肛瘘发病机制的研究现状
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摘要
<正>肛瘘是肛肠科的常见病之一,在我国发病率占肛肠病的1.67%～3.6%,国外为8%～25%~([1])。90%～95%的肛周脓肿和肛瘘起源于肛隐窝~([2]),但发病机制尚不明确。普遍认为,肛周脓肿和肛瘘是同一疾病的不同阶段。本文从解剖学、组织学、微生物学、分子生物学方面就肛隐窝感染引起肛瘘发病机制的研究现状概述如下。1肛隐窝及肛周间隙的解剖学基础1956年Eisenhammer~([3])认为肛腺感染后沿肛腺导管蔓延形成括约肌间脓肿,感染再沿肛腺导管分支或联合纵肌纤维向不同方向蔓延到不同肛周间
引文
[1]安阿玥.肛肠病学[M].北京:人民卫生出版社,2005:217.
[2]Sainio P.Fistula-in-ano in a defined population.Incidence and epidemiological aspects[J].Ann Chir Gynaecol,1984,73(4):219-224.
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[4]Shafik A.A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation.Ⅳ.Anatomy of the perianal spaces[J].Invest Urol,1976,13(6):424-428.
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[6]Shafik A.A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation.Ⅵ.The central abscess:a new clinicopathologic entity in the genesis of anorectal suppuration[J].Dis Colon Rectum,1979,22(5):336-341.
[7]Seow-Choen F,Ho JM.Histoanatomy of anal glands[J].Dis Colon Rectum,1994,37(12):1215-1218.
[8]Parks AG.Pathogenesis and treatment of fistuila-in-ano[J].Br Med J,1961,1(5224):463-469.
[9]Lunniss PJ,Sheffield JP,Talbot IC,et al.Persistence of idiopathic anal fistula may be related to epithelialization[J].Br J Surg,1995,82(1):32-33.
[10]Goligher JC,Ellis M,Pissidis AG.A critique of anal glandular infection in the aetiology and treatment of idiopathic anorectal abscesses and fistulas[J].Br J Surg,1967,54(12):977-983.
[11]Mitalas LE,van Onkelen RS,Monkhorst K,et al.Identification of epithelialization in high transsphincteric fistulas[J].Tech Coloproctol,2012,16(2):113-117.
[12]Eykyn SJ,Grace RH.The relevance of microbiology in the management of anorectal sepsis[J].Ann R Coll Surg Engl,1986,68(5):237-239.
[13]Toyonaga T,Matsushima M,Tanaka Y,et al.Microbiological analysis and endoanal ultrasonography for diagnosis of anal fistula in acute anorectal sepsis[J].Int J Colorectal Dis,2007,22(2):209-213.
[14]Magalhaes JG,Tattoli I,Girardin SE.The intestinal epithelial barrier:how to distinguish between the microbial flora and pathogens[J].Semin Immunol,2007,19(2):106-115.
[15]Greenburg G,Hay ED.Epithelia suspended in collagen gels can lose polarity and express characteristics of migrating mesenchymal cells[J].J Cell Biol,1982,95(1):333-339.
[16]Lim J,Thiery JP.Epithelial-mesenchymal transitions:insights from development[J].Development,2012,139(19):3471-3486.
[17]Hofman P,Vouret-Craviari V.Microbes-induced EMT at the crossroad of inflammation and cancer[J].Gut Microbes,2012,3(3):176-185.
[18]Scharl M,Rogler G.Pathophysiology of fistula formation in Crohn's disease[J].World J Gastrointest Pathophysiol,2014,5(3):205-212.
[19]Yadav V,Varum F,Bravo R,et al.Inflammatory bowel disease:exploring gut pathophysiology for novel therapeutic targets[J].Transl Res,2016,176:38-68.
[20]Ratto C,Litta F,Lucchetti D,et al.Immunopathological characterization of cryptoglandular anal fistula:apilot study investigating its pathogenesis[J].Colorectal Dis,2016,18(12):O436-O444.
[2]Sainio P.Fistula-in-ano in a defined population.Incidence and epidemiological aspects[J].Ann Chir Gynaecol,1984,73(4):219-224.
[3]Eisenhammer S.The internal anal sphincter and the anorectal abscess[J].Surg Gynecol Obstet,1956,103(4):501-506.
[4]Shafik A.A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation.Ⅳ.Anatomy of the perianal spaces[J].Invest Urol,1976,13(6):424-428.
[5]Shafik A.A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation.Ⅲ.The longitudinal anal muscle:anatomy and role in anal sphincter mechanism[J].Invest Urol,1976,13(4):271-277.
[6]Shafik A.A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation.Ⅵ.The central abscess:a new clinicopathologic entity in the genesis of anorectal suppuration[J].Dis Colon Rectum,1979,22(5):336-341.
[7]Seow-Choen F,Ho JM.Histoanatomy of anal glands[J].Dis Colon Rectum,1994,37(12):1215-1218.
[8]Parks AG.Pathogenesis and treatment of fistuila-in-ano[J].Br Med J,1961,1(5224):463-469.
[9]Lunniss PJ,Sheffield JP,Talbot IC,et al.Persistence of idiopathic anal fistula may be related to epithelialization[J].Br J Surg,1995,82(1):32-33.
[10]Goligher JC,Ellis M,Pissidis AG.A critique of anal glandular infection in the aetiology and treatment of idiopathic anorectal abscesses and fistulas[J].Br J Surg,1967,54(12):977-983.
[11]Mitalas LE,van Onkelen RS,Monkhorst K,et al.Identification of epithelialization in high transsphincteric fistulas[J].Tech Coloproctol,2012,16(2):113-117.
[12]Eykyn SJ,Grace RH.The relevance of microbiology in the management of anorectal sepsis[J].Ann R Coll Surg Engl,1986,68(5):237-239.
[13]Toyonaga T,Matsushima M,Tanaka Y,et al.Microbiological analysis and endoanal ultrasonography for diagnosis of anal fistula in acute anorectal sepsis[J].Int J Colorectal Dis,2007,22(2):209-213.
[14]Magalhaes JG,Tattoli I,Girardin SE.The intestinal epithelial barrier:how to distinguish between the microbial flora and pathogens[J].Semin Immunol,2007,19(2):106-115.
[15]Greenburg G,Hay ED.Epithelia suspended in collagen gels can lose polarity and express characteristics of migrating mesenchymal cells[J].J Cell Biol,1982,95(1):333-339.
[16]Lim J,Thiery JP.Epithelial-mesenchymal transitions:insights from development[J].Development,2012,139(19):3471-3486.
[17]Hofman P,Vouret-Craviari V.Microbes-induced EMT at the crossroad of inflammation and cancer[J].Gut Microbes,2012,3(3):176-185.
[18]Scharl M,Rogler G.Pathophysiology of fistula formation in Crohn's disease[J].World J Gastrointest Pathophysiol,2014,5(3):205-212.
[19]Yadav V,Varum F,Bravo R,et al.Inflammatory bowel disease:exploring gut pathophysiology for novel therapeutic targets[J].Transl Res,2016,176:38-68.
[20]Ratto C,Litta F,Lucchetti D,et al.Immunopathological characterization of cryptoglandular anal fistula:apilot study investigating its pathogenesis[J].Colorectal Dis,2016,18(12):O436-O444.