Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1420_Библиотеки_им_академика_М_И_Перельмана.pdf
Скачиваний:
0
Добавлен:
15.09.2026
Размер:
10 Мб
Скачать
☆
Diagnosis and Treatment of Anal Fistula
Renjie Shi Lihua Zheng
Editors
Diagnosis and Treatment of Anal Fistula
Editors
Diagnosis and Treatment of Anal Fistula
Editors
Renjie Shi Department of Anorectal Surgery Afliated Hospital of Nanjing University of Traditional Chinese Medicine Nanjing, Jiangsu, China
Lihua Zheng Department of Proctology China-Japan Friendship Hospital Beijing, China
ISBN 978-981-16-5803-7 ISBN 978-981-16-5804-4 (eBook)
https://doi.org/10.1007/978-981-16-5804-4
© Chemical Industry Press 2021
Jointly published with Chemical Industry Press The print edition is not for sale in China (Mainland). Customers from China (Mainland) please order the print book from: Chemical Industry Press. This work is subject to copyright. All rights are reserved by the Publishers, whether the whole or part of the material is concerned, specically the rights of reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Preface

This book deals with the diagnosis and treatment of anal stula, a difcult anorectal disease. This book is an elaboration and discussion on the history of anal stula, anatomy and physiology related to anal stula, etiology and pathology of anal stula, examination, diagnosis, treatment principles, surgi­cal procedures and their evaluation, conservative treatments, academic dis­putes, and other aspects. The research and progress of the diagnosis and treatment of anal stula at home and abroad are comprehensively and deeply expounded on. It contains the author’s long-term research accumulation and clinical experience. This book provides an overview of both the history and current situation of the disease, pays close attention to new research trends, combines closely with clinical practice, is comprehensive in content and rich in information, and has excellent practicability. It is suitable for all research­ers, graduate students, and clinical medical personnel engaged in anorectal specialty to learn from and reference.
Nanjing, China RenjieShi Beijing, China LihuaZheng
v

Acknowledgements

I would like to thank Joanna song (Oxon) and Junfang song for their help in language edit. I also would like to thank my family for their support, espe­cially my daughter Yunyang Shi, for her help in language edit.
vii

Contents

1 History of Cognition and Treatment of Anal Fistula . . . . . . . . . . 1
Renjie Shi and Feng Jiang
2 Anatomy and Physiology of Anal Fistula . . . . . . . . . . . . . . . . . . . 11
Renjie Shi, Dong Yang, and Min Zhang
3 The Etiology of Anal Fistula. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Renjie Shi, Feng Jiang, and XiaYong Yang
4 Clinical Manifestations of Anal Fistula . . . . . . . . . . . . . . . . . . . . . 43
Renjie Shi and Hongsheng Mao
5 Common Methods of Examination for Anal Fistula . . . . . . . . . . 47
Renjie Shi and Lihua Liu
6 Classification and Diagnosis of Anal Fistula. . . . . . . . . . . . . . . . . 89
Renjie Shi and JinHui Gu
7 The Therapeutic Principle of Fistula-in-Ano . . . . . . . . . . . . . . . . 101
Renjie Shi and Lihua Zheng
8 Surgical Treatment of Anal Fistula . . . . . . . . . . . . . . . . . . . . . . . . 109
Renjie Shi and Lihua Zheng
9 Nonoperative Treatment of Anal Fistula . . . . . . . . . . . . . . . . . . . . 173
Renjie Shi and YiXin Zhang
10 Diagnosis and Treatment of Special Anal Fistula . . . . . . . . . . . . . 181
Renjie Shi and Fang Liu
11 Controversial Problems in the Diagnosis and Treatment
of Anal Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Renjie Shi and Yu He
ix

Contributors

JinhuiGu Suzhou Hospital of Traditional Chinese Medicine, Afliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, China
YuHe People’s Hospital of Suzhow New District Hospital, Suzhou, Jiangsu, China
FengJiang Afliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
Fang Liu Sixth Afliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
LihuaLiu Nanjing Jiangbei Hospital, Nanjing, Jiangsu, China
HongshengMao Jingjiang People’s Hospital, Jingjiang, Jiangsu, China
RenjieShi Department of Anorectal Surgery, Afliated Hospital of Nanjing
University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
DongYang Afliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China
XiayongYang Taizhou Hospital of Traditional Chinese Medicine, Taizhou, Jiangsu, China
MinZhang People’s Hospital of Deyang, Deyang, Sichuan, China
Yixin Zhang Afliated Hospital of Xuzhou Medical University, Xuzhou,
Jiangsu, China
LihuaZheng Department of Proctology, China-Japan Friendship Hospital, Beijing, China
xi
History ofCognition andTreatment ofAnal Fistula
RenjieShi andFengJiang
1
Abstract
The names of anal stula and perianal abscess have been recorded in Chinese literature more than 2000 years ago. For the treatment of anal stula, historical documents of anal stulec­tomy and internal medication could be found. In the Sui Dynasty, it was believed that the cause of anal stula was related to the body as a whole. The treatment method of inserting medicine into stulas to corrode stulas was proposed in the Song Dynasty. In the Yuan Dynasty, the seton therapy of anal stula based on gravity and medicated thread was developed. Since then, this therapy has been continuously improved and optimized in terms of materials and methods and is still widely used in clinical practice at present. Modern medicine has recognized the etiology, exami­nation methods, and treatment principles of anal stula since the time of Hippocrates more than 2000 years ago. However, the role of the anal gland in the pathogenesis and treatment of anal stula was not recognized until 1958,
R. Shi (*) Department of Anorectal Surgery, Afliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
F. Jiang Afliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
and it has been possible to cure anal stula since then. Currently, the treatment of anal s­tula is developing in the direction of protect­ing anal function and improving the cure rate.
Keywords
Anal stula · Chinese medicine · History Name of the disease · Pathogen · Pathology Treatment · Seton therapy
1.1 The Knowledge andTreatment History ofAnal Fistula inChinese Medicine
In the ancient Chinese literature, “abscess,” “s­tula,” or other terms were rst put forward in the “Shan Hai Jing,” which was written in the Western Zhou Dynasty. For example, an extract in “Shan Hai Jing • Zhongshan Jing” details, “there were many Teng Fish in He River which can be eaten to get carbuncle and treat stula.”
Next, hemorrhoids were classied into four categories: male piles, female piles, pulse piles, and blood piles in the “Prescriptions of Fifty-Two Diseases,” which was written in the Western Han Dynasty (206 BC–AD 8). The symptoms of male piles were the anus having snail-like, rat-nipple like prolapses. The prolapses were small tumors on the surface of which there were often erosions,
© Chemical Industry Press 2021 R. Shi, L. Zheng (eds.), Diagnosis and Treatment of Anal Fistula,
https://doi.org/10.1007/978-981-16-5804-4_1
1
2
R. Shi and F. Jiang
ulcers, and mouthwashes. The symptoms of female piles were half-inch of hemorrhoids in the anus shaped like a horn. Hemorrhoids that pro­lapsed and bled during defecation or female pile had several orices, and many white mites came out of the orice. Oral medicine, fumigation treatment, and surgical treatment for male piles and abscess were also written in this book. The treatment methods for male piles and abscess were mainly external, such as smoking, dressing, and ironing. For example, when treating male piles, “Quickly burn the base of the hemorrhoids to make it necrotic, and use ointment made from rice and ashes to apply to the wound. The patients who had male piles with multiple orices should eat the fat from the cooked sheep meat and three buckets of rice. If Male piles are located on the external edge of the anus, about the size of the nucleus of jujube, sometimes itchy, sometimes painful, if it can be cut, it should be cut. If not, mix turtle's brain and bile worms into an applica­tion or iron the hemorrhoids with small cobble­stones after burning with vinegar. When treating Male piles without stula, cook a bucket of dates, a bucket of ointment, make four buckets of medi­cine solution and pour it into a tub for a sitz bath, so that pinworms can run out by themselves.”
The book recorded that “Male piles are located outside the anus, the size of larger ones like a jujube and the size of smaller ones like a nucleus of jujube. When treating these kinds of male piles, it is effective to use a small cupping to pull the nucleus out for two measures of rice cooking time, pull out the cupping, ligature the nucleus with a thin wire, and then use a knife to peel off it. There will be a small block of blood clots in the nucleus, and the operation is completed after peeling it off.” This is similar to the incision and drainage of the perianal abscess.
Under the section for female piles, there was a record: for patients with deep rectal rectum, kill a dog, take the dog’s bladder, put it on a bamboo tube, insert it into the anus and inate it, pull the lesion out of the anus, and slowly cut the lesion with a knife under direct vision. After the opera­tion, the powder of Scutellaria baicalensis was applied to the patient for recovery. This is likely to be an incision treatment of the anal stula.
The earliest record of abscess was found in the “Huang Di Nei Jing,” “Ling Shu • Yong Ju”: abscess occurs on the buttocks that are red and swollen, named pilonidal disease. “The patients need to be treated immediately, if not, the patient will die in 30 days.” Pilonidal disease may be the earliest name in Chinese medicine for an anorec­tal abscess. The earliest record of a stula is found in the article “Su Wen • Sheng Qi Tong Tian Lun”: the coldness is deep in the veins and stays in the muscles and the movement of blood and Qi is not smooth, resulting in stagnation. As time progresses, it becomes a scab.
The term of “hemorrhoid and stula” was seen in the “Shen Nong’s Herbal” rstly. It docu­mented the main cause of the diseases carbuncle sore and hemorrhoid stula. Hemorrhoid stula refers to hemorrhoids, stula, and other anorectal diseases. A total of 365 kinds of effective drugs were collected in this book before the Han Dynasty, and there were more than 50 types of involuntary diseases involving anorectal diseases, 21 types can be used to cure hemorrhoids such as astragalus, acacia, clam, hedgehog skin, bee­hives, and so on, and 14 kinds of them can cure stulas such as oysters and scorpions. There are astragalus, realgar, and other four types that can be used to cure hemorrhoids and stulas together.
Gong Qingxuan in the Southern and Northern Dynasties wrote “Liu Juan-zi’s Gui-Yi-fang” (AD 499), which is the earliest existing surgical monograph in China. In this book, the dialectical treatment of perianal abscesses, such as “Yun Ju” and “Chi Shi,” is discussed in detail.
The etiology, pathogenesis, and syndrome dif­ferentiation and treatment of hemorrhoid stula were recorded in “Zhu Bing Yuan Hou Lun” (AD
610), which was written by Chao Yuanfang in the Sui Dynasty. In the “Zhi Bing Zhu Hou,” he pro­posed seven categories: male piles, female piles, pulse piles, intestinal piles, blood piles, Qi piles, and alcohol piles. The etiology and pathogenesis of these were also expressed vividly in the book. The male pile is a description of the symptoms of anal stula, which are rat-like, nipple-like scorpi­ons that grow next to the anus and always have outows of pus and blood. In the section of “Earthworm stula”: “earthworm stula … Its