7.1.1 肛裂

评分与重要性等级: B
复习:
2021

Jiangan Zhang, Zhengzhou

概述:

定义

直肠远端难以愈合的、放射性裂隙。 

病因和发病机理

不清楚，诱因：便秘、痔疮和瘙痒性皲裂性臀沟皮炎。 

症状

排便时或便后针刺样剧痛，粪便和内裤上可见鲜红色血液。皮损为长短不一的梭形溃疡。慢性病例的溃疡壁增厚，基底潜行，头端可见肛乳头肥大，尾端可见皮赘（前哨痔），扩约肌张力增加。 

定位

90%的损害在肛管远端的6或12点钟方向。 

并发症

刺激性肛周皮炎，并有继发过敏性接触皮炎可能，扩约肌间的肛裂。 

诊断

依据临床表现和病史特点诊断。 

鉴别诊断

硬下疳（一期梅毒病变）、单纯疱疹、溃疡性结肠炎或Crohn病和直肠癌。 

Prevention & Therapy

药物降低扩约肌的张力（化学性扩约肌切开术）：硝化甘油软膏，内或外肛门扩约肌注射肉毒杆菌毒素A，简易麻醉下扩约肌扩张，扩约肌侧切，切除肛裂。 

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