I. Definition
An abnormal tube between the rectum of the anal canal and the skin around the anus is called an anal fistula. In Chinese medicine, it is called anal fistula.
Diagnostic points
1. Most of them have a history of perianal rectal abscess, swelling and pain next to the anus, water and pus, and repeated attacks.
2. Local examination reveals the external mouth, palpable ducts, internal mouth, etc.
Differential diagnosis
1.Purulent sweat gland inflammation.
2.perineal urethral fistula.
3.Sacrococcygeal cyst.
Examination
1.Compulsory items: finger diagnosis, visual examination, anoscopy, three routine, coagulation index, blood sugar, liver and kidney function, ECG pathology, infection 4 items, etc.
2.Preparatory items: magnetic resonance imaging, methylene blue test, X-ray iodine oil imaging, perianal ultrasound, chest X-ray.
V. Treatment
Eligible patients with anal fistula enter the clinical pathway
1. Internal treatment.
If the evidence belongs to damp-heat injection, the treatment should be to clear damp-heat, and the formula should be Dioscorea Z Dampness Infiltration Soup plus or minus.
For those with evidence of positive deficiency, the treatment is to benefit the Qi and nourish the Blood, to support the positive and to support the toxin, and the formula is selected from Tori Disinfectant Drink.
For those with yin deficiency and internal heat, the treatment is to nourish yin and clear heat.
2.External treatment.
Fumigation.
Anorectal fumigation with Chinese herbs.
Surgery.
1. treatment principles.
Correctly search for the inner opening of the fistula, completely remove the primary lesion of infection, and protect the anal sphincter and anal function to the maximum extent possible, in order to achieve the purpose of curing the anal fistula without damaging the anal function.
2.Surgical methods.
(1) anal fistula incision and drainage and excision and suturing for low level simple anal fistula.
(2) Fistula incision and drainage for low-grade complex fistula.
(3) Fistulotomy and suturing for high-grade simple fistula.
(4) incision and hanging of anal fistula to drain the mouth for high-grade complex anal fistula.
(5) incision and other sphincter-preserving procedures such as tunnel dragging
Anti-infective treatment and other symptomatic treatment.
(6) tunnel dragging for high anal fistula
(7) Staged surgery for complex anal fistula
(8) Implementation of minimally invasive concept, main tube excision, and use of branch sutures.