Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical SurgeryВестник экспериментальной и клинической хирургии2070-478X2409-143XVoronezh State Medical University named after N.N. Burdenko29010.18499/2070-478X-2013-6-4-526-535Review of literatureОбзор литературыUnknownAcute Paraproctitis. Review of the LiteratureОстрый парапроктит. Обзор литературыДемьяновА.В.author@vestnik-surgery.comАндреевА.А.author@vestnik-surgery.comN.N. Burdenko Voronezh State Medical Academy, 10 Studencheskaia Str., Voronezh, 394036, Russian FederationВоронежская государственная медицинская академия им. Н.Н.Бурденко, Воронеж, Российская Федерация24122013645265352804201628042016Copyright ©; 2013, Voronezh N.N. Burdenko State Medical UniversityCopyright ©; 2013, ФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава России2013Voronezh N.N. Burdenko State Medical UniversityФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава Россииhttps://vestnik-surgery.com/journal/about/editorialPolicieshttps://vestnik-surgery.com/journal/article/view/290

Acute anal abscess remains the issue of the day of modern surgery, which is due to, in particular, its occurrence in 0.5% of the population, 0.5-4% of surgical and 10-50% of coloproctological patients. In the article, the analysis of the literature on the etiology, classification, clinical picture, diagnosis and treatment of acute anal abscess is performed. The review revealed that 98% of acute anal abscess is caused by mixed microflora - staphylococci, streptococci in combination with E. coli. The clinical picture of acute anal abscess depends on the localization of inflammation, the virulence of microflora and the immunoreactivity of the organism. Diagnostic methods of acute anal abscess are finger and bidigital rectal examination, anoscopy, rectal examination with a mirror and rectoromanoscopy. Endorectal electrical thermometry, ultrasonography, abscessography, chromoabscessography, computed tomography, magnetic resonance imaging and others can be used as well. Once the diagnosis of acute anal abscess is established, urgent surgical intervention must be performed, which consists of the incision and drainage of abscess with the possible elimination of the opening in the zone of the anal crypt. The postoperative management of patients with acute anal abscess may involve the use of ultrasound, laser, phototherapy, oxygen and ozone therapy, wound dialysis, hydrophonophoresis, multicomponent drugs and others. Thus, as the data in the literature reveals, many questions concerning the management of patients with acute anal abscess are not resolved to the full extent. This is evidenced by the development of inflammatory complications in 13-20%, relapses in 1.5-40%, anal sphincter deficiency in 1.5-27.9% of cases, which makes it worthwhile to continue research on developing new methods of treatments for acute anal abscess

Острый парапроктит (ОП) остается актуальной проблемой современной хирургии, что обусловлено, в том числе, его встречаемостью у 0,5% населения, 0,5–4% хирургических и 10–50% колопроктологических больных. В статье проведен анализ данных литературы по вопросам этиологии, классификации, клиники, диагностики и лечения ОП. Обзор показал, что ОПв 98% случаев вызывается смешанной микрофлорой – стафилококки, стрептококки в сочетании с кишечной палоч- кой. Клиническая картина ОП зависит от локализации воспаления, вирулентности микрофлоры и иммунореактивности организма. Методами диагностики ОП являются пальцевое и бидигитальное исследования прямой кишки, аноскопия, ос- мотр ректальными зеркалами, ректороманоскопия, могут применяться эндоректальная электротермометрия, ультра- соно-, абсцессо-, хромоабсцессографии, компьютерная томография, магнитно-резонансные исследования и другие. По- сле установления диагноза ОП необходимо выполнение срочного хирургического вмешательства, которое заключается во вскрытии и дренировании гнойника с возможной ликвидациейотверстия в зоне анальной крипты. Послеоперационное веде- ние больных с ОП может включать использование ультразвука, лазера, фототерапии,кислородо-, озонотерапии, раневого диализа, гидрофонофореза, многокомпонентных препаратов и другие. Таким образом, как свидетельствуют данные лите- ратуры, многие вопросы, касающиеся ведения больных ОП, остаются решенными не до конца, что подтверждается раз- витием в 13-20% случаев воспалительных осложнений, в 1,5-40% – рецидивов заболевания, в 1,5-27,9% – недостаточности анального сфинктера, что делает целесообразным продолжение исследований по разработке новых методов лечения ОП.

acute paraproctitis, treatmentострый парапроктит, лечение1. Abdullaev M.Sh., Mansurova A.B. Ostryy paraproktit u bol'nykhs sakharnym diabetom (obzor literatury) [Acute paraproctitis in patientswith diabetes mellitus (review of literature)]. // Coloproctology.2012; 1: 46-51. (in Russ.).2. Abramov E.K., Morozov Iu.I., Markov A.M. Problemy proktologii: tezisy dokladov. [Proc. Conf."Problems of proctology"]. // Moscow. 1981; 107. (in Russ.).3. Akopian E.B. Mestnye vospalitel'nye posleoperatsionnyeoslozhneniia paraproktitov. Diagnostika, lechenie i profilaktika[Local inflammatory postoperative complications of paraproctitis.Diagnosis, treatment and prevention. Cand. Diss. Med. Sci.]. //Tbilisi. 1981; 18. (in Russ.).4. An V.K., Rivkin V.L. Aktual'nye problemykoloproktologii: Materialy pervogo s"ezda koloproktologovRossii s mezhdunarodnym uchastiem [Proc. 1st Cong. "Actualproblems of Coloproctology"]. // Samara. 2003; 21-22. (in Russ.).5. Balaitis Iu.V., Poida A.I., Zhel'man V.A. [Features of developmentand generalization of infection in acute paraproctitis]. PervyiBelorusskii mezhdunarodnyi kongress khirurgov. Sborniknauchnykh trudov [Proc. 1st Int. Cong. Surg.]. // Vitebsk. 1996;165-167. (in Russ.).6. Borodinets A.L., Ageev V.P., Kremen' V.E. [Results of treatmentof acute paraproctitis]. Pervyi Belorusskii mezhdunarodnyikongress khirurgov [Proc. 1st Int. Cong. Surg.]. // Vitebsk. 1996;158-159. (in Russ.).7. Borodinets A.L., Rusinovich V.M., Kirkovskii V.V. Problemykoloproktologii. Sbornik nauchnykh trudov GNTs koloproktologii[Proc. GSC's of coloproctology "Problems of Coloproctology"]. //Moscow. 1998; 16: 31-36. (in Russ.).8. Vorob'ev G.I. Osnovy koloproktologii [Basics of Coloproctology]. //Moscow: Meditsinskoe informatsionnoe agentstvo, 2006; 432.(in Russ.).9. Vorob'ev G.I., Nikitin A.M., Rivkin V.L. Obsledovanieproktologicheskogo bol'nogo [The survey of proctologicalpatient]. // Moscow, 1993; 28. (in Russ.).10. Goshchitskii L.G., Mozel' Iu.L., Mikhlin B.A. Sbornik "Problemyproktologii" [Digest "Problems of Coloproctology"], // Moscow.1994; 14: 15–18. (in Russ.).11. Grigor'ev E.G., Shcherbatykh A. V. Klinicheskie lektsii pokhirurgii. Chast' 2. Izdanie 4-e, pererabotannoe i dopolnennoe.[Clinical lectures on surgery]. // Irkutsk, Irkutskii gosudarstvennyimeditsinskii universitet. 2009; 220. (in Russ.).12. Dul'tsev Iu.V., Salamov K.N. Paraproktit [Paraproctitis]. //Meditsina. 1981; 206. (in Russ.).13. Zhakipbaev K.A., Makishev A.K., Mun N.V.Problemy koloproktologii: Sbornik nauchnykh trudov GNTskoloproktologii [Proc. of the GSC of coloproctology "Problemsof Coloproctology"]. // Moscow. 1998; 16: 46-49. (in Russ.).14. Zaremba A.A. Klinicheskaia proktologiia [Clinical proctology]. //Riga: «Zvaigzne» Publ., 1987; 359. (in Russ.).15. Ishimov M.S., Khidiiatov I.I., Amirova D.Kh. [The possibility ofusing computed tomography in the diagnosis of deep forms ofacute paraproctitis]. 3-ia Vserossiiskaia nauchno-prakticheskaiakonferentsiia «Novye tekhnologii v khirurgii» [3rd Conf "NewTechnologies in Surgery"]. // Ufa. 129-130. (in Russ.).16. Kogan A.I. Materialy k patogenezu, klinike i terapiipriamokishechnykh svishchei [Materials to a pathogenesis,clinic and therapy of rectal fistulas. Doct. Diss. Med. Sci.]. //Dnepropetrovsk. 1957; 31. (in Russ.).17. Mal'tsev V.N., Korolenko V.B. Vrachebnaia taktika pri ostromparaproktite. Problemy reabilitatsii proktologicheskikh bol'nykh[Medical tactics to the patient with acute paraproctitis. Problemsof rehabilitation of patients with proctologic pathology]. // Minsk.1998; 19-20. (in Russ.).18. Masliak V.M., Stasyshin R.I. Aktual'nye problemykoloproktologii: Materialy konferentsii [Proc. of Conf. "ActualProblems of Coloproctology"]. // Nizhnii Novgorod. 1995; 272-274. (in Russ.).19. Naumov A.I., Maskin S.S., Gevorkov A.R. Endolymphatictherapy of the acute purulent paraproctitis. Aktual'nye problemykoloproktologii: Materialy konferentsii [Proc. of Conf. "ActualProblems of Coloproctology"] //. 1999; 94. (in Russ.).20. Oleinikov P.N., Baranov O.N., Nosov V.A. Sbornik tezisov 3 Vserossiiskoi nauchno -prakticheskoi konferentsii «Novye tekhnologii v khirurgii» [Proc.of Conf. "New Technologies in Surgery"]. // Ufa. 1998; 140-142.(in Russ.).21. Oleinikov P.N., Baranov O.N., Nosov V.A., Klimanov A.V. Ul'trafioletovoye oblucheniye krovi v kompleksnom lecheniibol'nykh s ostrym paraproktitom[Ultraviolet irradiation of blood in the complex treatment ofpatients with acute paraproctitis]. // Proc. of Conf. "New Technologies in Surgery". Ufa. 1998; 142-14422. Rivkin V.L., Bronshtein A.C., Fain S.N. Rukovodstvo pokoloproktologii [Guidance of Coloproctology]. // Moscow, 2001;300. (in Russ.).23. Semionkin E.I. Koloproktologiia (Uchebnoe posobie)[Coloproctology (Tutorial)] // Moscow: ID MEDPRAKTIKAPubl., 2004; 234. (in Russ.).24. Seropian G.A., Bichev R.P.,Dezortsev I.L. Aktual'nye problemykoloproktologii [Proc. of Conf. "Actual Problems ofColoproctology"]. // Irkutsk, 1999; pp. 120-121. (in Russ.).25. Suvorova G.N. Osobennosti gistogeneza i regeneratsii priamoikishki i ee sfinkternogo apparata. [Features of histogenesis andregeneration of the rectum and sphincter apparatus. Doct. Diss.Med. Sci.]. // Saransk. 2001; 42. (in Russ.).26. Sufiiarov R.S., Nurtdinov M.A., Gabidullin Z.G.,Gabdrakhmanova A.A. Lecheniye paraproktita, vyzvannoyeassotsiatsii Sankt-Aureus s pr. Vulgaris, Morganellamorganii iEnterobacter aggl [Treatment of paraproctitis caused byassociations St. Aureus with pr. Vulgaris, Morganellamorganii andEnterobacter aggl.] // Vestnik Iuzhno-Ural'skogo gosudarstvennogouniversiteta. Seriia: Obrazovanie, zdravookhranenie, fizicheskaiakul'tura, 2012; 8 (267): 70-73. (in Russ.).27. Timerbulatov V.M., Kalanov R.G., Ishimov M.S Paraproktit[Paraproctitis]. // Ufa, 1998; 205. (in Russ.).28. Fedorov V.D., Vorob'ev G.I., Rivkin V.L. Klinicheskaiaoperativnaia koloproktologiia [Clinical operative proctology]. //Moscow, 1994; 450. (in Russ.).29. Fedorov V.D., Dul'tsev Iu.V. Proktologiia [Proctology]. // Moscow:Meditsina Publ., 1984; 384. (in Russ.).30. Khrenov V.E., Stygin O.V., Zvol'skaia E.Iu.Materialy konferentsii "Aktual'nye problemy koloproktologii"[Proc. of Conf. "Actual Problems of Coloproctology"]. // NizhniiNovgorod. 1995; 304. (in Russ.).31. Shelygin Iu.A., Blagodarnyi L.A. Spravochnik po koloproktologii[Handbook of Coloproctology]. // Moscow: Litterra, 2012; 596. (inRuss.).32. Ektov V.N., Nalivkin A.I. Aktual'nye problemy koloproktologii:Tezisy dokladov [Abstracts of Conf. "Actual Problems ofColoproctology"]. // Rostov-na-Donu. 2001; 88. (in Russ.).33. Nelson R. Anorektal'naya abstsess svishcha: chto my znayem? [Anorectal abscess fistula: what do we know?] // SurgClin. North Am. 2002; 82(6): 1139–1151.34. Sahni VA, Ahmad R, Burling D. Kakoy metod luchshe vsego podkhodit dlyavizualizatsiya perianal'noy fistuly? [Which method is best forimaging of perianal fistula?] // Abdom Imaging, 2008; 33: 26: 30.35. Senagore A.J. Intrarektal'noye i vnutri anal'noye ul'trazvukovoye issledovaniye votsenke kolorektal'nogo patologii [Intrarectal and intra-anal ultrasonography in theevaluation of colorectal pathology.] // Surg. Clin. North. Am. 1994;74: 6: 1465-1473;36. Stoker J. at al. Endolyuminal'naya MRT pryamoy kishki i zadnego prokhoda:tekhnika, prilozheniya i podvodnyye kamni [Endoluminal MR imaging of the rectum and anus:technique, applications, and pitfalls.] // Radiographics. 1999; 19: 2:383-398.37. Ustynoski K., Rosen L., Stasik J. et al. Podkova abstsess svishcha:Seton lecheniye. [Horseshoe abscess fistula:seton treatment.] // Dis. Colon Rectum. 1990; 33: 7: 602-605.38. Van Outryve M. Endoskopicheskoye ul'trazvukovoye issledovaniye v vospalitel'nomzabolevaniya kishechnika, paracolorectal vospalitel'noy patologii, izaochnaya anomalii [Endoscopic ultrasonography in inflammatorybowel disease, paracolorectal inflammatory pathology, andextramural abnormalities.] // Gastrointest. Endosc. Clin. N. Am.1995; 5: 4: 861-867.39. Van de Stadt J. Svishch v ANO: mesto rektal'nogo prodvizheniya loskuttekhnika. [Fistula in ano: the place of rectal advancement flaptechnique.] // Acta. Chir. Belg. 2000; 100: 3: 123-127.40. Van Tets W.F., Kuijpers H.C. Seton lecheniye perianal'nykh svishcheys vysokoy anal'nom ili rektal'nogo otkrytiya [Seton treatment of perianal fistulawith high anal or rectal opening.] // Br. J. Surg. 1995; 82: 895-897.41. Veronikis D.K., Nichols D.H., Spino C. Nobl-MengertFishoperatsiya-Revisited: kompozitsionnyy podkhod k stoykimrektovaginal'noy svishchi i slozhnyye defekty promezhnosti [The Noble-MengertFishoperation-revisited: a composite approach for persistentrectovaginal fistulas and complex perineal defects.] // Am. J. Obstet.Gynecol. 1998; 179: 1411–1416.42. Wedell J., Meier zu P. Eissen et al. Razdvizhnaya zakrylkov dlya uluchsheniya[Lecheniye vysokogo urovnya svishchey Sliding flap advancement fortreatment of high level fistulae.] // Br. J. Surg. 1987; 74: 390-391.43. Whiteford M.H., Kilkenny J., Hyman N. et al. parametry praktikidlya lecheniya peri abstsessov i svishchey-v-ANO (v novoy redaktsii). [Practice parametersfor the treatment of peri abscess and fistula-in-ano (revised).] // Dis.Colon Rectum. 2005; 48: 1337-1342.44. Zimmerman D.D., Delemarre J.B., Gosselink M.P., HopW.C. et al. Kureniye vliyayet na iskhod transanal'noy slizistykh obolochekprodvizheniye loskut remont transsphincteric svishchey [Smoking affects the outcome of transanal mucosaladvancement flap repair of transsphincteric fistulas.] // Br. J.Surg. 2003; 90: 3: 351-354.45. Zmora O., Mizrahi N., Rotholtz N. et al. Fibrinovyy kley zapechatyvaniyapri lechenii perianal'nykh svishchey. [Fibrin glue sealingin the treatment of perineal fistulas.] Dis. Colon Rectum.2003; 46: 5: 584-589.