Mardini Houssam E, Schwartz David A
David A. Schwartz, MD Director, Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, 1501 TVC, Nashville, TN 37232, USA.
Curr Treat Options Gastroenterol. 2007 Jun;10(3):211-20. doi: 10.1007/s11938-007-0014-2.
The management of perianal abscesses and fistulas is relatively straightforward in most cases and based on a sound knowledge of the anatomy of the anorectum and adherence to established medical and surgical principles. Asymptomatic fistulas should not be treated, whereas abscesses require surgical drainage under general anesthesia. Fistula treatment includes drainage of any associated sepsis and eradication of the fistula track to prevent recurrence while preserving sphincter integrity. A small percentage of anal abscesses and fistulas are complex and very challenging to manage, particularly in conditions such as rectovaginal fistulas and abscesses and/or fistulas complicating Crohn's disease. Treatment strategies in these situations rely on an accurate clinical assessment of the degree of rectal inflammation and perianal pathology. Treatment should combine aggressive medical therapy (antibiotics, immunomodulators, and anti-tumor necrosis factor antibody treatment) and minimal surgical interventions. Patients with proctitis have a significantly lower healing rate and a significantly higher complication rate with aggressive surgical interventions.
在大多数情况下，肛周脓肿和肛瘘的处理相对简单，基于对肛管直肠解剖结构的扎实了解以及遵循既定的医学和外科原则。无症状的肛瘘不应治疗，而脓肿需要在全身麻醉下进行手术引流。肛瘘的治疗包括引流任何相关的脓毒症以及根除瘘管以防止复发，同时保持括约肌的完整性。一小部分肛门脓肿和肛瘘情况复杂，处理极具挑战性，尤其是在直肠阴道瘘以及克罗恩病并发的脓肿和/或肛瘘等情况下。这些情况下的治疗策略依赖于对直肠炎症程度和肛周病变的准确临床评估。治疗应结合积极的药物治疗（抗生素、免疫调节剂和抗肿瘤坏死因子抗体治疗）以及最小限度的手术干预。对于直肠炎患者，积极的手术干预会使其愈合率显著降低，并发症发生率显著升高。
