{"countAll":0,"orderType":null,"readLevel":"0","lyTopicReq":{"id":"1903","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":null,"content":null,"barId":"1903","topicTypeId":null,"topicThemeId":"1032","readLevel":0,"files":null,"clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":null},"lyBarModerators":{"list":[],"list4Map":null,"pageBegin":0,"pageSize":8,"pageNumber":0,"totalPage":0,"totalRow":0},"metaSearch":{"description":"为病友提供:肛瘘论坛_病友交流平台_病友论坛，让病友在便捷的求医路上不花一分冤枉钱。","keywords":"肛瘘论坛_病友交流平台_病友论坛","title":"肛瘘论坛_病友交流平台_病友论坛","channels":null},"data":{"list":[{"id":"9386","isDel":0,"createAt":1513409865726,"createBy":"db869ccaaef711e7a3d800163e04584d","createName":"海绵宝宝","updateAt":0,"updateBy":null,"updateName":null,"userId":"db869ccaaef711e7a3d800163e04584d","title":"儿童易患肛瘘的原因","content":"


\"儿童易患肛瘘的原因\"

（1） 小儿骶骨曲尚未形成，两侧坐骨结节距离较近，加之肛门内括约肌紧张度较弱，因此粪便易直接压迫肛管处齿线，肛窦粘膜擦破，易使细菌侵入致病;女孩因直肠前面有子宫，压迫直肠，与成人直肠屈曲相似。故发病低于男孩。

 

（2） 小儿常因尿布皮炎，刺激肛门周围皮肤，致使毛囊、汗腺、皮脂腺感染，形成肛门周围皮下脓肿与肛窦相通，而成肛瘘。 （3） 新生儿，尤其是男孩受母体激素失调的影响，使皮脂腺分泌亢进，引起肛门皮脂腺炎。感染形成肛周皮下脓肿与肛窦相通，而致肛瘘。

 

（4） 近年来，有人认为新生儿生理性缺乏免疫球蛋白G（IgG）、免疫球蛋白A等，免疫机能不全，因此易发生肛门感染，形成肛瘘。


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肛瘘的多发性，可形成直肠阴道瘘、直肠尿道瘘和直肠膀胱瘘，危及周围脏器。并且肛瘘有恶变倾向即肛瘘能转变成癌症。肛瘘合并肛门直肠癌的病例近年来不断增多。

\"肛瘘易癌变的原因是什么呢\"

 

肛瘘癌变以黏液腺癌占大多数。一般认为癌变与长期慢性炎症的刺激有关。硬结形成，黏液分泌及疼痛常为癌变的先兆，值得人们引起高度的重视。从大量的临床资料来看，导致肛瘘癌变的原因有以下几个方面：

 

（1）长期的慢性炎症刺激：长期的炎症存在，使得脓性物以及粪便从瘘管排出，从而刺激细胞异常增生，导致恶性病变；

 

（2）细菌感染：细菌长期存在于瘘管内，特别是绿脓杆菌或结核杆菌感染，缠绵不愈，可导致癌变；

 

（3）药物刺激：长期大量地使用各种局部外用药，经常刺激局部，导致癌变。总之，肛瘘应早诊断、早治疗、防止病久癌变。


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\"肛瘘复发的因素是什么\"

瘘是肛肠病中变化最多治疗难度最大的疾病，手术是目前唯一的有效治疗手段，但许多患者在术后又复发了，到底是什么原因造成的？复发不仅是治疗失败，由于瘘管的完整性遭破坏和手术留下的瘢痕，将给再次手术增加较大难度，也将对肛门的括约功能造成严重影响。因此，分析失败原因，尽量争取一次手术成功有极其重要意义。

 

1.内口定位错误

 

内口是肛瘘的感染源，肠腔的致病菌正是从内口进入肛周才引起肛周脓肿和肛瘘的，一般位于肛门内3-4cm处的直肠和肛管交界处。外口是感染病灶的溃破口，多数在肛缘外，也有少数在肛内。肛瘘手术的成败最重要的因素在于准确定位内口和充分切开内口。

 

肛瘘外口多是显性的，内口则90%以上是隐性的。临床上寻找内口的最主要方法是从瘘管内探查或指诊触摸。由于很多肛瘘迁延日久，瘘管内反复感染形成粘连而堵塞不通，就无法通过探查和造影的方法来寻找。对于瘘管弯曲、多外口的复杂瘘同样也无法探查。如果没有一定的临床经验，没有掌握肛瘘内口的形成规律，往往在术中只切开了部分瘘管，真正的内口仍存，导致术后复发。

 

2.挂线术盲目人为制造内口

 

挂线术是中医传统疗法，也是目前临床治疗肛瘘采用的最主要方法，其原理是利用胶线的弹力收缩，慢性勒割管壁，敞开瘘管而起到治疗作用。但我们发现挂线术不仅存在痛苦大、愈合时间长、对肛门括约肌损伤重等缺点外，还有相当高的复发率。

 

无论是早期的瘘管壁全部挂线还是现在的切挂，其方法都是将胶（丝）线从肛瘘外口穿入瘘管，然后从内口拉出，收紧线的两端并结扎在一起。如果瘘管畅通，线开从内口准确拉出，瘘管壁被完整打开而获得治愈，但如果瘘管中间粘连或内口闭合，在穿线过程中就很有可能穿出管壁进入瘘管外组织，然后从人为的穿破口出来，这样，部分关键的瘘管和内口就被遗漏而没有打开，从而造成手术失败，术后复发。


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\"女性为什么不容易得肛瘘\"

 

推测性激素的影响是肛瘘发生的主要原因。在青春期，人体自身的性激素开始活跃，随即一部 分皮脂腺，特别是肛腺开始发育增殖，男青年较女性增生明显。由于肛腺分泌旺盛，若加上肛腺排 泄不畅或肛腺管阻滞，则易感染引起肛腺炎，这可解释男性青壮年为何肛瘘发病率较高。而女性肛 管导管较直，不如男性弯曲，分泌物不易淤积，所以女性肛瘘发病率较低。人到老年，与其他皮脂 腺普通萎缩的同时，肛腺也随之萎缩，故老年人肛瘘少见。

 

肛瘘的表现是怎样的？

 

括约肌间肛瘘　多为低位肛瘘，最常见约占70%为肛管周围脓肿的后果，瘘管只穿过内括约肌 ，外口常只有一个距肛缘较近约3～5cm，少数瘘管向上在直肠环肌和纵肌之间形成盲端或穿入直肠 形成高位括约肌间瘘。

 

经括约肌肛瘘　可以为低位或高位肛瘘，约占25%为坐骨直肠窝脓肿的后果，瘘管穿过内括约 肌，外括约肌浅部和深部之间，外口常有数个并有支管互相沟通，外口距肛缘较近约5cm左右，少 数瘘管向上穿过肛提肌到直肠旁结缔组织内形成骨盆直肠瘘。


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\"得了肛瘘为什么不能自愈\"

 

1、内口的存在：脓肿虽然破溃或已切开引流，但原发感染源如肛窦炎、或肛腺感染依然存在，肠腔内容物还可从内口继续进入瘘管;

 

2、肛门部不能静养，脓腔不易粘合：排粪、排尿时，因括约肌收缩或因炎症刺激肛门括约肌，使肛门括约肌经常处于痉挛状态;

 

3、肠腔中的粪便、肠液和气体继续进入瘘管，刺激管壁，使管壁结缔组织增生变厚，管腔难以闭合;

 

4、脓腔引流不畅，或外口缩小，时闭时溃，脓液蓄积腔内，导致脓肿再发并穿破而形成新的支管或瘘道;

 

5、管道多在不同高度穿过肛门括约肌，括约肌收缩阻碍脓液排出，以致引流不畅。


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女,27岁。有痔疮一年多了，脓肿切开引流19天，创口愈合的差不多了，昨天晚上肛门处突然灼痛，疼得一宿没睡，感觉火辣辣的，手脚也发烫，经常有便意，但又没有粑粑。今天大早去医院检查，肛瘘了。

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男,31岁。我做的高位肛瘘切除术，之后进行类克治疗，目前打完第三次类克，手术三个月伤口未愈。手术后伤口旁有个硬结，当时您说这个硬结以后会吸收掉，今天换海藻绵时发现伤口内有一个白点，挤压硬结，白点会有白色液体、血液渗出，硬结就小了很多，不知这是什么情况，麻烦帮助解答下

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可能因为这段时间喝酒和吃上火的食物，也有一点每晚都很迟睡，其他没什么状况，水也没少喝，湛江大医院可以割吗？ 现在有涨痛情况，想消除涨痛，里面有浓了，用什么可以消除涨痛。

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男,61岁。肛瘘半年了，还有混合痔，得过梅毒以治愈，医院收治吗。

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男,4个月。前期流脓，现在已经不流，但是凹陷！婴儿没有发烧

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