Στενότητα ορθού, οισοφάγου και κόλον

　　Η γενετική δυσμορφία και η φλεγμονή είναι οι κοινές αιτίες της στενότητας του ορθού, του οισοφάγου και του κόλον, όπως οι περιεγκεφαλικές αμυγδαλές, οι περιεγκεφαλικές αμυγδαλές, οι εκτεταμένες fistulae του ορθού και του οισοφάγου, η granulomatous colitis, η ulcerative colitis, η tuberculosis, η schistosomiasis granuloma, η lymphogranulomatosis venerea, η actinomycosis κ.λπ., μπορούν να προκαλέσουν στενότητα του ορθού και του οισοφάγου.

　　Οι ασθενείς με στενότητα του ορθού, του οισοφάγου και του κόλον μπορεί να εμφανίσουν συχνή καθήκωση, ακόμη και να αναπτύξουν κλειστό κόπων. Η μακροχρόνια δυσκολία στην απομάκρυνση μπορεί να προκαλέσει σταδιακή dilatation του άνω οισοφάγου και κόλον, προκαλώντας σύνδρομο συντηρητικής megakolon

　　1、καθήκωση

　　Η καθήκωση είναι η μείωση της συχνότητας των κόπων, με λιγότερες από δύο κόπες την εβδομάδα2～3Θαυμασμός2～3κυκλοδρόμηση1Θαυμασμός, ή λίγες και σκληρές κροτίδες ονομάζονται καθήκωση, αλλά μερικοί άνθρωποι είναι συνήθως2～3κυκλοδρόμηση1Θαυμασμός, και η φυσική κατάσταση των κροτίδων είναι κανονική, αυτή η κατάσταση δεν πρέπει να θεωρείται ως καθήκωση; για τον ίδιο άνθρωπο, αν οι κροτίδες του είναι καθημερινές1times or every2days1times changes to2days or more before defecation1times, should be considered constipation.

　　2, fecal impaction

　　Dry fecal mass blocks the rectum and cannot be excreted, causing severe constipation symptoms and perineal pain.

　　3, secondary megarectal syndrome

　　such as congenital anal stenosis, postoperative scar stenosis, or external rectal tumor compression, which causes defecation to be unsmooth, feces to be retained, and secondary colonic dilation. It can be diagnosed by anal examination. Idiopathic megacolon is related to improper defecation training, and the characteristic is that the rectum and colon of the child have normal ganglion cells. It is manifested by no history of constipation in the neonatal period,2～3years old appear symptoms, chronic constipation is often accompanied by anal soiling, and abdominal pain is common before defecation. In rectal examination, in addition to rectal distension and accumulation of feces, the anal sphincter is in a tense state, and rectal anal manometry has normal reflexes.

　　Patients with anal, rectal, and colonic stenosis often have a history of anal or rectal surgery, injury, or inflammation, or have used local injection therapy, corrosive suppositories, etc., and gradually appear the above symptoms of difficult defecation, etc. When examining the anal or rectal with fingers, the narrowness is found, sometimes only the tip of the little finger can be inserted, sometimes a hard fibrous band or annular stenosis is felt, sometimes there is a linear fissure at the anal orifice due to dry and hard stool. This situation should be distinguished from the defecation difficulty caused by common anal fissure and anal spasm. Pain during finger palpation can only be checked and distinguished after local infiltration anesthesia. Visual examination of the anal area often has feces or secretions. To clarify or exclude possible causes, or before considering the repair of stenosis, barium enema should be performed to observe whether there are changes in the rectum and colon. For annular smooth rectal stenosis, Frei test can be performed to distinguish from syphilis lymphogranuloma. When suspected of malignant tumors, rectoscopy or sigmoidoscopy should be performed, and biopsy should be done to confirm the diagnosis.

　　When there is damage and inflammation in the anal and rectal surgery, it is necessary to prevent anal stenosis. For example, when removing hemorrhoids, a normal skin and mucosa should be retained between the hemorrhoids. In addition, when performing anal fistula surgery, too much skin should not be removed. After surgery, maintain local cleanliness and hygiene to prevent various infections that may cause anal stenosis. Local warm saline sitting bath can keep the area clean, and it is also possible to apply it at the bottom of the anal sinus.5％～10％silver nitrate solution, every day1times. Olive oil can also be used30～60 mL enema. Even small injuries and localized inflammation can cause patients to experience unbearable severe swelling and pain. In surgical operations, it is necessary to minimize the damage to the anal tissue and avoid roughness, trying to minimize the injury to the sphincter muscles; after surgery, maintain local cleanliness and hygiene to prevent various infections that may cause anal stenosis. Do not use rough, unclean toilet paper to wipe after each bowel movement; change clothes frequently to keep the anal area clean; use warm water to steam in the one-kangtang sitting bath basin to accelerate local blood circulation, alleviate pain, and promote recovery.

　　The patients with anal, rectal, and colonic stenosis should undergo laboratory and instrumental examinations, detailed as follows:

　　First, laboratory examination

　　(1Blood: including routine blood tests, bleeding and coagulation time, erythrocyte sedimentation rate, plasma protein, and Valsalva test. The erythrocyte sedimentation rate accelerates in extensive abscesses in anorectal and colonic diseases, and it also accelerates in enteritis, proctitis, diverticulitis, and tuberculosis. The measurement of carcinoembryonic antigen (CEA) is an indicator of the effect of cancer-induced rectal and anal stenosis surgery and the monitoring of recurrence;

　　(2Fecal routine and culture: Rectal, colonic, and perianal swab specimens should be examined within 1h;1h examination has a small amount of fresh blood, usually from the rectum, sigmoid colon, and descending colon, and bleeding from the cecum and upper gastrointestinal tract can also appear when excreted quickly, but bleeding from the upper gastrointestinal tract often manifests as black stools, and small amounts of bleeding from the stomach, small intestine, and colon manifest as occult blood in the stool;

　　(3Fecal occult blood test: It is a simple method for detecting colon and rectal tumors and bleeding from other causes;

　　(4Frey (Fie) test: It is a method for checking inguinal lymphogranuloma, a positive result indicates infection but does not indicate that the disease is in an active stage, but the rate of false positives is high;

　　(5Desquamated cell examination: It can distinguish benign or malignant tumors and can distinguish rectal and colon cancer from diverticulitis.

　　Second, instrumental examination

　　(1Motor conduction examination: The normal value of the latent period of the distal motor latency of the pudendal and perineal nerve endings is1.9ms, the latent period of anal incontinence or urinary incontinence increases, the latent period of spinal cord motor latency is normal, the latent period of the external sphincter L is5.5ms, the latent period of the puborectalis muscle activity in humans4.8ms while L is3.7ms;

　　(2Ultrasound examination: Rectal ultrasound imaging is relatively accurate, with high sensitivity, specificity, and predictive value, which can determine the depth of infiltration and staging of rectal cancer in the intestinal wall, and can detect high-level tumors and bladder invasion and prostate invasion and metastasis as well as local recurrence after surgery, but cannot clearly determine lymph node invasion and pelvic spread, distinguishing inflammation and cancer is difficult, and can guide the collection of biopsy tissue;

　　(3Rectoscopy examination: The mucosal color is hyperemic and edematous, whether there are erosions, ulcers, polyps, tumor stenosis, and foreign bodies, and internal hemorrhoids, anal papillae, anal sinuses, and anal fistula orifices can be examined near the dentate line;

　　(4Sigmoidoscopy examination: It is a simple and easy-to-implement method,70％ above rectal and colon cancer can be directly seen with this scope; The incidence of adenomas and other lesions found in routine sigmoidoscopy is up to39％, adenomas15％ have malignant changes, and can be treated for diseases in the rectum and colon through sigmoidoscopy, improving the accuracy of diagnosis;

　　(5Fiber colonoscopy examination: It can directly examine the various parts of the rectum, colon, cecum, ileocecal valve, and terminal ileum, and can also perform biopsy, cancer cell examination, polypectomy, and cauterization, which is beneficial for early diagnosis of colon diseases;

　　(6X-ray examination: Chest X-ray examination determines the presence of pulmonary tuberculosis and tumor metastasis in the abdomen, and determines the presence of colon stricture and obstruction. Barium enema examination can see the large intestine, especially the narrowing and mucosal arrangement of the rectum and anal canal, and whether polyps and tumors are destroyed;

　　(7CT scan examination: It is a sensitive method for checking anal canal and rectal cancer, which can detect the invasion of cancer in the pre-sacral, pelvic lateral wall, pelvic organs, and lymph nodes, determine the size of the cancer, extension of the intestinal wall, fat around the rectum, uterus, and muscles, and help formulate surgical and radiotherapy treatment plans before and after surgery;

　　(8)MRI检查：可做直肠癌手术前检查和手术后复发检查，测定放射治疗后残留癌的范围，另外尚可诊断直肠和肛门狭窄及其病变程度。

　　肛管直肠和结肠狭窄的病因比较复杂，可由先天性畸形、炎症、外伤、肿瘤和手术创伤等原因引起。故此在饮食上需要吃一些清淡易消化的食物，适当的多吃一些新鲜的蔬菜水果，尤其是富含纤维素的食物，避免吃辛辣刺激性的食物，以便保持大便的通利情况。注意保持肛门口的清洁情况，以免导致局部炎症感染等情况。

　　肛管、直肠、结肠狭窄可由先天性畸形、炎症、外伤、肿瘤和手术创伤等原因引起。结肠狭窄除先天性畸形和损伤造成外，多数是结肠切除术后以及溃疡性结肠炎、肉芽肿性结肠炎等的并发症。下面小编为大家介绍肛管、直肠、结肠狭窄的治疗方法有哪些。

　　1、药物治疗

　　包括用高锰酸钾温水坐浴或灌肠、内服液状石蜡、外用栓剂、灌肠等使大便通畅，有浅裂隙或溃疡时用10％硝酸银搽擦或外敷药膏等。

　　2、扩张法

　　对手术后或损伤后轻度狭窄，多可用扩张法治疗，用手指或扩张器进行扩张，每日1次或每周1～2次，渐渐加大扩张器直径，并延长扩张间隔时间，对花柳性淋巴肉芽肿引起的环状直肠狭窄亦适用。

　　3Θεραπεία χειρουργικής

　　Για τις σοβαρές στένωση και τις στένωση με σκληρά σκάλυλα που έχουν αναπτύξει για μεγάλο χρονικό διάστημα, η μέθοδος επέκτασης μπορεί να έχει προσωρινή αποτελεσματικότητα, αλλά είναι εύκολο να επανεμφανιστεί, η μέθοδος χειρουργικής ανάλογα με την κατάσταση της βλάβης, την έκταση της στένωσης ή την τοποθεσία της στένωσης είναι διαφορετική.

　　Περιγράψαμε τις μεθόδους θεραπείας της στένωσης του πρωκτού, του ανώτερου και του κάτω εντέρου, ενώ μετά την επέμβαση πρέπει να διατηρήσουμε την τοπική καθαριότητα και υγιεινή για να αποφύγουμε την επανεμφάνιση της στένωσης του πρωκτού από διάφορες λοιμώξεις.