摘要
医源性肛门直肠狭窄是肛门直肠术后较为严重的并发症之一,常由痔瘘切除术、痔上黏膜环切术、内痔硬化剂注射术、低位直肠癌保肛术中操作不当等原因引起.临床中因排便困难,甚或便时肛门剧烈疼痛为患者带来极大痛苦.肛门及低位直肠狭窄可于指诊时直接触及狭窄环,高位直肠狭窄可于结肠镜下观及狭窄的程度与范围.轻度狭窄可暂予保守治疗为主,若狭窄程度不缓解或狭窄较重,可结合狭窄部位、范围及形成原因,选择不同的手术方式,常见术式主要包括:瘢痕封闭术、括约肌部分切开术、纵切横缝术、狭窄挂线术、皮瓣转移肛门成形术及结肠造口术等,临床治疗时常以一种术式为主,必要时可选择2种及以上术式联合应用.本文对肛门直肠狭窄的诊断与治疗策略作一综述.
Iatrogenic anorectal stenosis is one of serious complications after anorectal surgery, and it is often caused by improper operation in surgical resection of hemorrhoids and anal fistula,procedure for prolapse and hemorrhoids（PPH）, internal hemorrhoid agent injectionand saving anal sphincter in low rectal cancer.Because of the difficulty of defecation, severe anal pain may occur. Stenotic ring can be directly touched in anal and low rectal stenosis.The degree and extent of the stenosis can be observed by colonoscopy in upper rectal stenosis. Mild stenosis can be temporarily treated with conservative therapy. If the degree of stenosis does not relieve or stenosis is more severe, we can choose different types of surgery according to the position, scope and the reasons of stenosis, which include scar closed procedure, longitudinal incision and transverse suture procedure, thread-drawing procedure, reconstruction of the anus by skin flap transposition or colostomy. Although only one procedure was adopted in the majority of cases, two or more procedures can be combined.This article reviews the diagnosis and treatment of anorectal stenosis.
出处
《世界华人消化杂志》
CAS
2016年第11期1632-1638,1621,共7页
World Chinese Journal of Digestology
关键词
医源性肛门直肠狭窄
诊断
治疗
Iatrogenic anorectal stenosis
Diagnosis
Treatment
