犬肛门囊炎的局部治疗:33只犬的回顾性研究

王帆

Local treatment for canine anal sacculitis: A retrospective study of 33 dogs

犬肛门囊炎的局部治疗:33只犬的回顾性研究

作者：Annette Lundberg | Sandra N. Koch | Sheila M.F. Torres

 

翻译：王帆

 

Abstract 

Background: Little information has been published regarding treatment of canine anal sacculitis (AS).

Objectives: Primary objective: determine the outcomes of AS local treatment at the referral dermatology service of the authors' institution. Secondary objective: determine signalment, body condition score (BCS), stool quality and comorbidities associated with AS.

Animals: Thirty-three dogs with AS presented to the referral dermatology service between 1 January 2010 and 31 March 2021.

Materials and methods: An electronic medical record search was conducted. Information regarding sex, breed, age at disease onset, weight, BCS, stool quality, comorbidities, treatment and treatment outcome were collected. Treatment outcome was categorised as “resolved clinically”, “clinical signs resolved per owner”, “did not complete treatment” or “failed”. Dogs were excluded if seen by another service, not treated for AS, or if perianal sinuses (fistulae), anal sac masses, or anal sac abscesses were identified.

Results: Nineteen dogs were male and 14 female. Twenty-four breeds were included. Average age at disease onset was 4.4years. Average BCS was 5.8 of 9. Stool quality was “poor” in seven of 33 and normal in 23 of 33 cases. Atopic dermatitis was the most common comorbidity (12 of 33). Treatment typically consisted of anal sac flushing with saline followed by infusion using a commercially available steroid/antibiotic/antifungal ointment. Treatment was repeated on average 2.9 times. Resolution of AS was obtained in 24 of 33 cases, clinical signs resolved per owner in four of 33, five of 33 cases did not complete treatment, and no cases failed treatment.

Conclusions and clinical relevance: Local treatment with flushing and infusion is effective for treating AS in dogs.

KEYWORDS anal sac, anal sacculitis, canine, dog

摘要 

背景-关于犬肛门囊炎 (AS) 治疗的已发表信息很少。

目的-主要目的:确定作者所在皮肤科转诊机构的AS 局部治疗效果。次要目的:确定与AS相关的特征、体况评分 (BCS)、粪便质量和并发疾病。

动物-2010年01月01日至2021年03月31日期间，33只转诊到皮肤科的AS患犬。

材料和方法-进行电子病历检索。收集了关于性别、品种、发病年龄、体重、BCS、粪便质量、并发疾病、治疗和治疗效果的信息。治疗结果分类为“临床症状消退”、“宠主认为临床症状消退”、“未完成治疗”或“失败”。如果犬因其他原因就诊， 未接受AS治疗，或者如果发现肛周瘘(瘘道)、肛门囊肿块或肛门囊脓肿，则将其排除。

结果-19只犬为雄性，14只为雌性。包括24个品种。发病时的平均年龄为4.4岁。平均 BCS为5.8/9。33例中7例粪便质量“差”，23例正常。特应性皮炎是最常见的并发疾病 (12/33)。治疗通常包括用生理盐水冲洗肛门囊，然后使用市售类固醇/抗生素/抗真菌软膏灌注。平均重复治疗2.9次。24/33个病例的AS得到缓解，4/33个病例宠主认为临床症状缓解，5/33个病例未完成治疗，没有病例治疗失败。

结论和临床相关性-冲洗和灌注的局部治疗可有效治疗犬AS。

关键词：肛门囊、肛门囊炎、犬科、犬

 

INTRODUCTION

介绍

Non-neoplastic anal sac disease (NASD) is common in dogs with an incidence ranging from 2% to 15.7%. A large epidemiological study reported a prevalence of 4.4% in nonreferral small animal hospitals. Non-neoplastic anal sac disease can include impaction, inflammation with or without infection (also termed sacculitis), and abscessation. These conditions are seen as a continuum and differentiation between the individual conditions is poorly defined. The common criteria for diagnosis are: (i) impaction, defined as overfilling and distention of the anal sac; (ii) anal sacculitis (AS), defined as inflammation of the sac lining with or without infection; and (iii) anal sac abscessation, which is when the walls of the anal sac are compromised due to infection, leading to localised cellulitis and eventually draining tracts. Anal sacculitis accounts for approximately 12% of all forms of NASD.

非肿瘤性肛门囊病(NASD)在犬中很常见，发病率在2%到15.7%之间。一项大型流行病学研究报告称，非转诊小动物医院的患病率为4.4%。非肿瘤性肛门囊疾病可包括嵌塞、炎症伴有或不伴有感染(也称为肛门囊炎)和脓肿。这些疾病被视为一种连续事件，很难区别定义单个疾病。常见的诊断标准是:(i)嵌塞，定义为肛门囊过度充盈和膨胀;(ii)肛门囊炎(AS)，定义为肛门囊炎症伴有或不伴有感染;以及(iii)肛门囊脓肿，即肛门囊壁因感染而受损，导致局部蜂窝织炎，并最终产生瘘道。肛门囊炎约占NASD的12%。

 

For such a common disease, surprisingly little evidence-based information exists regarding risk factors and medical treatment of AS. Anal sacculitis is typically considered secondary to an underlying condition or risk factor. Occasionally, it is considered idiopathic. Risk factors including stool quality, diet type and changes, obesity, skin disease and breed have been proposed. Fibre-rich diets have been investigated for the treatment and prevention of NASD and treatment of AS with oral antibiotics has been discussed previously. Antibiotic resistance requires that systemic antibiotics be used judiciously. Treatment via anal sac flushing and infusion with a topical antibiotic and/or anti-inflammatory also has been described; the protocol and described outcomes are largely anecdotal.

对于这样一种常见疾病，令人惊讶的是，关于AS的危险因素和医疗的循证信息很少。肛门囊炎通常被认为是继发于潜在疾病或危险因素。偶尔，它被认为是特发性的。危险因素包括粪便质量、饮食类型和变化、肥胖、皮肤病和品种。富含纤维素的饮食已经被研究用于NASD的治疗和预防，口服抗生素治疗AS之前已经讨论过。抗生素耐药性要求慎用全身性抗生素。通过肛门囊冲洗和灌注局部抗生素和/或消炎药的治疗也有描述;该方案和描述的结果在很大程度上是轶事。

 

This study was conducted to provide additional information on the features of AS in dogs and to validate the authors' perceived success with their anal sac flush and infusion protocol. The primary objective of this retrospective study was to determine the outcomes of local treatment for AS. A secondary objective was to determine signalment, body condition score (BCS), stool quality and comorbidities of dogs with AS.

本研究旨在提供关于犬AS特征的补充信息，并验证作者所认为的肛门囊冲洗和灌注方案的成功。这项回顾性研究的主要目的是确定AS局部治疗的结果。次要目标是确定AS犬的特征、体况评分(BCS)、粪便质量和并发疾病。

 

MATERIALS AND METHODS

材料和方法

Computerised medical records from the authors' institution were searched electronically between 1 January 2010 and 31 March 2021 using the drop-down diagnosis of “anal sacculitis” or “infection - anal sac” and species as “canine”. Clinical diagnosis was made based on the presence of clinical signs associated with AS (licking/ chewing the perianal region, scooting, blood in the stool, or leaking anal sacs). Diffuse thickening of the anal sac wall; haemorrhagic or purulent discharge during anal sac expression; and/or the presence of a larger than expected number of inflammatory cells, erythrocytes, large numbers of coccoid bacteria, intraneutrophilic bacteria, or yeast on cytological evaluation were subjectively used to support the diagnosis of AS. Gross appearance of anal sac contents and cytological composition were not used for diagnosis without corresponding clinical signs as both can be highly variable in clinically normal canine anal sacs. Dogs were excluded if (i) AS was diagnosed and treated by another service at the authors' institution as diagnostic criteria and treatment were not always consistent with that of the referral dermatology service, (ii) they were not treated for the disease, and (iii) they had one of the following conditions: perianal sinuses (fistulae), anal sac masses or anal sac abscesses – in such cases the AS was considered secondary.

2010年1月1日至2021年3月31日期间，作者所在机构的电脑化医疗记录通过电子搜索，使用下拉诊断“肛门囊炎”或“感染-肛门囊”，物种为“犬”。临床诊断基于与AS相关的临床症状(舔舐/啃咬肛周区域、摩擦肛门、便血、或肛门囊漏)。肛门囊壁弥漫性增厚;肛门囊显露时出血或脓性分泌物;和/或在细胞学评估中出现比预期数量更多的炎症细胞、红细胞、大量球菌、中性粒细胞内细菌、酵母菌，这些主观上被用于支持AS的诊断。在没有相应的临床症状的情况下，肛门囊内容物的大体外观和细胞学成分不能用于诊断，因为这两者在临床上正常的犬肛门囊中是高度多变的。如果有以下情况，患犬将排除研究(i) AS是由作者所在机构的另一服务机构诊断和治疗的，因为诊断标准和治疗方法并不总是与转诊皮肤科服务机构的治疗方法一致，(ii)它们没有接受该疾病的治疗，以及(iii)它们有以下情况之一:肛周窦(瘘管)、肛门囊肿物或肛门囊脓肿——在这种情况下，AS被认为是继发的。

 

The following epidemiological data were retrieved from the patients' medical records: sex, breed, age at disease onset reported by owners, age at presentation, weight and BCS. In addition, stool quality reported by the owners at the time of presentation and comorbidities were collected. The following data were retrieved based on treatment before presentation at the authors' referral dermatology service: systemic antibiotics and glucocorticoid prescribed for the condition, other systemic medications, information regarding anal sac flush and/or infusions, and frequency of anal sac expression(s). The following data were collected based on treatment by the authors' referral dermatology service: perianal topical treatment prescribed at initial appointment, systemic treatment prescribed at initial appointment, anal sac flushing material, infusion medication, number of anal sac treatments, interval between treatments, and treatment outcomes.

从患犬的医疗记录中检索了以下流行病学数据:性别、品种、主诉发病年龄、就诊年龄、体重和BCS。此外，收集患犬在出现症状时所报告的粪便质量和并发疾病。根据在作者的转诊皮肤科服务就诊前的治疗情况，检索了以下数据:针对该疾病开出的全身性抗生素和糖皮质激素，其他全身性药物，关于肛门囊冲洗和/或灌注的信息，以及肛门囊显露频率。基于作者转诊皮肤科服务的治疗，收集了以下数据:初诊时开出的肛周外部治疗处方、初诊时开出的全身治疗处方、肛门囊冲洗材料、灌注药物、肛门囊治疗次数、治疗间隔和治疗结果。

 

Treatment outcome was classified as “resolved clinically” if resolution of AS clinical signs was confirmed by the clinician along with reported resolution of clinical signs by the owner; “clinical signs resolved per owner” if clinical signs were reported resolved by phone conversion with the dog's owner without confirmation of clinical resolution; “did not complete treatment” if the owner elected not to return as per recommendation or no communication with the owner was documented after the last treatment; and “failed” if AS did not resolve after six infusions performed in hospital.

如果临床医生确认AS临床症状消退，且宠主报告临床症状消退，则治疗结果被归类为“临床症状消退”;如果临床症状是通过与宠主进行电话回访而解决的，而没有确认临床症状的解决，则“宠主认为临床症状消退”;如果宠主选择不按照建议复诊或在最后一次治疗后没有与宠主沟通记录，则为“未完成治疗”;如果在医院进行6次灌注后AS仍未消除，则为“失败”。

 

Statistical methods

统计方法

Descriptive statistics (mean, minimum, maximum, percentage) were performed on the information collected using Excel (Microsoft; Redmond, WA, USA).

对使用Excel收集的信息进行描述性统计(平均值、最小值、最大值、百分比)。

 

RESULTS

结果

There were 218 dogs diagnosed with “anal sacculitis” or “infection - anal sac” at the authors' institution during the study period. Of these, only 57 were patients of the referral dermatology service. Dogs were excluded for the following reasons: AS was treated by a different service (10), presence of perianal sinuses (fistulae) (eight), no treatment was performed for AS (three), presence of anal sac neoplasia (one), anal sac abscess (one), and infusions performed at home by the dog's owner (one). A total of 33 dogs met the study inclusion criteria.

在研究期间，在作者所在的机构有218只犬被诊断为“肛门囊炎”或“感染-肛门囊”。其中，只有57例是皮肤科转诊服务的患犬。犬被排除在外的原因如下:AS由不同的服务机构治疗(10只)，存在肛周窦(瘘管)(8只)，没有对AS进行治疗(3只)，存在肛门囊瘤(1只)，肛门囊脓肿(1只)，并由犬的主人在家进行灌注(1只)。共有33只犬符合研究纳入标准。

 

Incidence

发病率

There were 3,731 dogs seen by the authors' referral dermatology service between 1 January 2010 and 31 March 2021. Based on the evaluated period, the incidence of AS was 1.5%.

在2010年1月1日至2021年3月31日期间，有3731只犬接受了作者的皮肤科转诊服务。基于评估期间，AS的发生率为1.5%。

 

Signalment, weight and BCS

特征、体重和BCS

Fourteen of 33 (42.4%) dogs were neutered males, 14 of 33 (42.4%) were neutered females and five of 33 (15.2%) were intact male dogs. There were 24 breeds (or mixes thereof) retrieved in this study. The average age at disease onset reported by owners was 4.4years old (range=0.4–11.1years) and the average age at presentation to the authors' referral dermatology service was 5.2years old (0.7–11.3years). The average weight of the dogs was 25.6kg (3.1–52.2kg). The average BCS based on a scale of 1–9 was 5.8 (4–9). For this grading scale, a BCS of 4–5 was considered ideal.16 These findings are detailed in Table 1. Stool quality and comorbidities Stool quality was considered “poor” in seven (21.2%) cases. This included cases with diarrhoea (three), soft stool (two) and loose stool (two). Stool quality was considered normal in 23 (69.7%) cases and was not recorded in three (9.1%) cases. This was based on a subjective assessment made by owners and clinicians. Patients with AS were recorded as having a total of 33 comorbidities. The most common comorbidity recorded was atopic dermatitis (AD), present in 12 (36.4%) cases. No comorbidities were recorded in nine (27.3%) cases. A complete list of stool quality and comorbidities is included in Table 1.

33只犬中14只(42.4%)为已去势公犬，14只(42.4%)为已绝育母犬，5只(15.2%)为未去势公犬。在本研究中检索到24个品种(或其杂交品种)。宠主报告的发病平均年龄为4.4岁(范围为0.4- 11.1岁)，就诊于作者转诊皮肤科服务的平均年龄为5.2岁(0.7- 11.3岁)。平均体重为25.6公斤(3.1-52.2公斤)。根据1-9的评分标准，平均BCS为5.8(4-9)。对于这个评分表，BCS为4-5被认为是理想的这些研究结果详见表1。7例(21.2%)患犬认为粪便质量“差”。这包括腹泻病例(3例)、软便病例(2例)和稀便病例(2例)。23例(69.7%)粪便质量正常，3例(9.1%)无粪便记录。这是基于宠主和临床医生的主观评估。有记录的AS患犬共有33种并发疾病。最常见的并发疾病记录是特应性皮炎(AD)，存在12例(36.4%)。9例(27.3%)无并发疾病记录。粪便质量和并发疾病的完整列表见表1。

 

Treatment and outcomes

治疗和结果

Eighteen of 33 (54.5%) dogs received systemic antibiotics for AS before presentation to the referral dermatology service. Of these dogs, five (27.8%) received a single course of a single antibiotic, three (16.7%) received multiple courses of a single antibiotic, nine (50.0%) received multiple courses of multiple antibiotics and one (5.6%) received systemic antibiotics but the type(s) were not recorded. Flushing and/or infusions had been performed before referral in eight (24.2%) dogs. Treatments prior to presentation are reported in Table 2.

33只犬中有18只(54.5%)在转诊皮肤科之前接受了抗AS的全身抗生素治疗。其中5只(27.8%)接受了单疗程单抗生素治疗，3只(16.7%)接受了多疗程单抗生素治疗，9只(50.0%)接受了多疗程多抗生素治疗，1只(5.6%)接受了全身性抗生素治疗，但未记录其类型。8只(24.2%)犬在转诊前进行了冲洗和/或灌注。就诊前的治疗见表2。

 

At the initial referral service appointment, unilateral treatment was performed in six (18.2%) dogs, bilateral in 26 (78.8%) dogs, and laterality was not recorded in one (3.0%) dog. Apart from one case of unilateral disease which was treated bilaterally and one case where the affected side was not specifically recorded, side of disease and treatment corresponded directly. Although the AS treatment protocols were not standardised among the clinicians, generally it was similar and included: (i) expression of the anal sac using a gloved, lubricated finger; (ii) evaluation of the anal sac content for abnormalities (blood and/or purulent material) followed by cytological examination; (iii) gentle insertion of a lubricated Tom Cat catheter [3.5 French ×5½ inch (14cm)], cut approximately in half at a right angle, into the anal sac opening and through the anal sac duct; (iv) attachment of a 6mL syringe to the catheter and flushing the anal sac until the fluid obtained on expression ran clear; and (v) infusion of the anal sac using the same catheter with a commercially available steroid, antibiotic, and antifungal otic ointment until the anal sac was felt to be full and the product began to come out of the sac. The procedure was repeated until resolution of clinical signs, usually at two week intervals. Sedation to facilitate the treatment was performed according to each patient's needs. The flushing fluid was sterile saline in 27 (81.8%) cases and was not recorded in six (18.2%) cases. An ointment containing gentamicin, mometasone, and clotrimazole was used for infusion in 24 (72.7%) dogs, and an ointment containing nystatin, neomycin, thiostrepton and triamcinolone was used in nine (27.3%) dogs. In one dog, an ointment containing nystatin, neomycin, thiostrepton and triamcinolone was used initially, and then was switched to an in-hospital compounded solution of 1mL ticarcillin clavulanate 3.1g and 0.5mL dexamethasone 4mg/mL based on culture and susceptibility of Pseudomonas aeruginosa.

在最初的转诊服务预约中，6只(18.2%)犬进行了单侧治疗，26只(78.8%)犬进行了双侧治疗，1只(3.0%)犬没有记录治疗患侧。除了一个单侧疾病进行了双侧治疗和一个没有具体记录具体患侧外，患侧和治疗侧一致。虽然AS的治疗方案在临床医生之间没有标准化，但通常是相似的，包括:(i)带手套涂润滑剂，用手指挤压肛门囊;(ii)评估肛门囊内容物是否异常(血液和/或化脓性物质)，然后进行细胞学检查;(iii)缓慢插入切一半呈直角的涂润滑剂的公猫导尿管[3.5法国×5½英寸(14cm)]，插入肛门囊开口，顺进肛门囊导管;(iv)将6mL注射器固定在导管上，冲洗肛门囊，直到冲出液体清澈为止;(v)使用同一导管将市售类固醇、抗生素和抗真菌药膏灌注肛门囊，直到感觉肛门囊胀满，药物开始从肛门囊中流出。重复进行这一过程，直到消除临床症状，通常每两周一次。根据单个患犬情况，必要时进行镇静以促进治疗。27例(81.8%)冲洗液为无菌生理盐水，6例(18.2%)未记录冲洗液。24只(72.7%)犬使用了含有庆大霉素、莫米松和克霉唑的药膏，9只(27.3%)犬使用了含有制霉菌素、新霉素、硫链丝菌素和曲安奈德的药膏。在一只犬中，最初使用含有制霉菌素、新霉素、硫链丝菌素和曲安奈德的软膏，然后根据铜绿假单胞菌的细菌培养和药敏试验，切换到1mL替卡西林克拉维酸3.1g和0.5mL地塞米松4mg/mL的院内复方溶液。

 

Anal sacculitis resolved clinically in 24 of 33 (72.7%) cases; clinical signs resolved per owner without clinical confirmation in four of 33 (12.1%) cases and five of 33 (15.2%) cases did not complete treatment. No cases met the criteria for failed treatment.

33例中有24例(72.7%)肛门囊炎得到临床解决;在33例(12.1%)患犬中，有4例(15.2%)患犬的临床症状在没有临床确认的情况下得到解决，33例(12.1%)患犬中有5例(15.2%)患犬没有完成治疗。没有病例符合治疗失败的标准。

 

For the 28 dogs that completed treatment, the average number of flushings and infusions was 2.9 (1–6). The average interval between flushings and infusions was 16.8days (5–80days) and the median was 14days. The type of infused medication did not appear to have affected the treatment outcome. Three (10.7%) of the 28 dogs experienced recurrence of AS. Two of these dogs were categorised as “resolved clinically”. The recurrence happened at an interval of 85days for one and 445days for the other. For both dogs, factors contributing to the development of AS were unknown. Another dog was categorised as “clinical signs resolved per owner” and experienced recurrence at 345days. This dog later was diagnosed with seasonal AD which the attending clinician believed contributed to the development of AS. All three dogs who experienced recurrence responded well to a second round of treatment. Treatment and outcomes for each dog are summarised in Table 3.

28只完成治疗的犬，冲洗和灌注的平均次数为2.9次(1-6次)。冲洗和灌注的平均间隔时间为16.8天(5-80天)，中位数为14天。注入药物的类型似乎没有影响治疗结果。28只犬中有3只(10.7%)复发。其中两只犬被归类为“临床解决”。其中一例复发时间间隔为85天，另一例为445天。对于这两只犬来说，导致AS发展的因素是未知的。另一只犬被归类为“宠主认为临床症状已解决”，并在345天内复发。这只犬后来被诊断为季节性AD，主治医生认为这有助于AS的发展。所有三只经历复发的犬对第二轮治疗反应良好。表3总结了每只犬的治疗和结果。

 

At the initial appointment, topical perianal treatment was prescribed in 14 (42.4%) cases and new systemic medications were prescribed in seven (21.2%) cases. No systemic medications were prescribed in 19 (57.6%) cases. In five (15.2%) cases, medications for comorbidities were continued. The perianal abnormalities identified on physical examination, topical treatment and systemic treatment are detailed in Table 3.

初诊时，14例(42.4%)患犬开了外用肛周治疗，7例(21.2%)患犬开了新的全身性药物。19例(57.6%)未开全身性药物。5例(15.2%)患犬继续使用药物治疗并发疾病。经体格检查、外部治疗和全身治疗发现的肛周异常详见表3。

 

DISCUSSION

讨论

This is the first retrospective study to report the success rate of local treatment of AS in dogs. Based on these results local treatment of AS is considered an effective alternative to oral antibiotic therapy. Using this approach, 72.7% of the cases achieved complete clinical resolution and an additional 12.1% had resolution of clinical signs as indicated by the owner. A previous prospective study found that one local infusion of 80% aqueous phenol solution following flushing with 0.9% saline solution was effective at resolving 100% of cases of AS for up to 60days. While encouraging for the successful treatment of AS with local therapy, that study was limited by lack of detail about diagnosis and resolution, as well as having a small number of cases in each treatment category. Another study reported an estimated 60% success rate with oral antibiotics with or without flushing of the anal sacs. However, that study did not describe the number of dogs that received oral antibiotics alone, the number of dogs that received flushing of the anal sacs, and the total number of dogs that experienced resolution. Unfortunately, this lack of information impedes comparing the current study findings with this report.

这是第一个报告局部治疗犬AS成功率的回顾性研究。基于这些结果，局部治疗被认为是口服抗生素治疗的有效替代方案。使用这种方法，72.7%的病例获得了完全的临床缓解，另有12.1%的病例得到了宠主认为的临床症状缓解。此前的一项前瞻性研究发现，在用0.9%生理盐水冲洗后，一次局部灌注80%石碳酸水溶液，可有效解决100%的AS病例，持续60天。虽然局部治疗成功治疗AS令人鼓舞，但由于缺乏诊断和解决方案的细节，以及每种治疗类别的病例数量较少，该研究受到了限制。另一项研究报告，口服抗生素伴或不伴肛门囊冲洗的成功率约为60%。然而，该研究并没有描述只接受口服抗生素的犬的数量，接受肛门囊冲洗的犬的数量，以及经历解决的犬的总数。不幸的是，信息的缺乏阻碍了将当前的研究结果与本报告进行比较。

 

In another more detailed study, NASD led to systemic antibiotic use in 1% of dogs in first-opinion practices in the UK, a similar rate to pyoderma. Over half of the dogs included in the current study had a history of systemic antibiotics prescribed for AS. Of these, 52.6% had multiple courses of multiple different antibiotics prescribed, and still required further treatment, indicating that AS may be a significant area of concern for unnecessary use of systemic antibiotics. The use of topical therapy alone could greatly improve antibiotic stewardship.

在另一项更详细的研究中，在英国，NASD导致1%的犬在首诊医院中使用全身性抗生素，与脓皮病数据相似。超过一半的犬都曾服用过治疗AS的全身性抗生素。其中，52.6%的患犬多次服用多种不同的抗生素，仍然需要进一步治疗，这表明AS可能是不必要使用全身性抗生素的一个重要关注领域。单独使用局部治疗可以大大提高抗生素管理。

 

The incidence of AS identified in this study was lower than identified in previous studies. This discrepancy may be explained by the fact that previous studies evaluated the combined occurrence of NSAD in small animal practice, while this study only investigated AS in a specialty referral practice. One study identified a high incidence of AS of 12.5% in a combination of three veterinary practices in England and Australia. This may indicate a geographical difference, a changing incidence over time, and/or a difference between the patient populations of a general practice and referral dermatology service.

本研究中发现的AS发生率低于以往的研究。这种差异可能是由于之前的研究评估了小动物实践中NSAD的合并发生率，而本研究仅调查了专科转诊实践中的AS。一项研究发现，在英国和澳大利亚的三家兽医医院中，AS的发病率高达12.5%。这可能表明地理差异，随时间变化的发病率，和/或全科和转诊皮肤科服务的患犬群体之间的差异。

 

Several factors including stool quality, diet type and changes, BCS, skin disease, and breed have been suggested to lead to the development of AS.However, few studies investigating the aetiology of this condition exist. Of the comorbidities identified in this study, AD was the most frequent. This is consistent with the view that perianal inflammation and self-trauma, which occur with allergic skin disease, may contribute to anal sac duct stenosis, leading to impaction and sacculitis. Owing to the retrospective nature and limited number of dogs included in this study, the relationship between AS and the comorbidities identified could not be determined. Although a small percentage of dogs experienced recurrence, these recurrences may illustrate that the local treatment of AS addresses the condition and not the underlying cause. Therefore, further studies should focus on investigating the predisposing causes and risk factors for AS.

粪便质量、饮食类型和变化、BCS、皮肤病和品种等因素都可能导致AS的发生。然而，很少有研究调查这种情况的病因存在。在本研究中发现的并发疾病中，AD是最常见的。这与过敏性皮肤病发生的肛周炎症和自损可能导致肛囊管狭窄，导致嵌塞和肛门囊炎的观点一致。由于本研究的回顾性性质和纳入的犬只数量有限，无法确定AS和确定的并发疾病之间的关系。尽管有小部分的犬经历了复发，但这些复发可能说明局部治疗AS解决的是病情而不是根本原因。因此，进一步的研究应关注AS的易感原因和危险因素。

 

A previous study identified 75% of cases of AS as having a history of diarrhoea seven to 21days before onset of clinical signs of AS.Diarrhoea was typically mild and self-limiting within one to two days. Sixty percent of dogs in that study ate an all-meat diet and had poorly formed stool. A further 15% were regularly fed chop bones and had a history of rectal impaction. The current study suggests that stool quality plays a smaller role in the development of AS, with only 20.6% of dogs having poor stool quality at the time of presentation. The difference could be explained by the fact that all except two dogs in this study were primarily fed commercially available dog food. It also is possible that some incidences of poor stool quality may have resolved by the time of presentation and were not recorded in the medical records. Increased BCS also has been reported to be implicated in the development of AS. In the current study, the average BCS was 5.8 on a 9 point scale. Of dogs for whom body condition score was recorded, 54.8% were overweight with a BCS >6 and 9.7% were obese with a BCS of 8–9. Nearly half of the dogs had an ideal BCS of 4–5, so no conclusions can be drawn about the role of obesity in the formation of AS.

此前的一项研究发现，75%的AS病例在出现AS临床症状前7至21天有腹泻史。腹泻通常是轻微的，在一到两天内可以自行控制。在这项研究中，60%的犬只吃肉，粪便不成形。另外15%的患犬定期进食碎骨并有直肠嵌塞的病史。目前的研究表明，粪便质量在AS的发展中扮演的角色较小，只有20.6%的犬在出现粪便质量较差时。这种差异可以用以下事实来解释:在这项研究中，除了两只犬外，所有的犬都主要喂食了市售的犬粮。也有可能是一些粪便质量差的情况在就诊时已经解决，而没有记录在医疗记录中。据报道，增加的BCS也与AS的发展有关。在目前的研究中，平均BCS为5.8(满分9分)。在记录体况评分的犬中，54.8%的犬超重，BCS＞6, 9.7%的犬肥胖，BCS为8-9。近一半的犬的理想BCS为4-5，因此无法得出关于肥胖在AS形成中的作用的结论。

 

The primary limitations of this study are its retrospective nature and lack of standardisation of therapy. In some cases not all subjects of interest were recorded. Despite some differences in the treatment protocol, the recommendations were fairly consistent based on the clinical experience of the authors.

本研究的主要局限性是其回顾性性质和缺乏标准化的治疗。在某些病例中，并不是所有相关评估都被记录下来。尽管在治疗方案上有一些差异，但基于作者的临床经验，建议是相当一致的。

 

This study indicates that flushing and infusion using a steroid/antimicrobial topical medication is an effective treatment for AS. This offers an alternative to oral antibiotic therapy for this condition, aiding in antibiotic stewardship. Further investigation into this much neglected area of study is needed including aetiology, risk factors, prevention and prospective investigation of local AS treatment. Evaluation of the outcome of anal sac flushing without infusion and infusions with topical steroid with and without topical antibiotics are areas worthy of future study.

本研究表明，使用类固醇/抗菌外用药物冲洗和灌注是治疗AS的有效方法。这为这种情况提供了一种口服抗生素治疗的替代方案，有助于抗生素管理。这一被忽视的研究领域需要进一步研究，包括病因、危险因素、预防和局部AS治疗的前瞻性研究。评价不灌注肛门囊冲洗和外用类固醇灌注和不使用外用抗生素的结果是值得进一步研究的领域。