{"title":"肛门和肛周疾病","authors":"Bruce D. George, Jonathan Gosling","doi":"10.1016/j.mpmed.2024.02.001","DOIUrl":null,"url":null,"abstract":"<div><p>Most anal diseases can be diagnosed by a careful history and examination. Management of haemorrhoids involves exclusion of more serious pathology, adequate explanation of the disorder, and dietary and defecatory advice; most do not require additional treatment. Outpatient procedures or surgical intervention can be required for more symptomatic cases. Anal fissures are initially managed with bulking laxatives and non-constipating analgesics; glyceryl trinitrate ointment is standard first-line treatment. Lateral internal sphincterotomy is indicated rarely for fissures that do not heal after pharmacological management, although it is associated with a small risk of impaired continence. Anal fistulae and abscesses represent extremes of a single disease spectrum. Perianal abscesses should be treated by prompt adequate surgical drainage. Low fistulae are treated by fistulotomy. High fistulae require more complex sphincter-preserving techniques. Patients with faecal incontinence should be investigated with anal physiological tests and endoanal ultrasonography. Conservative treatment includes dietary modification, constipating drugs, physiotherapy and biofeedback. Sacral nerve stimulation represents a new, expensive but relatively non-invasive treatment option for patients with faecal incontinence after failure of first-line conservative therapy. Patients with functional constipation should be assessed to distinguish slow transit from obstructed defecation. Laparoscopic ventral rectopexy can be appropriate for selected patients with rectal intussusception.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anal and perianal disorders\",\"authors\":\"Bruce D. George, Jonathan Gosling\",\"doi\":\"10.1016/j.mpmed.2024.02.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Most anal diseases can be diagnosed by a careful history and examination. Management of haemorrhoids involves exclusion of more serious pathology, adequate explanation of the disorder, and dietary and defecatory advice; most do not require additional treatment. Outpatient procedures or surgical intervention can be required for more symptomatic cases. Anal fissures are initially managed with bulking laxatives and non-constipating analgesics; glyceryl trinitrate ointment is standard first-line treatment. Lateral internal sphincterotomy is indicated rarely for fissures that do not heal after pharmacological management, although it is associated with a small risk of impaired continence. Anal fistulae and abscesses represent extremes of a single disease spectrum. Perianal abscesses should be treated by prompt adequate surgical drainage. Low fistulae are treated by fistulotomy. High fistulae require more complex sphincter-preserving techniques. Patients with faecal incontinence should be investigated with anal physiological tests and endoanal ultrasonography. Conservative treatment includes dietary modification, constipating drugs, physiotherapy and biofeedback. Sacral nerve stimulation represents a new, expensive but relatively non-invasive treatment option for patients with faecal incontinence after failure of first-line conservative therapy. Patients with functional constipation should be assessed to distinguish slow transit from obstructed defecation. Laparoscopic ventral rectopexy can be appropriate for selected patients with rectal intussusception.</p></div>\",\"PeriodicalId\":74157,\"journal\":{\"name\":\"Medicine (Abingdon, England : UK ed.)\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medicine (Abingdon, England : UK ed.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1357303924000379\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicine (Abingdon, England : UK ed.)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1357303924000379","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Most anal diseases can be diagnosed by a careful history and examination. Management of haemorrhoids involves exclusion of more serious pathology, adequate explanation of the disorder, and dietary and defecatory advice; most do not require additional treatment. Outpatient procedures or surgical intervention can be required for more symptomatic cases. Anal fissures are initially managed with bulking laxatives and non-constipating analgesics; glyceryl trinitrate ointment is standard first-line treatment. Lateral internal sphincterotomy is indicated rarely for fissures that do not heal after pharmacological management, although it is associated with a small risk of impaired continence. Anal fistulae and abscesses represent extremes of a single disease spectrum. Perianal abscesses should be treated by prompt adequate surgical drainage. Low fistulae are treated by fistulotomy. High fistulae require more complex sphincter-preserving techniques. Patients with faecal incontinence should be investigated with anal physiological tests and endoanal ultrasonography. Conservative treatment includes dietary modification, constipating drugs, physiotherapy and biofeedback. Sacral nerve stimulation represents a new, expensive but relatively non-invasive treatment option for patients with faecal incontinence after failure of first-line conservative therapy. Patients with functional constipation should be assessed to distinguish slow transit from obstructed defecation. Laparoscopic ventral rectopexy can be appropriate for selected patients with rectal intussusception.