What should I do with the anal fistula?

  1. The bottom of the inner mouth must be completely removed, including the anal valve, anal sinus, anal gland, part of the internal sphincter, and the inner mouth ulcer and surrounding scar tissue are all removed. Because the treatment of the inner mouth is an important part of whether the anal fistula can be completely cured!    2. After the inner mouth is removed, the incision should be extended by 0.5-1.0 cm, and the depth is suitable for the fistula.   3. If the inner mouth is in the area of ​​the mother’s hemorrhoids, the internal hemorrhoids should be ligated when the inner mouth is removed, so as to prevent postoperative hemorrhage, remember.   4. After injecting melanin and other pigments into the fistula, it should be noted whether the anal fistula has only one internal port, or is connected to several adjacent anal sinuses. All anal sinuses that have leaked during surgery should be completely removed, but it should also be noted that the pigment liquid should not be injected too much to avoid artifacts or infection! There is also a type of patient. The anorectal expert will use another method, I hope it will be given Everyone helps!   Because some patients with anal fistula are not in the acute or subacute stage, which means that the fistula is completely closed when he sees the doctor, the fistula is found at the outer mouth of the anal fistula, and the fistula tissue is completely removed along the fistula Of course, including the removal of the inner mouth together, and then expanding the wound drainage, this method is suitable for patients with the outer mouth within 5 cm from the anal margin. If it is more distant or complex anal fistula, you can open another mouth after you determine the position of the fistula (the complex anal fistula hits the main fistula first) and remove it according to the above method, and scrape the drainage at the distal end.  Add three points:    (1) The accuracy of fistula iodine oleography is very poor, flat film is not intuitive, and due to iodine allergy and other reasons, it is gradually being eliminated. MRI and intra-cavity B-ultrasound are good methods for finding the direction, location and location of the anal fistula, which is more accurate.   (2) Anoscopy before or during surgery is also important. Usually the inner anal sinus is deepened, congested, or secreted out. It is more meaningful when combined with finger examination and probe examination.   (3) The inner mouth is not necessarily continuous, and there are many closed ones. Multiple methods of mutual reference to confirm the inner mouth can improve accuracy.  Discuss two points:    (1) Anal fistula does not need to wait for all fistulas to be formed before radical surgery can be performed at any time during the acute abscess period or after incision and excretion, provided that the inner mouth is clear and handled with confidence. The appearance of postoperative complications is mainly related to technology and grasp of treatment principles, and has nothing to do with the formation of fistula wall.   (2) “After the internal opening is removed, the incision should be appropriately extended 0.5-1.0 cm, the depth is suitable for the fistula.” In fact, it is not necessary to extend so much, because the damage is large and it is easy to bleed. Usually the method of ligating the two marginal mucosa at the inner mouth (along with the anal sinuses on both sides) is used.

Spontaneous abortion needs to be alert to uterine lesions

 The birth of life is a wonderful thing. At first it was just as big as a tadpole. After continuously absorbing nutrients, it began to flourish and grow, but one day disappeared, what would you do?  In addition to genetic, infection, corpus luteum insufficiency, human chromosome abnormalities and other factors, uterine pathology is also the main reason for spontaneous abortion.  Uterine fibroids This disease is mainly caused by tumor tissues that gradually deform the uterine cavity into degenerative changes, ulcers on the surface of the endometrium, and reduced blood flow to the endometrium and myometrium, which is unfavorable for implantation and development of pregnant eggs and abortion. For young women eager to give birth, enucleation of uterine fibroids can be performed without hysterectomy to maintain fertility.  Cervical loosening of the cervix The pregnant woman suffering from loosening of the internal cervix generally has a miscarriage in the second trimester. This is because, as the fetus gradually grows and the amniotic fluid gradually increases, the pressure in the uterine cavity continues to increase, causing the cervical opening of the fetal membrane sac to protrude and cause the fetal membrane to rupture. The loosening of the cervix is ​​related to factors such as previous cervical tear injury, multiple abortions, and dysplasia of the uterine isthmus. Cervical cerclage in 12-15 weeks of gestation or cervical repair in non-pregnancy period can receive good results. Uterine malformation The human uterus is a muscular organ that develops and deforms the accessory middle renal duct. Incomplete fusion of the bilateral lumens or incomplete absorption of the mediastinum after fusion can lead to congenital single-horned uterus, double-horned uterus, double uterus, and uterine mediastinum. A uterine malformation. Uterine mediastinum accounts for about 80% of uterine malformations, the most common uterine malformation for spontaneous abortion and premature delivery. The uterine mediastinum causes abortion mainly due to ischemia of the mediastinum and dysplasia of the endometrium. Insufficient blood supply after implantation of the fertilized egg affects the normal development of the fetus. In recent years, hysteroscopy has special value in the diagnosis and treatment of uterine mediastinum. Not only is it easy to confirm the diagnosis, but also mediastinal resection is possible under hysteroscopy, and surgery can significantly reduce the miscarriage rate.  Uterine adhesions In patients with intrauterine adhesions, most of them have a history of endometrial damage, such as multiple abortions and excessive curettage. The pathological changes of abortion caused by intrauterine adhesions are shrinkage and deformation of the uterine cavity, endometrial sclerosis and area reduction, which affects embryo development. According to statistics, for those diagnosed with intrauterine adhesions, after surgical separation, dilatation of the palace, and comprehensive treatment with medication, the abortion rate can be reduced from 67% to 26% during the treatment period.

Will the perianal abscess heal without treatment?

 Perianal abscesses occur predominantly in young adults aged 20-40, with more men than women. Will the perianal abscess heal without treatment? will not. In the past, the disease was mostly treated by incision and drainage, but most of them will form anal fistula, and it needs to be cured after a second operation. What is the surgical treatment of perianal abscess? Let’s discuss it below.   &Nbsp. Surgical treatment of perianal abscess   Under lumbar anesthesia, radial or arc incision is made at the place where the abscess fluctuates obviously, and the abscess is fully discharged or the index finger is used to explore the abscess cavity and separate the abscess cavity interval. Then flush the pus cavity with hydrogen peroxide and physiological saline. Trim the flap to make the incision into a fusiform shape for smooth flow. The probe with the ball head is inserted through the incision and probed gently and carefully along the bottom of the pus cavity, while the index finger of the other hand is deep into the anus, and the pointer is combined to find the inner mouth. Penetrate the rectum at the highest point of the thinnest pointer distance, introduce rubber bands, gather the two ends of the rubber band, and then tighten and fix it after suitable tightening. The Vaseline gauze is filled into the incision, the external gauze is pressed, the T-shaped belt is fixed and the operation is completed.  Appropriate antibiotics should be used to control infection after operation, and intestinal lotion should be used to prevent constipation. Nitrous alum lotion is fumigated and washed daily, and the dressing is changed regularly. If the rubber band does not fall off 7-10 days after surgery, you can tighten the rubber band about 1 cm to accelerate the fall off. After the rubber band fell off, change the dressing with Shengji Powder until healed.  Will perianal abscess heal by itself? Perianal abscess will not heal without treatment, so patients should be treated with the above treatment methods. Cutting the thread is a traditional treatment for perianal abscess, which mainly uses the continuous tension of the rubber band to gradually expand the inner mouth and drainage channel. Although the inner mouth continues to be infected, it can indeed ensure smooth drainage, which will not cause inflammation to spread, and is beneficial to the growth of granulation tissue from the base. 

Definition of Obstetrics and Gynecology (19) Placement of the placenta before abnormal fetal appendages

Definition: After 28 weeks of pregnancy, the placenta is attached to the lower part of the uterus, the position is lower than the first fetal exposure, and the lower edge reaches or covers the cervical ostium. Note: Before the 28th week of pregnancy, the ultrasound examination found the placenta predecessor, which is called the placenta preposition state, and was not diagnosed as placenta previa. Classification: Complete placenta previa (central placenta previa): The placenta covers the entire cervical ostium. Partial placenta previa: The placenta covers part of the cervical ostium. Marginal placenta previa: the lower edge of the placenta reaches the cervical ostium. Low-value placenta: the lower edge of the placenta is less than 2 cm from the cervical ostium. Dangerous placenta previa: placenta previa and placenta attached to cesarean section or fibroids removed scars, high risk of placental adhesion, implantation and fatal hemorrhage. The etiology is unclear, but multiple uterine cavity operations, various endometrial lesions, and multiple pregnancy are more likely to occur. There is no inducement, painlessness, and repeated vaginal bleeding during the third trimester or after labor. Diagnosis mainly depends on ultrasound (especially vaginal ultrasound) to determine the relationship between the lower edge of the placenta and the cervical ostium. Principles of treatment: inhibiting contractions, correcting anemia (Hb≥110), preventing infection, properly expecting, and terminating pregnancy in a timely manner (the main treatment method is cesarean section).

New knowledge: you must know the anal fistula check

Anal fistula is also called “anorectal fistula”. Most anal fistula is formed by rupture of anorectal abscess or incision and drainage. The abscess gradually shrinks, but the intestinal contents continue to enter the pus cavity. During the process of healing and shrinking, a tortuous cavity is often formed, which is not easy to heal due to poor drainage. There are many scar tissues around the cavity after a long time, forming a chronic infectious duct . Chinese medicine called the disease “hanging carbuncle”, “sitting carbuncle”, “dirty poison”, etc., mostly caused by anal canal rupture around the rectum, and the granuloma duct around the anus formed after a long time. Mastering the correct examination method of anal fistula is extremely important for the treatment. Here we introduce several examination methods of anal fistula for reference. ①Probe inspection: use the probe to extend into the fistula from the external opening of the fistula, and the index finger into the anal canal. For those with curved fistulas, the probes cannot pass through smoothly. Do not use excessive force to make the probes penetrate the wall of the fistula and cause new infections. ② Anal sinus hook examination: protruding into the anus with a speculum, anal sinus with redness and inflammation can be seen, and the inner mouth is mostly here. Check the anal sinus repeatedly with the anal sinus hook, it is not difficult to find the inner mouth. Do not use violence when probing, so as to avoid puncturing the normal anal sinus and causing a new infected inner mouth. ③Methylene blue mark: place a moderate gauze in the anus, and then inject 5% methylene blue aqueous solution into the fistula from the outer mouth, then gently pull the gauze out and observe the position of the inner mouth. Afterwards, the anus was opened with a speculum. Near the dentate line, the most prominent coloration was detected by anal sinus hook or probe, and most of the inner mouth could be found. ④ Other: Examination methods such as X-ray examination and anal canal pressure measurement are rarely used and can be used by those with conditions.

Analysis of types and causes of spontaneous abortion

Spontaneous abortion occurs before the 12th week of pregnancy and is called early abortion. The latter occurs at 12 weeks and is called late miscarriage. The clinical types of miscarriage include: 1. Threatened abortion refers to spontaneous abortion before 28 weeks of gestation. A small amount of vaginal bleeding occurs first, followed by paroxysmal lower abdominal pain or low back pain. 2. Inevitable abortion refers to spontaneous abortion that has been inevitable. It developed from threatened abortion, when vaginal bleeding increased, paroxysmal lower abdominal pain worsened, or vaginal fluid (ruptured fetal membrane) appeared. 3. Incomplete abortion refers to spontaneous abortion in which pregnancy products have been partially excreted from the body, and some remain in the uterine cavity. 4. Complete abortion refers to spontaneous abortion in which all pregnancy products have been discharged, vaginal bleeding has gradually stopped, and abdominal pain has gradually disappeared. Gynecological examination has closed the cervix and the uterus is close to normal size. The causes of early spontaneous abortion are often inadequate corpus luteum function, hypothyroidism, chromosomal abnormality, and abnormal immune function. The most common causes of late miscarriage are laxity of the cervix, uterine malformation, uterine dysplasia, and uterine fibroids. Those with loose cervical ostia after pregnancy are usually in the middle of pregnancy. The fetus grows, the amniotic fluid increases, the pressure in the uterine cavity increases, the fetal sac protrudes toward the cervical ostium, and the cervical canal gradually shrinks and expands. Most patients have no conscious symptoms, and once the fetal membrane ruptures, the fetus is expelled immediately.

How to properly treat habitual abortion

Many young people get pregnant unexpectedly without being prepared to be parents. They have to abortion artificially. However, some who are ready to become parents will have spontaneous abortions, and some may even abort more than three times in a row. This is the disease, called habitual abortion, so how to properly treat habitual abortion? Let’s take a look at it together. 1. Chinese medicine believes that the disease is mostly caused by insufficient kidney qi and impotence. It is advisable to nourish the kidney and strengthen the spleen, fix the qi and nourish the blood, and adjust it before pregnancy. Zishen Yutai Pills nourishes the kidney and spleen, nourishes Qi and strengthens the body, nourishes the blood and stabilizes the fetus, strengthens the body, and prevents habitual abortion and threatened abortion. Stop taking during the menstrual period, take 2 months as a course of treatment, can take 1-3 courses of treatment. 2. If the patient’s cervical slack is loose, repair the cervical slack before the pregnancy. 3. Patients with uterine malformation should undergo corrective surgery before pregnancy, and contraception for one year after surgery. 4. Patients with cervical insufficiency who are pregnant should undergo transvaginal cervical cerclage at 14 to 18 weeks of pregnancy and follow up regularly after surgery. If abnormalities are found, they should be admitted to the hospital in time. 5. For those with insufficient corpus luteum function, it is recommended to inject progesterone or HCG as early as possible. The drug should be used until 10 weeks of gestation or more than the number of weeks of previous miscarriage. It is also necessary to rest in bed. , Pressure, etc. 6. Before conception, both men and women should go to the hospital for careful examination, including genital examination and necessary laboratory tests, and conditional chromosome examination can be done. 7. Periodic prenatal examinations should begin regularly during the second trimester. Doctors can detect and handle abnormal conditions in a timely manner and can guide health care during pregnancy. 8. Women usually pay attention to a reasonable diet, especially pregnant women should pay attention to dietary choices, should properly supplement vitamins and various necessary trace elements, and eat more vegetables and fruits. Tips: There are many reasons for habitual abortion, and the treatment methods are also different. It is recommended that you go to a regular hospital for active symptomatic treatment. Habitual abortion can be cured.

How to treat habitual abortion correctly

Many young people get pregnant unexpectedly without being prepared to be parents. They have to abortion artificially. However, some who are ready to become parents will have spontaneous abortions, and some may even abort more than three times in a row. This is the disease, called habitual abortion, so how to properly treat habitual abortion? Let’s take a look at it together. 1. Chinese medicine believes that the disease is mostly caused by insufficient kidney qi and impotence. It is advisable to nourish the kidney and strengthen the spleen, fix the qi and nourish the blood, and adjust it before pregnancy. Zishen Yutai Pills nourishes the kidney and spleen, nourishes Qi and strengthens the body, nourishes the blood and stabilizes the fetus, strengthens the body, and prevents habitual abortion and threatened abortion. Stop taking during the menstrual period, take 2 months as a course of treatment, can take 1-3 courses of treatment. 2. If the patient’s cervical slack is loose, repair the cervical slack before the pregnancy. 3. Patients with uterine malformation should undergo corrective surgery before pregnancy, and contraception for one year after surgery. 4. Patients with cervical insufficiency who are pregnant should undergo transvaginal cervical cerclage at 14 to 18 weeks of pregnancy and follow up regularly after surgery. If abnormalities are found, they should be admitted to the hospital in time. 5. For those with insufficient corpus luteum function, it is recommended to inject progesterone or HCG as early as possible. The drug should be used until 10 weeks of gestation or more than the number of weeks of previous miscarriage. It is also necessary to rest in bed. , Pressure, etc. 6. Before conception, both men and women should go to the hospital for careful examination, including genital examination and necessary laboratory tests, and conditional chromosome examination can be done. 7. Periodic prenatal examinations should begin regularly during the second trimester. Doctors can detect and handle abnormal conditions in a timely manner and can guide health care during pregnancy. 8. Women usually pay attention to a reasonable diet, especially pregnant women should pay attention to dietary choices, should properly supplement vitamins and various necessary trace elements, and eat more vegetables and fruits. Tips: There are many reasons for habitual abortion, and the treatment methods are also different. It is recommended that you go to a regular hospital for active symptomatic treatment. Habitual abortion can be cured.