Inheritance Of Academic Experience Of Professor Jiang Chunying In Anorectal Disease And Clinical Study Of Diagnosis And Treatment Of High Anal Fistula

Objective:On the basis of summary of the academic thought and clinical experience of Professor Jiang Chunying in diagnosis the treatment of anorectal diseases,form theoretical system and method on diagnosis and treatment of high anal fistula of Professor Jiang Chunying.By studying this theoretical system and method with modern medical technology,put forward the new idea of modern Chinese medicine for the pathogenesis and treatment of high anal fistula.Methods:Step one,learning with the teacher,the author understands, records, organizes ideas, methods and the experience of diagnosis and treatment of anorectal disease of the teacher through three years of teach by precept and example, recording 180 pieces of notes with the teacher, reorganizing 60 typical medical cases, summarisng 36 pieces of clinical experience and 77 pieces of classic works, initially forms the academic system of Professor Jiang Chunying in the diagnosis and treatment of anorectal diseases.Step two, In the process of systematizing medical cases of the ten years,1720 cases are obtained,including 647 anal fistula cases.According to the difference of diagnosis,treatment and type,the author obtaines 120 typical cases, which combined with the teacher the academic origin and compared with the current academic theory at the same time, and forms the unique diagnosis and treatment of high anal fistula recognized by Professor Jiang Chunying.Step three,under the guidance of academic thought of Professor Jiang Chunying in the diagnosis and treatment of high anal fistula,the author obtained 60 cases of high anal fistula independently,including 24 cases of high simple anal fistula and 36 cases of high complicated anal fistula,which MRI technique are used to verify in preoperative and incision drainage and seton are used in the operation.After the operation,common diagnostic methods,such as Paeks classification,miles classification and MRI classification are used to compare the outside mouth, the inside mouth and the path of fistula with those in the operation.Finally,the author analyzes the clinical data statistically.Result:1.Clinical experience of diagnosis:Those cases,which the outside mouth are away form the anal margin above 5 cm and the inside mouth are in the vicinity of the dentate line of posterior anal canal are important significance for the diagnosis of high anal fistula only when the anal sphincters are harder(P<0.01).2.The empirical determination of the main fistula is important significance for the diagnosis of high simple anal fistula (P< 0.01), which is similar with that of MRI (P> 0.05), while the diagnosis of high complex anal fistula is worse than MRI (P< 0.01).3.MRI in preoperative is used to assess the relationship between fistula and anal muscles, mainly related to the anal sphincter, external sphincter, puborectalis and anal provided muscle (P< 0.01), which is consistent with the experience of diagnosis of high anal fistula in the degree of hardening of anorectal ring (P> 0.05).4.MRI also found that there are many abscess in high complex anal fistula,which is better than clinical diagnosis(P< 0.01).5.Parks classification is performed only after the operation (P< 0.01), and the Miles classification is worse than that of empirical diagnosis (P< 0.01).6.The effect of incision line therapy in the treatment of high anal fistula is positive (P < 0.01).Conclusion:1.The inside mouth of high anal fistula is almost constant in total, which is after the anal crypt of vicinity of the dentate line at the anus;2.Due to the deep infection of internal muscle near the inside mouth, fibrosis is formed along the direction of the muscle and as the anal retroposition is center,and the upper anal muscle canal is tougher and harder;3. The path of fistula is curved, which is over the internal sphincterin from the inside mouth,through the inferior margin of levator ani or the deep part of the external anal sphincter to the sides of the siatic rectum clearance, and pierces the skin downwards and forwards;4. Most of the outside mouth is in the surface projection of the siatic rectum clearancenamely the sides of external anal sphincter. When outside touch the surface,only partial induration or hard cable can be found in the collapse hole area;5.Probe, recess hook and other auxiliary exploration can help diagnose;6.MRI is great significant in the diagnosis of high anal fistula, especially in the high complex anal fistula.