Abcarian Herand
Clin Colon Rectal Surg. 2011 Mar;24(1):14-21. doi: 10.1055/s-0031-1272819.
Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection. Abscesses are thought to begin as an infection in the anal glands spreading into adjacent spaces and resulting in fistulas in ~40% of cases. The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases. A surgeon dealing with fistulas on a regular basis must tailor various operations to the needs of the patient depending on the complexity of the fistula encountered.
肛门直肠脓肿和肛瘘是成人中最常见的疾病。脓肿和肛瘘应被视为同一肛门直肠感染的急性期和慢性期。脓肿被认为始于肛门腺感染，蔓延至相邻间隙，约40%的病例会导致肛瘘。肛门直肠脓肿的治疗是早期、充分、依赖引流。肛瘘的治疗虽然在所有病例中都需手术，但由于括约肌切开术可能导致大便失禁，所以更为复杂。原发性肛瘘切开术和切开挂线术导致大便失禁的发生率相同，这取决于肛瘘的复杂程度。因此，即使手术的目的是治愈肛瘘，但为了避免大便失禁，在不进行主要括约肌切开术的情况下进行保守治疗是必要的。然而，用诸如引流挂线、纤维蛋白粘合剂、肛瘘栓、直肠推进皮瓣、带蒂皮瓣、肛门成形术和LIFT（括约肌间瘘管结扎术）等保守（非括约肌切开）手术替代根治性手术，在许多情况下都会导致更多复发/持续存在，需要反复手术。经常处理肛瘘的外科医生必须根据所遇到肛瘘的复杂程度，为患者量身定制各种手术。
