A high anal fistula is a fistula located above the deep external sphincter and can be divided into high simple anal fistula (only one fistula) and high complex anal fistula (multiple fistula openings and fistula arms).
I. Symptoms
One of the symptoms of anal fistula: pus flow
The amount of pus is related to the size, length and number of fistulas. The fistulas that are newly formed or in acute inflammation have a lot of pus, smell bad, are yellow and thick, and the secretions irritate the skin and make it itchy, while the fistulas that do not heal over time have less pus or sometimes none. When the external mouth is obstructed or pseudo-healed, the pus increases dramatically, local abscesses, and the temperature increases. This is often due to an acute attack of anal fistula inflammation or the formation of a branch. Tuberculous anal fistula pus is copious and clear, rice-swill-like, and may have cheese-like necrotic material.
Symptoms of anal fistula No. 2: Pain
When the fistula is clear and there is no inflammation, there is often no pain, only localized swelling and discomfort, which increases when walking. When the fistula is infected or swollen and inflamed due to poor drainage of pus, it can cause pain. In the case of internal fistula, the lower part of the rectum and the anus often feel burning and discomfort, and pain when defecating. The pain is usually not obvious, but when the pus accumulates in the lumen and drains poorly, there is local swelling and pain, and obvious pressure pain, and the pain is reduced after the pus drains.
The third symptom of anal fistula: masses anal
The lump is often one of the complaints of the patient. If the external mouth is closed during an acute attack of inflammation, the lump increases when there is poor drainage.
Symptoms of anal fistula four: itching
The stimulation of mucus secretions in the anus or pus around the external opening often leads to anal skin suffering or eczema.
Symptoms of anal fistula 5: poor defecation
If a complex anal fistula is not healed for a long time, it can cause large fibrotic scar or ring-shaped strips to form around the anorectum, which affects the diastole and closure of the anus, making it difficult to have a bowel movement and a feeling of incomplete bowel movement.
Symptoms of anal fistula No. 6: systemic symptoms
During the acute inflammation period and repeated attacks of complex anal fistula, fever of different degrees, or long-term chronic wasting symptoms such as emaciation, anemia and weakness may appear.
The main hazards
1. Pus discharge: the pus in the fistula will flow out along the external opening, increasing the pus at the anus, wetting the underwear and stimulating the skin around the anus, thus causing itching and pain.
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The most important thing is that when the discharged pus penetrates the anal sphincter, malignant changes may be formed, endangering the life of the patient.
Treatment methods
In the examination of high complexity anal fistula, the Korean electronic anoscope can be used to go deep into the rectum of the anal canal and collect high-definition images of the lesion, so that both doctors and patients can clearly and intuitively understand the condition, effectively avoiding leakage and misdiagnosis, and the results can be confirmed in three or five minutes with an accuracy rate of more than 99%.
Fourth, the surgical method
With the development of medicine, scholars at home and abroad have gradually realized that open treatment ignores the contradictory relationship between open cure and maintaining anal function, therefore, more and more attention is paid to the surgery for high-grade complex anal fistula that must preserve the anal sphincter function. The following surgical methods are mainly available.
1.Medicinal decannulation with internal suture
Pre-operative preparation for anal fistula is performed under lumbar anesthesia. A longitudinal or oval incision is made at the center of the internal orifice to reveal the primary foci, and the inflammatory and necrotic tissues are scraped with a small scraper to thoroughly remove the infected anal sinus, anal gland, anal gland duct and intermuscular lesions. The internal sphincter below the incision was then interrupted with 0-gauge intestinal sutures. The medial end of the fistula was adequately blocked. Then, the appropriate intestinal mucosa above the internal opening was peeled and pulled down. To cover the internal port, the mucosal flap was sutured to the skin of the anal canal with a number of No. 1 silk sutures to strengthen the closed coverage of the internal port so that the contents of the intestinal cavity could not enter. Next, a small scraper was used to reach into the main fistula or dead cavity from the external opening and scratch the luminal tissue. Finally, a thin tube is inserted from the main branch to instill the decannulation drug respectively, allowing the tube to be withdrawn after parting with the drug and injecting the drug, or an appropriate drug twist is selected according to the size and depth of the tube and inserted into the tube through the external port, leaving a 12.5px long twist at the outer end for removal during replacement. Place petroleum jelly gauze inside the anus, cover the inner mouth, and wrap and fix it.
2.Inner port closed tube drainage method
Prepare according to the preoperative routine disposal and fully expose the internal orifice. If the internal orifice and the primary foci are in the posterior part of the anal fistula, then the posterior anal sphincter triangle access is used to directly remove the primary foci, the main tract and the internal orifice, cover the internal orifice with the rectal mucosa of the lower edge of the peeled and pulled down internal orifice, then the removed main tract is sutured to close the canal, while the external orifice and the branch canal are removed or scratched, and the traumatic cavity and sinus tract are filled with tissue. In the case of fistulas with internal orifices in lateral or anterior position, except for the cutaneous access from the outer edge of the anal canal where the primary foci are located, the other methods are the same as above, and the internal orifices are dressed with petroleum jelly gauze and fixed.
3.Open and incision or hanging operation (open window operation)
Prepare for the procedure as usual, find the internal port, and then open a window, i.e., make a bite, in the main of complex anal fistula immediately adjacent to the anal margin to isolate the source of infection in the canal or cavity outside this window. The diameter of the window should not be less than 25 px to allow for adequate drainage. The main tube at the anal verge is not cut open, the lumen is scratched, the infected lesion is removed, the hyperplastic tissue at the external mouth is cut out, and a rubber band is hung in a relaxed state at the window between the branch tube and the sinus tract. More than one window can be opened and then flushed with a sensitive solution based on preoperative bacterial culture of the fistula secretions and drug sensitivity testing. The tube between the window and the internal opening is incised to extend 12.5 px upward from the dentate line; the open tube at the dentate line of the anal verge is fully reopened to completely remove the infected anal fossa; the tube affecting the deep sphincter and puborectal muscle and the intermuscular tube above the dentate line are hung with rubber bands, and the tightness is determined according to the condition. Apply petroleum jelly gauze internally and externally. Wrap and fix.
4, anal fistula surgery points of attention.
(1) simple low anal fistula, this type of fistula is more common, the internal port and the external port correspond to each other, the incision should be radial.
(2) High anal fistulas, where the canal crosses above the deep external sphincter, the incision should be chosen as above, depending on whether the rectal ring is fibrotic or not; if it is fibrotic, it can be cut and drained. In the case of non-fibrosis, the high canal is partially threaded to prevent anal incontinence.
(3) Horseshoe fistula, which has a wide range of lesions, deep and curved canals, and crosses the upper part of the caudal ligament, it is appropriate to use an arc incision and a radial incision for drainage of the main canal. The principles of high canal management are the same as those of high anal fistula.
5. Incision treatment for anal fistula surgery.
(1) The curved incision should be more than 37.5px from the anal verge to prevent the ring-shaped scar from affecting the anal function after healing.
(2) The incision of the external canal should be perpendicular to the external sphincter and should not be made oblique to avoid poor drainage and influence the healing of the wound.
(3) Full sutures, open drainage of the main canal, and full sutures are given to the rest of the wounds after the lesion is cleared, leaving no dead cavity or foreign body to ensure the one-stage healing of the sutured wounds.
V. Treatment modalities
HCPT minimally invasive surgery: the procedure is operated with the latest generation of U.S. imported full computerized multifunctional anorectal treatment system HCPT, which has high frequency capacitive field hemorrhoid treatment function, high frequency electric knife, capacitive field hemostatic clamp function. The treatment process is painless, non-bleeding, fast, thorough, without hospitalization and does not affect work. The recurrence rate after treatment is extremely low. This minimally invasive and painless treatment is to enter inside the anus through a rectal fiberscope, and through a monitor, to directly perform minimally invasive electrocoagulation on the inner opening, so that the inner opening of the anal fistula dries up and closes, and then wash away the pus inside the fistula, so that after a bowel movement, the bacteria and fecal water inside the feces cannot enter the surrounding tissues, so that no infection and pain will form, and then it will heal.
The four advantages of HPCT minimally invasive technology.
1, visual: patients can watch the whole process of their own surgery on the computer monitor; the whole process of surgery is carried out in a painless state.
2, high efficiency: the surgical process can be a direct minimally invasive electrocoagulation of anal fistula lesions, without other operations.
4.Saving: fast recovery after surgery, does not affect normal work and study.
VI. Surgical stages
The fistula has low fistula and high fistula, low fistula is a relatively mild stage of the disease, the general hospital can be treated, while the treatment of complex high fistula has more requirements, expert treatment to be carried out in stages. The general complex anal fistula is down the inner thigh in the direction of the scrotum, while the three pus cavities in the right buttock of this patient are from the anal area up to the waist and then folded down to the outer thigh. The fistula was 7 or 8 cm deep in the gluteus maximus muscle and was a rare high-grade complex anal fistula.
Surgery for high complex anal fistula is performed in three stages.
The first stage is the most critical and requires five simultaneous procedures, including incision and reduction of high complex anal fistula combined with multiple gluteal abscesses, preservation of the rectal ring, flap transfer fat filling, endograft rerouting pressure pad, and fistula excision.
The second stage is complete closure of the wound, along with repair of the sphincter muscle and re-flap implantation of the defective skin.
The third stage was to fill the poorly closed gap, resolve the complications, and further restore the function of the sphincter to the anus. After surgery and rehabilitation, the patient now has no runny stools, significantly better ability to control loose stools, and can sleep in any position.
Anal fistula and other anal diseases should not be ignored, and if you find that you have an anal disease, you should go to the hospital for timely treatment.
Seven, precautions
1.Preventive health care
There is no better prevention method for anal fistula. It is advisable to adopt comprehensive measures to improve local blood circulation, enhance cleanliness and hygiene, frequent cleaning or sitz bath, and prevent constipation, diarrhea and perianal abscess.
2. Rehabilitation and health care
Once an anal fistula is formed, immediately carry out anti-infection treatment, and pay attention to bed rest and reduce activities. The first thing you need to do is to take a light and easy to digest diet and avoid stimulating food. The local area can be fumigated, sitz bath or hot compress. The actual fact is that you will be able to find out about the symptoms of anal fistula, and you will need to get treatment in time to prevent the disease from developing and making treatment difficult.
The actual fact is that you will be able to get a lot more than just the actual actual actual actuality.
1, chrysanthemum, sugar, green tea leaves, put into a cup of tea water steep, slightly smothered for a moment, light fragrance and elegant, can clear heat and detoxification, blood vessels, in addition to damp paralysis, reduce anal fistula swelling and pain.
2, eel, lean pork, astragalus fried, add salt, sugar, yellow wine appropriate amount, remove the astragalus and eat. It is suitable for patients with deficiency type of anal fistula.
3, rice, millet, wash, put in a pot with the right amount of water to boil, wait until the porridge is half-cooked, add soy milk stirred and cooked, then you can eat. Suitable for patients with deficiency, both young and old. The actual fact is that you should eat lighter foods that contain more vitamins, such as winter squash, loofah, green beans, radish, etc. The most common type of anal fistula that does not heal is the deficiency cold type.