2020年10月18日星期日

hemorrhoids or anal cancer,Anal fistula

    1. What is anal fistula and what are the symptoms of anal fistula?

    Anal fistula refers to anorectal fistula. It is a sequelae of the rupture of an abscess around the anus. The fistula is different from the sinus. The sinus has only one tube outward from the sore. Although there are secretions and pus and blood flowing out from the sore, it is not connected to the body. Anal fistula has a tube that communicates with the sore in the rectum and the sore outside the anus. The sore in the rectum is called the internal opening, and the sore outside the anus is called the external opening. The main symptoms of anal fistula are pus, anal itch and pain. The amount of pus is related to inflammation. During the acute inflammatory period, there is a lot of pus, and there is often a foul smell. Due to the bending of the fistula, there are many branches, the drainage is not smooth, and there is often pus. In the chronic inflammation period, the discharge of pus is less, sometimes absent, and the pus is thin or rice-sweet-like discharge. Anal itching is caused by the secretions flowing out of the fistula irritating the local skin of the anus. Pain is caused by poor drainage, blocked secretions, or repeated inflammation. The pain can be fullness or burning pain in the anus. If there is no pus or blockage, there is generally no pain. Anal fistula inflammation can also be accompanied by systemic symptoms, such as chills and fever, and increased peripheral blood. If long-term suppuration forms a complex anal fistula, it may also be accompanied by anemia, weight loss, loss of appetite and so on.

    2. How does anal fistula form?

    Anal fistula refers to the fistula that communicates with the anal canal or rectal cavity. Anal fistula is the sequelae of the rupture of an abscess around the anorectal. One end of the fistula leads to the infection foci of the anal sinus and anal gland in the anal canal, called the internal opening; the other end leads to the skin around the anus, called the external opening. According to the folks, its main symptom is the continuous discharge of pus and blood from the sores on the skin around the anus, just like a broken house often leaks, so the ancients named it "anal fistula". Severe anal fistula sees feces flowing out, so people call it "rat stealing feces" more vividly. A fistula is different from a sinus. A fistula is a tube that has two fistulas between the body and the body. It can leak secretions and pus to the body. The sinus has a sinus floor, and only one open sinus tract leaks secretions and pus. Fistulas and sinuses are clinically different, and they must not be confused. The formation of anal fistula is an inevitable result of the development of abscesses around the anorectum. The formation of anal fistula roughly goes through four stages:

    In the first stage, the anal crypts and anal flaps are infected and inflamed. At first, it is limited to local inflammation. If it is not treated in time, the inflammation can spread around the anus.

    In the second stage, the inflammation starts from the local anal recesses and anal flaps, and gradually spreads, forming perirectal inflammation. If the inflammation cannot be controlled, it may invade the tissue gaps with low disease resistance.

    In the third stage, due to the decreased disease resistance of the tissues around the anorectal space, it becomes a place for germs to invade, spread, accumulate and multiply, causing the tissues here to be prone to infection and inflammation, which is invincible, and the formation of anorectal abscesses. If the anorectal abscess can be treated properly in the early stage, the abscess can often disappear and heal without leaving any sequelae; if the early treatment is delayed or improperly handled, the tissue necrotic pus can spread along the local space, making the condition aggravated and complicated. Surgical incision and drainage as soon as possible to excrete pus and control the development of inflammation.

    In the fourth stage, the abscess around the anorectum ruptures spontaneously or after incision, drainage and dressing, although the abscess cavity is gradually reduced, the ulcer does not close for a long time. At this time, the cavity wall has formed a hard duct wall with connective tissue hyperplasia. The space left in the middle is the fistula. Pus often flows out of the fistula, causing repeated infections and recurring attacks. It cannot heal itself for a long time and becomes a fistula.

    3. How to treat anal fistula?

    No single technique is suitable for the treatment of all anal fistulas, so the treatment of anal fistulas is performed based on the experience and judgment of the surgeon. The degree of sphincter amputation, functional impairment and postoperative cure rate should be weighed. How to solve the contradiction that the anal fistula can be cured and the function of the anus can be protected is still a difficult problem. Now we will make a brief discussion on this issue based on our clinical experience and related domestic and foreign reports.

    In May 2001, with the support of the key project of the Traditional Chinese Medicine Bureau of the Hunan Provincial Department of Health, we searched the China Journal Network (www.cnki.com) from 1994.1-1999.12 about the treatment of anal fistula in the literature, a total of 131 articles for statistical analysis , To discuss the surgical treatment of anal fistula.

    In 95 surgical treatment reports, 47 surgical names were mentioned, and they were mainly composed of 7 basic surgical procedures, namely, incision, resection, suture, suture, exclusion, wound expansion, and drainage. The frequency of each surgical procedure was: 95 times of drainage, 100%; 93 times of wound expansion, 97.9%; 86 times of incision, 90.5%; 66 times of sutures, 69.5%; 32 times of exclusion, 33.7%; 14 times of sutures Times, 14.7%; 9 times, 9.5% (see Table 1).

    Table 1 The frequency of use of seven basic surgical procedures in various types of anal fistula surgery

    Low Low Low High High Total

    Simplicity Complexity Simplicity Complexity

    (n,%) (n,%) (n,%) (n,%)

    Incision

    cut

    Thread Hanging

    Suture

    Absence

    Expansion

    Drainage

    5 (71.4%) 24 (88.9%) 26 (71.4%) 35 (71.4%) 89

    2(28.6%) 4(71.4%) 2(71.4%) 0(0) 9

    1 (14.3%) 5 (71.4%) 25 (71.4%) 34 (71.4%) 66

    0(0) 9(71.4%) 3(71.4%) 2(71.4%) 14

    0(0) 8(71.4%) 0(0) 24(71.4%) 32

    5 (71.4%) 27 (100%) 26 (71.4%) 35 (71.4%) 93

    7 (100%) 27 (100%) 26 (71.4%) 35 (71.4%) 95

    It shows that drainage, expansion and incision are the main surgical procedures for non-conservative treatment of anal fistula, and the frequency of use is as high as 90%. The utilization rate of thread-hanging technique is 69.5%, which shows that this technique is also indispensable in the surgical treatment of anal fistula, especially to solve high anal fistula, which highlights the characteristics and advantages of traditional Chinese medicine. The frequency of combined exclusion and suture were 33.7% and 14.7%, respectively; resection only accounted for less than 10%. It can be seen from the above table that incision, expansion, and drainage are used more frequently during the operation of low anal fistula, and incision, expansion, threading, and drainage are used more frequently during the operation of high anal fistula: Surgery is more frequent than simple surgery during the operation of complex anal fistula.

    Many studies have reported large differences in the results of anal fistula surgery due to population differences, different definitions of anal fistula classification and dysfunction, and different lengths of follow-up. In recent years, the methods of combining traditional Chinese medicine and modern medicine have been used, using comprehensive treatment methods such as thread hanging, exclusion, internal mouth repair, decoupling, skin flap transplantation, suture thread hanging drainage, thread tube drainage, etc. The correct application of antibiotics , Pay attention to the protection of the anal sphincter during the operation. Clinically, it has made great progress in maintaining anal control function, reducing recurrence and postoperative complications. However, there are still problems such as various sequelae and multiple operations. Therefore, how to reduce the recurrence in the true sense, improve the curative effect, protect the anal control function, and maintain the integrity of the anus shape and function needs further research and exploration.

    Correctly handling the internal ostium and the primary lesion is the key to the operation. The internal ostium must be completely removed during the operation. You can use probes, digital examination, staining, angiography, fistula external traction, cutting and checking, and carefully finding the internal ostium. Avoid rough movements that cause false roads and false internal mouths.

    (1) The basic principles of anal fistula incision and expansion surgery include: clarify the entire fistula from the inner mouth to the outer mouth, and determine and remove the main and branch tubes. Anal fistula incision is better than anal fistula resection. Although the recurrence rate of the two is similar, the latter has a large wound, long healing time, and a high incidence of anal incontinence. Anal fistula resection and suture are the complete removal of the diseased tissue and the suture of the wound. If the treatment is appropriate, the effect is good, but it is generally believed that the use of this method must be reasonable selection of cases and strict mastery of aseptic operation techniques. This method is easy to cause the infection to recur, but after failure, the cure date is prolonged and the condition is more complicated.

    Anal fistula surgery requires not only the radical cure of the disease, but also the preservation of the normal function and shape of the anus, which is very difficult. If you only emphasize the radical cure of the disease, cut along the fistula and blindly cut off the anal sphincter to form a large incision, which is conducive to drainage, but the result is deformity around the buttocks and anus and fecal incontinence. If it is only to preserve the function of the anal sphincter, it will face the problem of recurrence after operation. Therefore, the treatment principle must be strictly followed when performing the operation, and the operation method with the best curative effect and the least damage should be selected.

    (2) The hanging thread is to use an elastic material to penetrate the fistula and fix it. The application of thread hanging can promote fibrosis around the sphincter muscle along the fistula, so that the final anal fistula incision, or gradually tighten the thread, so that the degree of sphincter defect and anal incontinence is limited. The principle that thread-hanging therapy is not easy to cause anal incontinence is: (1) The foreign body stimulation of the thread can cause an inflammatory reaction around the sphincter, which causes local fibrosis and fixes the adhesion of the muscle end; (2) The mechanical strangulation of the thread, The slow separation effect can separate the local tissues while growing and repairing, and will not cause incontinence; (3) The thread is used as a guide wire for the deep part of the lesion and has a good drainage effect, which can reduce infection and promote wound healing.

    The thread-hanging organization should be small, and it is not advisable to bundle the thread-hanging. This requires that the lesion should be opened as much as possible during the operation, and only part of the muscle tissue should be thread-hanging, so that the purpose of the thread-hanging is more clear, and it can also avoid easy omissions when simply hanging the thread. Problems such as branch pipes and residual cavity. For large-bundle tissues, grouped hanging lines or double hanging lines can be used. Grouped hanging lines can solve the problem of incomplete cutting of large-bundle tissue hanging lines and the need to tighten the lines again. For those who need to cut and hang the thread at two places at the same time, you can first tighten the thread at one place and hang the floating thread first. After the first tightening thread is cut, the floating thread can be tightened. This can avoid the second operation or one time. Possible problems caused by surgery.

    (3) Smooth drainage of the wound surface is an important guarantee for the success of anal fistula surgery. Poor drainage after anal fistula surgery will lead to delayed wound healing or even failure to heal.

    ① Wound expansion and drainage. During the operation, the fistula should be cut and the wound should be properly expanded to make it a radial diamond-shaped incision, wide outside and narrow inside, with sufficient drainage.

    ②When the thread-hanging drainage is combined with the residual cavity that is difficult to handle and the internal orifice is large, the thread-hanging drainage should be used. The thread should not be tightened immediately during the operation, and the dressing, traction, flushing, and drainage should be changed after the operation to stimulate the surrounding area of ​​the internal orifice. And the residual cavity to remove rot and make new, and then cut it tightly. Floating lines can be used for drainage of branch pipes and open parts.

    ③ Inserting a tube to flush and drain the blind cavities of the main and branch tubes is an important part of the operation to improve the efficacy. Some high-level anal fistulas, due to the deep location and narrowing of the tube cavity, the blind cavity at the top of the main tube is hidden, and there will be side holes during the operation. A thin silicone drainage tube is placed in the lumen of the fistula, and the outer end of the rubber tube is sutured and fixed on the skin edge of the wound. After the operation, it is washed with hydrogen peroxide, normal saline, metronidazole, etc., and the wound surface of the deep wound cavity is transformed for about 10-15 days. For healthy granulation, no necrotic tissue, and the depth of wound cavity becomes shallow, the drainage tube is gradually removed in the sub-group.

    ④The number of openings is determined by the length of the main duct and branch ducts for open drainage. Based on the principle of smooth drainage of the lumen, a curette is inserted from the opening to scrape the necrotic tissue in the lumen of the fistula. Be left open. Be careful not to prematurely adhere or form dead spaces between the drainage windows. In the application research and multi-center clinical evaluation of the open fenestration method in anal fistula surgery, He Yongheng et al. found that the open fenestration method can reduce perianal tissue damage, reduce scar formation, and shorten the hospital stay.

    Although domestic and foreign scholars have made many beneficial attempts in the treatment of anal fistulas, especially high complex anal fistulas, they have also made certain achievements in how to solve the problem of completely removing the lesion, reducing the recurrence rate and protecting the anal self-control function. Very mature and standardized.

    We believe that the appropriate combination of incision and expansion, thread hanging, and drainage, combined with segmental fenestration and exclusion, can be used to treat various anal fistulas, and the effect is reliable. And standardized into our department's optimized treatment plan for anal fistula.

    For example, the posterior horseshoe anal fistula should not only completely eradicate the primary lesion, but also avoid tissue damage around the anal canal, especially to protect the integrity of the external anal sphincter. Therefore, during the operation, the wound should be opened in the posterior position to make a radial fusiform incision, find the inner mouth and the main lumen and hang the thread, expand the outer mouth of the branch pipes on both sides, scratch the corrupt tissue inside, and hang the floating thread. , If the pipe is too long, it can be left open. If the lumen of the posterior rectal space is too deep, the pipe should be placed for flushing and drainage. After healing, scar formation is less, the anal function is protected, the healing time is greatly shortened, the patient's pain is alleviated, the postoperative care is easy, and the treatment is thorough and not easy to relapse.

    Dressing change is very important for curing anal fistula. Whether the dressing is changed properly or not is not only related to the speed of wound growth and healing, but also can avoid delayed wound healing. When changing the dressing, observe whether there are bronchial sinus leftovers, so that it can be corrected at any time, and create more favorable conditions for wound healing. When changing the dressing, the drainage gauze must be filled into the wound cavity so that the granulation tissue grows outward from the base until the wound is flat. For the early inflammation of the wound, gentamicin and metronidazole gauze can be used to change the dressing. Granulation edema on the wound should be trimmed in time, or the dressing should be changed with hypertonic saline. For those with slow wound growth, use Shengjiyou gauze to change the dressing to promote wound healing. Whether the dressing is changed properly or not is not only related to the speed of wound growth and healing, but also to avoid delayed wound healing, as well as the presence or absence of bronchial sinus leftovers, so that it can be corrected at any time and create more favorable conditions for wound healing.

    Our department treats anal fistula in accordance with a standardized program, under the premise of ensuring the shape and function of the anus, carefully check the internal mouth, main duct, branch duct and blind cavity before the operation, and strive to completely remove the lesion, so that the patient can be cured at once.

    4. What is the matter of feces or urine outflow from the external mouth of anal fistula?

    The main manifestations of anal fistula are pus, anal itching and anal pain. According to statistics, more than 90% of fistulas around the anus are connected to the rectum. Since the inner mouth of the anal fistula in the rectum and the outer mouth of the skin outside the anus are connected by a pipe, when the anorectal fistula is repeatedly inflamed and the inner mouth is constantly sunken and deepened, if it is exhausted and defecate, its gas and stool It is very likely to enter the inner mouth, and finally feces from the outer mouth. At this time, the patient will feel gas and feces flowing out of the outer mouth. If the fistula is just near the perineum, and the inner mouth of the rectum is on the front wall of the rectum, the inner mouth is enlarged and deepened due to repeated inflammation, piercing the muscle layer of the urethra, and communicating with the urethra, then there will be urine when urinating Flow out from the outside mouth. Therefore, this anal fistula is also called urethral fistula. If the fistula is connected to the bladder, it is called anorectal fistula. This shows that feces or urine leakage outside the fistula is related to the fistula and its invaded parts and adjacent tissues and organs.

    5. How to prepare psychologically for patients with anal fistula before surgery?

    Most patients with anal fistula have undergone perianal abscess incision and drainage surgery. Before the abscess incision, the abscess cavity was filled with pus, the pressure in the cavity increased, the necrotic tissue was wrapped into a cyst, the local infiltration anesthesia was blocked, and the anesthetic could not infiltrate evenly. The entire abscess surface, so you will still feel pain when incising. If you use your fingers to fully expand the abscess cavity so that the pus is completely drained, the patient will feel more painful. Although antibacterial and anti-inflammatory and local washing and dressing were applied after the operation, the abscess eventually formed an anal fistula with pus and blood. When the doctor tells the patient that the anal fistula must be cured by surgery, the patient is naturally full of fear of the operation. Those patients whose anal fistula recurs after surgery are even more worried. They are even less confident about whether their anal fistula can be cured. In this case, it is particularly important to make psychological preparations for patients with anal fistula before surgery. So as medical workers, when receiving these patients, they must first be kind, enthusiastic in service, and friendly in speech, so that patients feel happy mentally and warm emotionally, thus shortening the distance between doctors and patients and increasing The patient's trust in the doctor. As patients and their family members, they should introduce their onset history, treatment status, and current symptoms to the doctor in detail, answer the doctor’s inquiries truthfully, and let the doctor familiarize themselves with their condition and characteristics. It should be understood that local anesthesia is incomplete during perianal abscess incision, and the principle that anal fistula disease can only be completely cured by surgery (and after the anal fistula is formed, the earlier the surgery is done, the easier it is to succeed). You must fully believe that your doctors, especially specialists, have accumulated a lot of successful clinical experience, and will be responsible for your own health and at the same time the doctor's own reputation. Understand that anal fistula surgery is different from perianal abscess surgery. After anal fistula is anesthetized, you generally no longer feel pain. Although there is pain in the postoperative wound, the doctor will give corresponding treatment. Try to imagine that with the completion of the anal fistula operation, the disease burden on my back will be removed, and my future studies, work, and life will be normal. If the patient is in a positive state of mind under the control of this kind of thought, it will naturally increase the confidence in overcoming the disease and the stress of surgery. If the patient listens to relaxing and beautiful music before the operation, or chats with family members and other patients, talks about interesting things that have nothing to do with the disease, or listens to the doctor’s successful experience in treating such diseases, the patient can stabilize his emotions. If you relax your mind, you can obviously improve your tolerance to pain and you can calmly accept the doctor's surgical treatment.

    6. How do patients with anal fistula take care of themselves after surgery?

    How can anal fistula patients undergo self-care after undergoing anal fistula surgery to reduce and prevent the many discomforts and complications that may occur after surgery? Generally speaking, the most common discomforts and possible complications after anal fistula surgery are: Pain, bleeding, constipation or diarrhea, urinary retention, loss of appetite and fatigue, insomnia, even fever, colds, allergies or infections of local wounds, etc. Therefore, patients and their families can take care of themselves or assist in the following aspects:

    ① Care for pain relief: Before the operation, the patient eats well and sleeps well, and relaxes his mind. The patient’s family should speak more to encourage the patient to overcome the fear and tension of the operation. Once the patient is out of the operation, the family members will greet the patient outside and have already made the bed soft and comfortable, giving the patient more mental strength, because family affection can make the patient feel warmer, plus enough physical fitness and adequate sleep, Improve pain tolerance. If the patient lies in bed for a long time, turns over or gets out of bed to urinate, or sits up and drinks water to eat, the movement should be light and gentle, the movement range should not be large, and the posture should be natural and comfortable. With appropriate use of oral painkillers, it can significantly reduce the operation pain.

    ② Observation and care for preventing bleeding: After the operation, the wound surface is mostly open, so there will be varying degrees of fluid leakage on the wound surface. How can we distinguish whether it is exudate or oozing or bleeding? At this time, the patient and family members should check whether the dressing is dry or wet after one or two hours. If it is wet and the color is light and dark red, it means It is a normal exudate; if there is a lot of exudation and the whole dressing is soaked, you can't tell whether it is bleeding or exudation. You can ask a doctor or nurse to observe it yourself. If the dressing wets quickly and the color is bright red, the patient himself obviously feels a pulsating sensation in the wound, or feels anal swelling or abdominal distension, and the doctor should be notified in time to prevent excessive bleeding or bleeding. In order to reduce and prevent bleeding, the patient should be less active and not eat warm and dry products; stop the treatment of other diseases, such as anti-rheumatic drugs, blood circulation regulating drugs, and traumatic injuries. Medicine; eat more soft and easy-to-digest foods, eat more fruits and vegetables, to keep stool smooth. After using toilet paper and taking a bath to wash the wound, the movements should be gentle, do not pull the hemostatic thread on the wound, and take the hemostatic and anti-inflammatory laxative prescribed by the doctor on time.

    ③Nursing to prevent urine retention: In order to prevent the pain of lower abdomen fullness and frequent urination shortly after the anal fistula operation, but the pain of urinary retention cannot occur, the patient should urinate before the operation and drink Liuyisan immediately after the operation. When the abdominal distension and urinary urge are obvious, it is best to go to the toilet with the help of the family member to urinate on their own, and at the same time, pay attention to the proper loosening of the T-band that strengthens the fixed dressing. The family prepares a hot water bottle for the patient to put on the lower abdomen to apply heat; if necessary, turn on the faucet and let the sound of running water induce the patient to urinate. The patient should concentrate his mind and hold his breath to increase abdominal pressure to promote urination. Usually after the above methods, most patients can urinate on their own; if 6 hours after the operation, the urine still does not come out, and the lower abdomen is full and bulging, the patient should cooperate with doctors and nurses for intubation or acupuncture catheterization.

    ④ Nursing care to prevent diarrhea or constipation: After anal fistula operation, if you pay attention to prevent diarrhea or constipation, the patient can reduce the pain of the wound during defecation, reduce the pain of the wound during bathing and dressing, and also reduce the chance of bleeding and infection. . Then, for patients with gastrointestinal deficiency, cold and easy diarrhea or patients with mild enteritis, it is best to eat an easy-to-digest diet, such as pasta, porridge, and eat half full and eat less greasy food before surgery. After the operation, the diet should be light. It is advisable to eat hot food when eating, eat less or not eat cold and cold products, and if necessary, take some digestive products such as yeast and hawthorn. For patients with constipation, eat more vegetables, fruits, honey, drink more water, eat soft foods, and pay special attention to the habit of regular bowel movements after getting up in the morning. 5 days after the operation, you can use soapy water enema before each bowel movement to promote bowel movement. At the same time, massage the abdomen more. Pay attention to the massage from the bottom right to the top right and then to the bottom left. You can use some moisturizing bowel under the guidance of the doctor. medicine.

    7. How to prevent wound infection after anal fistula operation?

    The wound after anal fistula surgery is basically left open. However, the doctor also requires the patient to defecate regularly every day. Undoubtedly, the wound will be contaminated by stool. Naturally, the patient and family members are very worried that the wound will become infected and inflamed. In fact, as long as the doctor pays attention to the cleansing and dressing of the wound, and the patients and family members strengthen prevention, it is rare to see wound infections after anal fistula surgery. Therefore, as patients and their families, it is necessary to pay attention to the habit of regular bowel movements after the operation. It is advisable to take one time a day to actively prevent or treat diarrhea and constipation. After going to the toilet, use warm PP powder or heat-clearing and detoxifying medicinal solution to take a bath, clean the fecal residue on the wound in time, change underwear frequently, and maintain local hygiene around the anus. If the clothes are soaked due to excessive water or sweating, change them in time. Pay attention to the warmth of the bedding, keep the bed flat, clean, dry, free of scum, and pay attention to a proper nutritious diet to improve the body’s resistance and prevent colds. Prevent bacteria from taking advantage of the deficiency and causing wound infection. In addition, if conditions permit, the patient’s bedding should be changed and washed frequently. When the weather is fine, the patient should be allowed to go out to bask in the sun and breathe fresh air. Always pay attention to the clean air circulation in the room, such as always open doors and windows, no smoking indoors. Since the wound exudates more after anal fistula surgery, it is advisable to put a rubber or plastic sheet on the bed where the buttocks are placed, and put some clean toilet paper on it to prevent the exudate from soaking the bed sheet and the cotton under it. At night, the patient should rest early to ensure enough sleep, so that the body is in the best functional state and promotes wound repair. If during the process of dressing and repairing the wound, the patient feels that the secretion increases, the wound has swelling or needle-like pain, or the skin around the wound is burning and red, the doctor should be notified in time to prevent or reduce the infection.

    8. How do patients with anal fistula adjust their diet?

    From the point of view of Chinese medicine, dietary conditioning is of great significance to the prevention and treatment of diseases. As early as the "Internal Classics", there is the saying that "there is fullness, the muscles and veins are laterally relieved, and the intestinal addiction is hemorrhoids", indicating that improper diet is the main cause of anorectal disease. Clinical medical practice has proved that proper dietary conditioning can promote the recovery of patients and prevent or reduce the occurrence of anal fistula disease. Therefore, patients with anal fistula should avoid eating spicy, fragrant, hot foods, mellow wines, thick, fat and sweet products and hair products, such as fried foods, peppers, ginger, garlic, betel nuts, spirits, pumpkins, spring bamboo shoots, etc., but should eat light and fresh Digestible food. Because the patients with anal fistula are mostly fierce male young adults, and the body is full of heat, it is better to have cold and light food. Specifically, water ducks, water fish, loach, snails, rabbit meat, and pigeon meat are suitable. Patients with tuberculous anal fistula are more suitable to eat whitebait, sea mussel, abalone, and sea cucumber that nourish yin and clear away heat. In addition, kelp, seaweed, asparagus, eggplant, cabbage, celery and spinach, bitter gourd, tomato, mung bean sprouts, and loofah are also suitable for patients with anal fistula. Fruits should be persimmons, bananas, loquats, water chestnuts, lotus seeds, horseshoes, walnut kernels, lilies, raw lotus roots, sweet potatoes, white fungus, etc. Those with dry intestines and constipation are often suitable for eating. If the anal fistula has been operated on, it is advisable to eat products with less residue and easy digestion such as rice porridge and noodles at the beginning of the operation. Every day, you can give half a catty of lean pork stew, and then add an appropriate amount of green vegetables. Those who have the conditions can eat bonito and sea bass soup to promote wound healing. In the later stage of wound repair, 20 grams of Codonopsis, 20 grams of raw astragalus and 250 grams of lean pig meat can be used in stewed soup to enhance the ability of muscle growth and mouth closure.

    9. What are the folk remedies that can assist in the treatment of anal fistula?

    Most patients with anal fistula have experienced perianal swelling, falling pain, fever, or constipation, ulceration of the lumps, bleeding and other pain. Some patients are busy with work and cannot spare time to go to the hospital for thorough diagnosis and treatment; some patients cannot be treated immediately because of a more serious disease of one kind or another; some patients also do not undergo surgery due to financial difficulties or fear of surgery Anal fistula, but the above symptoms really make the patient painful. In order to relieve the urgent need, the patient may try some folk remedies to diagnose and treat anal fistula. Usually the simplest and most feasible methods are: ①Soak raw soybeans and mash it into a muddy shape, and apply wet compress to the affected area; ②Use chixiaodou to grind into powder, adjust the egg white, and apply externally to the affected area; ③Add soy milk, rice swill, and ginger juice to the raw mung bean powder Mix thoroughly and apply externally to the affected area; ④ Use goose feathers to burn ashes and sprinkle on the affected area; ⑤ Pash the loach into mud and apply wet compress to the affected area; ⑥ Smash the carp intestines and apply externally to the affected area; ⑦ Burn the snail shells into ash, mix thoroughly with sesame oil, and apply to the affected area ⑧Pash the loofah into a mud and apply it to the affected area; ⑨Pash the raw eggplant or daylily root and apply wet compress to the affected area; mash the fresh purslane into a mud and apply it to the affected area, which can have obvious anti-inflammatory, swelling, antipyretic and pain-relieving effects. If combined with mung bean juice, watermelon juice, raw lotus root juice, Daqingye Jianshui or Coptis, Chrysanthemum and Licorice Jianshui, the effect will be better. Pay attention to use at the beginning of pain and swelling, and avoid eating pungent, warm, dry and hairy.

    10. How to exercise for patients after anal fistula surgery?

    After anal fistula operation, patients tend to stay in bed and move less due to wound pain, and even do not get out of bed even to wash and eat. However, lying in bed all day long, the blood circulation of the whole body is not smooth, which is bound to affect the body's metabolic function and delay the repair of the wound. Therefore, 2 to 3 days after the anal fistula operation, the patient can rest in bed more and should get out of bed every day. Such as walking slowly, about 15 minutes each time, 4 to 5 times a day to facilitate the exudation and secretion of the wound. Half a month after the operation, for patients with low-level simple anal fistula surgery and small wounds, they can walk outdoors, do Tai Chi, do deep breathing exercises, practice Qigong, and do gymnastics. For patients with high complex anal fistula surgery, they should insist on walking indoors to promote blood circulation throughout the body. When the inner mouth hanging line completely falls off, the patient should go outside and do the above fitness exercises to promote wound repair. In addition, patients should do more exercises such as levator anus exercises, bending exercises, squatting exercises, and stair climbing exercises. The purpose is to strengthen the anal function exercise and make the anal sphincter function basically or completely normal. There are two types of levator anus exercises: leg-clamping levator, sitting-standing levator, and tiptoe receding.

    ①Clamping the legs and lifting the anus: that is, the patient lies on his back, crosses the legs, clamps the buttocks and thighs forcefully, and gradually lifts the anus for about 5 seconds. The recovery can gradually extend the time of the anus. Repeat this 10 to 20 times, 2 to 3 times a day.

    ②Sit-up and anus-lifting method: the patient first sits on the side of the bed, crosses the feet, then stands up with hands on hips, while the anus is contracted and lifted for 5 seconds, and then relaxed and sit down. Repeat this 10 to 15 times, 2 to 3 times a day.

    ③ Tiptoe levitation method: the patient adopts a standing position, hands on hips, feet crossed, tiptoes up, and the anus is lifted at the same time for 5 seconds to restore. Repeat this 10 to 15 times, 2 to 3 times a day.

    When doing levator anus exercises, you can start to do it a few times a day less to tolerate. When doing bending exercises, the patient's legs should be slightly apart and bend over, with both hands stretched out to touch the toes, 10 to 15 times each time, 3 to 4 times a day. Squatting exercise method, that is, the patient's legs are slightly apart, the waist is straightened, the hands are raised forward, the knee joints are bent, so that the center of gravity of the body is moved down as much as possible, and then lifted. Repeat this way, squatting 20-50 times each time, daily 2 to 3 times. Climb stairs, climb 7 to 10 floors each time, 2 to 3 times a day. It should be noted that before the wound is healed, exercises should be gentle and gentle, not rough and fast, so as not to cause blood vessel rupture and bleeding in the wound; when the wound is completely healed and the scar has not softened, you should also avoid rough movements, excessive amplitude, and excessive frequency. Fast, so as not to tear the scar; when the anal fistula wound is fully healed, the patient can run or swim slowly to speed up breathing. Because the anus rises during inhalation and descends during exhalation, the rise and fall will inevitably drive the movement of the anal muscles.

    11. Can anal fistula be prevented? How to prevent it in daily life?

    Anal fistula is caused by the invasion of bacteria into the ducts of the anal glands in the anal sinuses. When the conditions are suitable, the bacteria in the ducts multiply and retrograde to the anal glands, and continue to multiply in a certain branch until the muscle layer is penetrated. Formation of perianal abscess, and eventually anal fistula. It is known from this that as long as bacteria do not invade the anal sinuses, anal fistulas can be prevented. Therefore, from the prevention and treatment of diseases, attention should be paid to the prevention and treatment of hemorrhoids, rectal polyps, anal fissures, anal sinusitis, anal papillitis, enteritis, constipation, rectal prolapse, etc., because these diseases often cause anal sinus inflammation and swelling, and local resistance is reduced , Bacteria are easy to invade. From the perspective of diet and daily life, it is advisable to eat light, fiber-rich products, avoid drinking alcohol and addicted to foods that are hot and fried, and pay attention to regular and quantitative diet. Develop good living habits, maintain the rules of life, and develop the habit of defecation regularly in the morning. Don't squat for a long time, don't read books or newspapers, concentrate on your mind, empty your stool once, wipe your anus gently with a clean and soft toilet paper, and then wash your anus with warm water. If conditions permit, it is best to use warm or cold water for a sitz bath every day, because after a warm sitz bath, it can cause congestion and expansion of local tissues and capillaries, strengthen capillary penetration, and achieve the purpose of improving local vascular, nerve and muscle function ; The cold water sitz bath can constrict capillaries, reduce exudation, and reduce swelling and stop bleeding. It is very effective for patients with dry stool, thrombotic external hemorrhoids and internal hemorrhoids. For people who are engaged in sedentary occupations, they should change their positions frequently, take time to move the lower limbs and waist, and raise the lower limbs as much as possible to promote blood return. For frequent business trips, it is advisable to ensure the regularity of life as much as possible, eat regularly, defecate regularly, ensure sleep, drink more water, eat more fruits and vegetables; when resting at home, avoid playing mahjong or poker all night long. You should always pay attention to food hygiene, especially in the hot summer, you should pay more attention not to eat bad food. Pay attention to the hygiene of cold drinks of melons and fruits, and pay attention that raw and cold cooked foods are not cut and used on all cutting boards to prevent the occurrence of enteritis. In addition, they often participate in physical exercises, such as gymnastics, swimming, running, dancing, etc., which can obviously promote blood circulation and muscle function throughout the body. The physique is strengthened and the body's disease resistance is improved, which can effectively prevent the occurrence of anal fistula.

    12. Why can't I leave the hospital prematurely after anal fistula?

    After anal fistula surgery, most patients are discharged in accordance with the doctor’s advice when the wound is completely healed. However, a few patients are required to be discharged early due to busy work or lack of care at home, or financial constraints and inability to pay for medical expenses. Then at least To what extent should the wound be repaired before discharge? According to medical practice, at least the internal mouth should be completely healed before discharge. Because the key to successful anal fistula surgery is the correct handling of the internal mouth. The success of the operation depends on the thoroughness of the operation and the correct dressing. If the patient is discharged prematurely before the inner mouth is healed, due to environmental influences, the patient cannot rest as well as in the hospital, or even have to travel several kilometers to the hospital for dressing change, and the transportation is not convenient, and the patient is often needed Walking for a long time, the wound may bleed due to friction or make the granulation tissue excessively proliferate and affect the healing. On the other hand, it’s not as good as living in the hospital after returning home, with irregular bowel movements, or too early to defecate, and the hospital does not go to work; or too late to defecate, the hospital is closed again, which prevents the wound from getting timely dressing changes Treatment affects healing. Some patients, because their home is too far away from the hospital, let their family members change the medicine at random, or ask non-specialist doctors to change the medicine. As a result, the surface of the wound is healed. In fact, it is bridge healing or pseudo-healing. In a few days, the wound will split automatically. After a long period of time, I had to re-operate to deal with the internal mouth and expand the external wound, which made the patient and the doctor dissatisfied. Therefore, patients with anal fistula must respect the doctor's opinion and be discharged early when the internal mouth is fully healed. After discharge from the hospital, you must also pay attention to food hygiene, regular life, regular bowel movements, proper exercise, and avoid sex when the wound is completely healed, and avoid changing dressings by non-specialist doctors.

    13. How can anal fistula patients relieve pain during defecation and dressing change after surgery?

    After anal fistula surgery, the wound is large and it reaches the anal sinus in the anal canal, and even extends slightly upward; and because of the high anal fistula, the anal sphincter is partially contracted and tightened, and the wound is stimulated by the friction of feces during defecation. It feels more painful, and some patients are very afraid of defecation. In fact, as long as the patient keeps the stool smooth, it is best not to let the stool become strips. You can eat more fiber-rich vegetables in your diet instead of dry meals. Before a meal, eat two bananas, or eat a few spoons of honey, or eat some Chinese medicine for laxative bowel movements. When defecate, hold your breath slowly and evenly to defecate. When the anus is opened for about a minute, take another breath to recover the anus, rest for a while, and then repeat the bowel movement. In this way, the wound will not be stretched due to excessive force for too long, which can reduce the pain of defecation. If possible, you can also take some sedative pain medicine half an hour before defecation, and ask the nurse to use 500 ml of warm soapy water to enema before defecation. Family members prepare a half-basin for clearing heat, detoxification, swelling and pain relief, and place it on a special chair frame. If the patient takes a long time, he can sit in the bath syrup for a few minutes. On the one hand, soaking in the syrup can relieve pain. The posture was changed so that the patient got a rest, and later squatted in the toilet to defecate. In this way, the wound pain during defecation can be significantly reduced.

    Before changing the dressing, you should follow the doctor's instructions, take a bath with warm Chinese medicine or PP powder solution for about 10 minutes, and try your best to clean the wound for yourself. At the same time, pay attention to taking painkillers such as Qutongpian, Diphene, ketorolac, etc. about 1 hour before bowel movement. In this way, the degree of fecal contamination in the wound can be reduced, and the work of the doctor to clean and disinfect the wound with disinfectant cotton balls when changing the dressing will be lighter, so the stimulation to the wound will be less, and the pain will naturally be less; After oral administration, the plasma drug concentration reaches the highest peak, and the doctor can operate it when the effect is best, which can relieve pain.

    14. Can anal fistulas be cured without surgery or can heal naturally?

    The incidence of anal fistula accounts for one-fourth of the entire anorectal disease, ranking second only to hemorrhoids.

    Anal fistula is mostly caused by perianal abscess ulceration, or fistula left after surgery. If a fistula develops, the operation should be performed as soon as possible, because the fistula will be delayed for a long time, the inflammation will gradually spread, the tissue will be eroded and rotted, and the area will increase day by day. It can not only derive branch pipes, but also invade deep tissues, especially spreading in Anal sphincter and anorectal ring. Sometimes, although an anal fistula can be temporarily closed, it is an illusion (called false healing). There are still bacteria and necrotic tissues that have not been completely eliminated in the duct. If the resistance drops or certain incentives are encountered, such as overeating, spicy and thick taste, Or catch cold and diarrhea, or work too much, etc., local inflammation can recur, infection and suppuration. When the closed mouth is not firm, pus can be discharged again at the original mouth, and it will not heal repeatedly. If the closed mouth is firm, the pus in the fistula can rupture into a new fistula in another weak place. Repeatedly, the fistula will gradually increase. Because long-term repeated pus discharge does not heal, it is bound to affect health. Therefore, if you suffer from anal fistula, if objective conditions do not allow it, conservative treatment is necessary, but it will not cure the anal fistula. For anal fistula to heal completely, you must rely on surgical treatment, and the earlier the better.

    15. How to cooperate with the doctor to prepare for anal fistula surgery?

    When patients with anal fistula prepare to undergo anal fistula surgery, most of the patients are nervous before the operation. I don't know whether the operation is smooth or whether it is painful during the operation. They seem a little panic and restless. In order to ensure the success of the operation as much as possible, the patient should also be fully prepared to cooperate with the doctor. First of all, the patient should maintain a relaxed and happy mood. Just imagine that after the operation, the troublesome and painful chronic diseases can be removed, and they can no longer worry about anal fistula as usual. In order to be more comfortable and hygienic after surgery, take a hot bath the day before surgery and change into clean clothes. Rest and go to bed as early as possible before surgery. Individuals who have poor sleep can soak their feet with warm water before going to bed, drink a cup of hot milk, take 1 or 2 tablets of Valium if necessary, and take care to prevent colds and gastroenteritis. On the day of surgery, it is advisable to eat light and digestible food for breakfast, and be careful not to overeat or eat too little. After the cleansing enema is given, the patient should go to the toilet a few more times, try to drain the stool and soapy water, and prepare a few pieces of clean and soft underwear and toilet paper to facilitate the replacement of the underwear contaminated by the exudation of the wound and the guarantee The doctor's operation went smoothly.

    16. What should the patient do during anal fistula surgery?

    When a doctor performs an anal fistula operation on a patient, the patient must relax his mind and follow the doctor's request to pose for the operation position. When the doctor administers anesthesia and pushes the medicine, the patient should be calm and steady, and should not yell at the slight pain when the needle is inserted, so as not to find the sacral hole or the needle to break into the muscle. After the anesthetic is pushed, the patient should truthfully tell the doctor the effect of the anesthesia. Because it is local anesthesia or sacral anesthesia, the patient is very clear about the actions and sounds of the local operation. Therefore, in addition to being not afraid, the patient has to wait for the doctor to perform the operation, instead of always saying "How long will the operation take? Is it alright?" ", "Hurry up" and other words that interfere with the doctor's mood. Because local anesthesia and sacral anesthesia only inhibit the somatic nerves, but have no inhibitory effect on the autonomic nerves, there is no pain during the operation, but there is pain in the digital examination and surgical stretch, so the patient must cooperate with the doctor in the operation , Do not shout, so as not to delay the operation time.

    17.How long does it take for anal fistula surgery to heal?

    Anal fistula is divided into simple anal fistula and complex anal fistula, high anal fistula and low anal fistula. Therefore, different anal fistulas have different surgical methods, and the size of the wound after the operation is also different. Usually, after the operation of low-position simple anal fistula, the wound surface is within 10 square centimeters. After correct and skilled routine dressing and other comprehensive treatments, it takes about 30 days to fully heal. For high complex anal fistulas, it usually takes about 50 days to repair the surgical wound. During wound repair, if you are allergic to certain medications, have eczema-like changes, or repeatedly trim excess granulation tissue that grows too fast, the wound repair will be delayed for about one week. If the allergens are not removed and the anti-allergic ointment is not used on the wound in time, the healing time of the wound will be significantly delayed. In addition, if the patient's physique is weak, the wound repair time will be extended.

    18. What are the possible complications after anal fistula surgery and what should be done?

    Complications may occur after anal fistula surgery, the most common are:

    (1) Bleeding: In general, there is no major bleeding during anal fistula surgery. Simple bleeding can be filled with gauze and fixed. The patient should rest in bed and reduce activities. If there are obvious bleeding points, the dressing will soon become red and soaked, so you should immediately call a doctor for examination and immediately go to the operating room to re-ligate the bleeding with silk thread. If there is a lot of bleeding, supplement fluids appropriately.

    (2) Urinary retention: Anal fistula surgery usually uses sacral anesthesia, so urinary retention is prone to occur, especially in elderly men. If the patient can stand up to urinate in the early postoperative period, urinary retention can often be eliminated. If urinary retention has occurred, neostigmine 0.5 mg intramuscular injection can be used to help urination, but it is contraindicated for patients with asthma. Urinary catheterization is possible when necessary, and Liuyisan, Bazhengsan or acupuncture points such as Qihai, Guanyuan, Sanyinjiao, and Yanglingquan can also be taken orally to promote urination. At the same time, the patient can use a hot water bottle to heat the lower abdomen, concentrate on the mind, and even turn on the tap to listen to the sound of running water to induce urination.

    (3) Anal incontinence: If the anal fistula surgery damages or cuts off the anorectal ring, or if the wound is tightly packed with gauze for a long time, it can cause different degrees of anal incontinence. Therefore, if the fistula passes through the anorectal ring, the thread-hanging method should be used to cut the rectal ring so as not to cause anal incontinence. For those who have repeated operations, postoperative patients should do more exercises with the levator ani muscle. Doing exercises for the relaxation and recuperation function of the anus three times a day, 3 minutes each time, can strengthen the function of the anal sphincter and prevent anal incontinence.

    (4) Wound infection: Although the anal pollution is serious, the actual wound infection is rare. Because anal wounds have strong innate immunity, after surgery, they often use syrup to take a bath. Pay attention to open the wound to facilitate the flow, and give the self-made gauze to the base of the mouth to change the dressing, so that the wound will not be contaminated and infected . If there are too many stools per day after the operation, the wound is not cleaned thoroughly, the basal drainage is not smooth, the medicine strip is not in place, and the patient is weak, infection may occur. Therefore, patients should learn to control their stools after surgery, preferably once a day. Those with enteritis can be treated with some symptomatic drugs.

    Caused by irritation of local skin on the anus. Pain is caused by poor drainage, blocked secretions, or repeated inflammation. The pain can be fullness or burning pain in the anus. If there is no pus or blockage, there is generally no pain. Anal fistula inflammation can also be accompanied by systemic symptoms, such as chills and fever, and increased peripheral blood. If long-term suppuration forms a complex anal fistula, it may also be accompanied by anemia, weight loss, loss of appetite and so on.

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