尋找膿腫切開(kāi)后，用探針尋找尋找時(shí)，避免暴力操作尋找準(zhǔn)確率取決于對(duì)肛周膿腫擴(kuò)散與括約肌關(guān)系的了解尋找內(nèi)口肛鏡下尋找內(nèi)口12治療原則肛門(mén)直腸周圍膿腫很難自愈一旦診斷明確，應(yīng)及時(shí)切開(kāi)引流，不可拘于有無(wú)波動(dòng)感，應(yīng)參考疼痛的程度和發(fā)病時(shí)日決定治療方案忌用抗生素保守治療，否則非但不能根治，還易致局部硬塊長(zhǎng)久難以消散引流要徹底﹑通暢治療原則肛門(mén)直腸周圍膿腫很難自愈13對(duì)在肛提肌以下的低位膿腫，盡量找到內(nèi)口，全身癥狀輕者，爭(zhēng)取一次性手術(shù)處理，以防形成肛瘺對(duì)發(fā)生在肛提肌以上的膿腫，尚未找到可靠的內(nèi)口或內(nèi)口明顯﹑全身癥狀重者，宜先切開(kāi)排膿，待形成肛瘺再行第二次手術(shù)對(duì)在肛提肌以下的低位膿腫，盡量找到內(nèi)口，全身癥狀輕者，爭(zhēng)取一14術(shù)中注意事項(xiàng)定位準(zhǔn)確先穿刺，抽出膿液后，再行切開(kāi)排膿切口選擇淺部膿腫行放射狀切口深部膿腫行弧形切口引流徹底切開(kāi)膿腫后用手指探查膿腔，分開(kāi)腔內(nèi)的纖維間隔以利引流預(yù)防肛漏形成術(shù)中切開(kāi)原發(fā)肛隱窩炎，防止肛漏形成術(shù)中注意事項(xiàng)定位準(zhǔn)確15預(yù)防與調(diào)護(hù)保持大便通暢，注意肛門(mén)清潔積極防治肛門(mén)病變患病后應(yīng)及早治療，防止炎癥范圍擴(kuò)大預(yù)防與調(diào)護(hù)保持大便通暢，注意肛門(mén)清潔16*!XTPLHDzvrnkgc840($YUQMIEAwsokgc951)%ZVRNJFBxtplhd951)&#WSOKGCyuqmiea62-&#WSPLHDzvrnjfb73+*!XTPLHEAwsokgc840($YUQMIEAwsplhd951)%ZVRNJFBxtplhda62-&#WSOKGCyuqmiea62+*!XTPLHDzvrnjfb73+*!XUQMIEAwsokgc840($YUQMJFBxtplhd951)%ZVRNJFBxuqmiea62-&#WSOKGCyuqmifb73+*!XTPLHDzvrnjfb740($YUQMIEAwsokgc840($ZVRNJFBxtplhd951)%ZVRNKGCyuqmiea62-&#WSOKGCzvrnjfb73+*!XTPLHDzvrnkgc840($YUQMIEAwsokgc951)%ZVRNJFBxtplhd951)&#WSOKGCyuqmiea62-&#WSPLHDzvrnjfb73+*!XTPLHEAwsokgc840($YUQMIEAwsplhd951)%ZVRNJFBxtplhea62-&#WSOKGCyuqmiea62+*!XTPLHDzvrnjfb73+*!XUQMIEAwsokgc840($YUQMJFBxtplhd951)%ZVRNJFBxuqmiea62-&#WSOKGCyuqmifb73+*!XTPLHDzvrnjfb740($YUQMIEAwsokgc840($ZVRNJFBxtplhd951)%ZVROKGCyuqmiea62-&#WSOKGCzvrnjfb73+*!XTPLHDzvrnkgc840($YUQMIEAwsokgc951)%ZVRNJFBxtplhd951)&#WSOKGCyuqmiea62-&#WSPLHDzvrnjfb73+*!XTPLHEAwsokgc840($YUQMIEAwsplhd951)%ZVRNJFBxtplhea62-&#WSOKGCyuqmiea62+*!XTPLHDzvrnjfb73+*!XUQMIEAwsokgc840($YUQMJFBxtplhd951)%ZVURNJFBxtplhd951)%ZVRNJFCyuqmiea62-&#WSOKGCyurnjfb73+*!XTPLHDzvrnjfc840($YUQMIEAwsokgc840)%ZVRNJFBxtplhd951)%ZWSOKGCyuqmiea62-&#WSOKHDzvrnjfb73+*!XTPLHDzvsokgc840($YUQMIEAwsokhd951)%ZVRNJFBxtplhd952-&#WSOKGCyuqmiea62-&!XTPLHDzvrnjfb73+*!XTPMIEAwsokgc840($YUQMIEAxtplhd951)%ZVRNJFBxtpmiea62-&#WSOKGCyuqmiea73+*!XTPLHDzvrnjfb73+($YUQMIEAwsokgc840($YURNJFBxtplhd951)%ZVRNJFCyuqmiea62-&#WSOKGCyurnjfb73+*!XTPLHDzvrnjfc840($YUQMIEAwsokgc840)%ZVRNJFBxtplhd951)%ZWSOKGCyuqmiea62-&#WSOKHDzvrnjfb73+*!XTPLHDzwsokgc840($YUQMIEAwsokhd951)%ZVRNJFBxtplhd952-&#WSOKGCyuqmiea62-&!XTPLHDzvrnjfb73+*!XTPMIEAwsokgc840($YUQMIEAxtplhd951)%ZVRNJFBxtpmiea62-&#WSOKGCyuqmiea73+*!XTPLHDzvrnjfb73+($YUQMIEAwsokgc840($YURNJFBxtplhd951)%ZVRNJFCyuqmiea62-&#WSOKGCyurnjfb73+*!XTPLHDzvrnjfc840($YUQMIEAwsokgc841)%ZVRNJFBxtplhd951)%ZWSOKGCyuqmiea62-&#WSOKHDzvrnjfb73+*!XTPLHDzwsokgc840($YUQMIEAwsokhd951)%ZVRNJFBxtplhd952-&#WSOKGCyuqmieaa62-&#WSOKGCyuqmiea62+*!XTPLHDzvrnjfb73+*!XUQMIEAwsokgc840($YUQMJFBxtplhd951)%ZVRNJFBxuqmiea62-&#WSOKGCyuqmifb73+*!XTPLHDzvrnjfb740($YUQMIEAwsokgc840($ZVRNJFBxtplhd951)%ZVROKGCyuqmiea62-&#WSOKGCzvrnjfb73+*!XTPLHDzvrnkgc840($YUQMIEAwsokgc951)%ZVRNJFBxtplhd951)&#WSOKGCyuqmiea62-&#WSPLHDzvrnjfb73+*!XTPLHEAwsokgc840($YUQMIEAwsplhd951)%ZVRNJFBxtplhea62-&#WSOKGCyuqmiea62+*!XTPLHDzvrnjfb73+*!XUQMIEAwsokgc840($YUQMJFBxtplhd951)%ZVRNJFBxuqmiea62-&#WSOKGCyuqmifb73+*!XTPLHDzvrnjfb740($YUQMIEAwsokgc840($ZVRNJFBxtplhd951)%ZVROKGCyuqmiea62-&#WSOKGCzvrnjfb73+*!XTPLHDzvrnkgc840($YUQMIEAwsokgc951)%ZVRNJFBxtplhd951)&#WSOKGCyuqmiea62-&#WTPLHDzvrnjfb73+*!XTPLHEAwsokgc840($YUQMIEAwsplhd951)%ZVRNJFBxtplhea62-&#WSOKGCyuqmiea62+*!XTPLHDzvrnjfb73+*!XUQMIEAwsokgc840($YUQMJFBxtplhd951)%ZVRNJFBxuqmiea62-&#WSOKGCyuqmjfb73+*!XTPLHDzvrnjfb740(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