肛门直肠疾病的检查方法

肛门直肠疾病的检查 Method for examination of anorectal diseases 2010-12-16 Wu Bin Tian Zhenguo Anorectal examination is very important for newly diagnosed patients with anorectal disease for the first time to the general outpatient service, you can get a preliminary diagnosis, but also because the doctor failed to carefully detailed history and neglect of specialized examination, which lead to misdiagnosis or delayed treatment, resulting in missed the timing of surgery, resulting in medical treatment sorry. 1 ask for medical history Detailed history is very important to diagnose the disease from the occurrence of symptoms and duration of the evolution process can understand the whole process of the disease, medical history, family history, history of surgery and drug allergy history have diagnostic value for reference. The typical symptoms of painless anorectal diseases: will the blood refers to defecation, blood, blood or blood, is internal hemorrhoids, mixed hemorrhoids, rectal polyps common symptoms. Will the blood and accompanied by severe pain for anal fissure; recurrent massive bleeding, sometimes accompanied by abdominal cramps, Meckel diverticulum may be. He reeked of bloody mucus diarrhea, should be considered in colorectal cancer. Mucus, pus and blood stool accompanied by abdominal pain and diarrhea, may be chronic ulcerative colitis. Anal bulge in perianal abscess, hemorrhoids, mixed hemorrhoids, rectal prolapse. In addition, hemorrhoids and mixed hemorrhoid injection after ligation, can also cause this symptom. In the late stage, hemorrhoids, mixed hemorrhoids, rectal prolapse, rectal polyp, anal papilla can appear anal prolapse, severe hemorrhoids can be incarcerated in the anus, and even swelling erosion and necrosis. Perianal purulent discharge is the main symptom of anal fistula. Moist around the anus, mostly perianal eczema. 2 anorectal fingers Anorectal digital examination is the most simple and important method in the examination of anorectal diseases. It is suitable for patients with history and symptoms of anorectal diseases, but the patients with early anal fissure should be referred to the clinic for examination. Anal rectal examination examination method: First Anal shape and the skin is normal, anal fissure anal canal epithelium or with visible ulcer sentinel hemorrhoids; anal fistula fistula visible outside the mouth, and have secretion; mixed hemorrhoids, external hemorrhoids perianal skin visible circular uplift. Touch anus week, without tenderness, tumor and string shape wait. If there is tenderness or fluctuation, it often prompts perianal abscess; the subcutaneous cord is pressed and connected with the external mouth, and the secretion is overflowed after pressing. This is an important basis for the diagnosis of anal fistula. The palpable lesion of the anus and rectum: (1): hemorrhoids can touch the mucosa uplift, such as thrombosis or for sclerotherapy, can touch smooth induration. (2) anal fistula: it can touch the cords of the skin outside the anus and connect with the external mouth. It can touch the sunken mouth of the anal recess. (3) rectum polyp: can touch the soft, smooth, fragile, movable round tumor, often pedicle, long pedicle, can be out of the anus. Attention should be paid to avoiding rupture and bleeding during operation and ligation. (4) perianal abscess: in the posterior rectum space, abscess and pelvic space abscess, the rectum wall can touch the tender swelling. (5) rectum prolapse: finger examination often has the relaxation of anal sphincter, Mass relaxation of rectal mucosa. (6) rectum cancer: can be touched on the rectum wall uneven hard tumour, its surface can have ulcer, some activity is undesirable. Advanced rectal cancer intestinal stricture formation, tumor activity, often pus and mucus finger. (7) rectal carcinoid: typically characterized by a single, sliding submucosal induration, with a smooth and complete mucous membrane. (8) the rectal wall tumor: Although this kind of tumor is rare, there are many kinds, such as teratoma, osteoma, neuroma and so on. When referring to the rectum mass, the rectum wall can be pushed to the front or both sides, and the rectal mucosa is smooth. 3 fiber colonoscopy Colonoscopy. Large bowel mucosa is orange red, smooth, soft, lustrous and elastic. When dilated, the veins are clear and sometimes the contours of the gut are visible. There are 1~3 rectal valves in the rectum, an oval appendiceal fossa in the cecum, and a papillary or lip like ileocecal valve. The adult ileocecal angle is 90 degrees. The mucous membrane of the normal ileum is pale red, velvety, lustrous and elastic, and the peristaltic wave is regular. Suffering from chronic colitis, chronic ulcerative colitis and Crohn's disease (Crohn's disease), intestinal tuberculosis, melanosis coli, colorectal cancer, colon microscope showed the corresponding pathological changes, to understand the characteristics of endoscopists were not repeat them here. 4 X-ray examination of anorectal diseases 4.1 double contrast examination of colon, double contrast radiography of colon (double gas barium radiography) is a commonly used method in clinic. The quality of Colon double contrast angiogram can show the fine structure of colonic mucosa, mucosa contour line like a pencil sketch of general slender, continuous and smooth, bowel dilatation is good, clear image, transparent, stereoscopic display single size of the lesions ranged from 2 to 3mm. 4.2 defecography defecography is a special method for X-ray examination of functional outlet obstruction constipation caused by. Functional outlet obstruction refers to a series of functional anorectal only during defecation in the process demonstrated abnormalities, including puborectalis muscle hypertrophy, adhesion, spasm, anal sphincter achalasia, prolapse of rectal mucosa, rectal intussusception; rectal prolapse (rectal protrusion); sigmoid colon or the pelvic floor hernia of the small intestine, oppression, and descending perineum syndrome. 4.3 anal fistula and perianal fistula sinus radiography, sinus radiography is mainly to check the analysis of iodine showed sinus fistula, length, branch, direction and depth from the surface. 5 anorectal function test 5.1 the colonic transit test of colonic transit test is the only test method of colonic transit motion of the disease, the examination method of slow motion on colonic transit constipation and functional outlet obstruction constipation caused by induced in clinical diagnosis has important significance. 5.2 anorectal pressure measurement, anorectal pressure measurement, the patient can not control defecation, there is a certain diagnostic significance. It is often helpful for the diagnosis of constipation. It is of significance for the diagnosis of congenital megacolon and hypertrophy of pubic and rectal muscles. 5.3 pelvic floor electromyography and pelvic floor electromyography are helpful to evaluate pelvic floor muscle innervation and to analyze fecal incontinence. It is important in the diagnosis of myogenic anorectal diseases. 6 special examination of anal canal, rectum and colon 6.1 anal canal, rectum and colon ultrasonography, anal canal, rectum and colon ultrasound examination, mainly used in colorectal benign tumor and malignant tumor examination, that is, intestinal lesions. Anal canal and transrectal ultrasonography are important for the location of purulent cavity in anorectal abscess, so as to guide the surgical treatment. 6.2 anal canal, rectum and colon CT examination, anal canal, rectum and colon CT examination in the diagnosis and treatment of colorectal tumors have unique value. E. barium examination and endoscopy examination are limited to the diameter and morphology of intestinal mucosa, intestinal wall of cavity, inside or outside of the cavity lesions can only provide indirect signs, CT can not only display the intraluminal lesions, the more important is that can directly see the intestinal wall and adjacent tissues and organs. It is of great significance for guiding surgical treatment. CT examination of the structure, morphology and development of congenital anorectal malformations is specific, which helps to select surgical methods. 6.3 anal rectum and colon magnetic resonance imaging of anal rectum and colon of magnetic resonance imaging for early colorectal malignant tumor detection and correct staging, has important value in the diagnosis and diagnosis of postoperative recurrence. It is important to evaluate and guide the surgical procedure before the operation of congenital anorectal malformations.