Clinical observation of copper ion electrochemical therapy combined with external hemorrhoidectomy in the treatment of mixed hemorrhoids
Li Dongbing Xie Zhennian
. keep changing. The most common, there are data showing that hemorrhoids in mixed hemorrhoids are clinically common and frequently-occurring diseases. Among them, mixed hemorrhoids are the most common, and data show that mixed hemorrhoids account for about 65.9% of hemorrhoid patients. The treatment of hemorrhoids is constantly changing with the renewal of understanding of hemorrhoids and the innovation of methods. Prolapse, bleeding, and pain are the main symptoms of hemorrhoids. There are many treatment methods for hemorrhoids. The external stripping and internal ligation (Milligan-Morgan operation) was once the most commonly used surgical method in clinic. Although this method is simple, it has severe postoperative pain, slow wound healing, long hospital stay and may produce anus Complications such as stenosis affect the ability of fine bowel control and defecation in the anus, and require high tolerance for patients, which cannot be tolerated by elderly, frail, and severely ill patients. Stapling prolapse and hemorrhoid circumcision anastomosis (PPH) has been widely used clinically in the past 10 years, but its cost, postoperative rectal stenosis and discomfort have been criticized. Although various methods of continuous improvement have emerged one after another, and each of these surgical methods has certain advantages, but it may not fundamentally solve the above-mentioned shortcomings, or the effect is not good. In 1998, electro-chemical therapy by cupric ion (ECTCI) was used to treat hemorrhoids. Afterwards, many experts studied it and believed that the pain was less and the complications were less. External resection) achieved good results. At the same time, a randomized controlled study was carried out with external stripping and internal ligation and PPH combined with external resection.
1 Treatment method
Enema was performed 2 times before operation, and the sacral canal was anesthetized.
ECTCI treatment: Insert a bell-mouth anoscope, check the bleeding and prolapsed hemorrhoid area, insert 4 sets of copper needle electrodes into 4 hemorrhoid tissues near the tooth line at a depth of 15 mm, and treat for 280 s. Pull out the electrode, the cotton ball presses the needle eye to prevent the copper ionic liquid from overflowing. Use the same method to treat the remaining hemorrhoids successively. The same hemorrhoid area can be treated repeatedly at the same time according to bleeding and congestion. General treatment is not less than 3 times. After the treatment, take out the anoscope and observe the reaction of the hemorrhoid during the treatment. Generally, you can see the blue-green changes in the tissue around the electrode that appear in the ECTCI treatment. After the operation, hemorrhoids and Ning Suppository were built in the anus, and hemostatic dressing was applied and bandaged.
Postoperative treatment: All patients in the 3 groups were treated with antibiotics for 3 days after the operation. They had a normal diet on the day of the operation. They were cleaned with Qudu Erhuang Decoction after defecation, and the dressing was changed routinely until they recovered.
1. Efficacy of hemostasis: 100% cure rate after hemostasis. 2. Curative effect of treatment of prolapse: the cure rate is 95.8%. 3.
Postoperative pain: After t-test, the pain score (24 hours after surgery, postoperative bowel movement) in the treatment group was significantly lower than that in the control group 1 and control group 2. There is statistical significance (P<0.01). 4. Various complications: in terms of postoperative bleeding, edema, urinary retention, delayed healing, anal stenosis, anal swelling, and decreased ability to control stool, the number of cases in the treatment group was significantly less than that of the control group 1 and the control group 2. , The difference was statistically significant (P<0.05).
5. Comparison of hospitalization days, recovery time, and cost: The number of hospitalization days, recovery time, and costs in the treatment group were significantly less than those in the control group 1 and control group 2, and the difference was statistically significant (P<0.05).
Explore the treatment of hemorrhoids. Choosing safe, fast, effective, and less painful treatments is the main criterion.
According to many years of clinical efficacy observations, the long-term effects of drugs and non-incision surgical methods are not as good as that of incisional surgery. However, the obvious pain and complications of incision surgery are always the key issues affecting the direction of treatment. In the past, the fear of surgical treatment of hemorrhoids was mainly painful and prone to sequelae. And its essence is to solve: (1) control of bleeding; (2) resolution of infection; (3) skin protection. Based on the above considerations, in the past, external stripping and internal tying methods were used to solve infection and bleeding problems. But at the same time, it is necessary to reduce the local damage of the operation, try to keep the skin in the anal area intact, and avoid complications such as anal canal defect and anal stenosis. The core of the contradiction and limitation of this treatment method is that it is limited by historical conditions, considering the integration of internal and external hemorrhoids, and mixed treatment of mixed hemorrhoids. The possible countermeasures are: (1) reduce the wound; (2) perform the operation in a painless area; (3) suture the wound. Based on the above ideas, the different situations of hemorrhoids should be dealt with accordingly. The basic tips are: internal treatment of internal hemorrhoids; external treatment of external hemorrhoids; underestimation of the anal margin; protection of the anal canal. Under the guidance of this ideology, we have used and continuously innovated the current two technologies (ECTCI, PPH stapler) for the treatment of internal hemorrhoids, combined with the electric knife to complete the resection of external hemorrhoids, and applied the necessary anal expansion method. This study shows that the treatment The hospital stay of the group was significantly shorter than that of the control group, and successfully solved all the surgical problems of hemorrhoids.
Classification and indexing of hemorrhoids. Due to the principles of internal treatment of internal hemorrhoids and external treatment of external hemorrhoids, from the perspective of guiding treatment, according to the location of hemorrhoids, it is divided into: (1) Internal hemorrhoids. According to the degree of bleeding and prolapse, it is divided into 4 degrees. (2) External hemorrhoids. Divided into 4 categories: ① Thrombosis. ② Varicose veins. ③Connective tissue. ④ Inflammation. Mixed hemorrhoids commonly called in China have no meaning. From the perspective of guiding treatment, the classification of internal and external hemorrhoids is more practical. From clinical experience, the degree of bleeding and prolapse are the main indicators to guide treatment, and circular prolapse and non-circular prolapse should be the main basis for selecting treatment methods. The diagnosis of mixed hemorrhoids has lost its clinical significance.
The theoretical basis of ECTCI plus external resection: ECTCI was developed from the traditional Chinese medicine dry hemorrhoid nail therapy, but dry hemorrhoid nail is painful and the long-term effect is not ideal. ECTCI is based on the principle of the hemorrhoid nail therapy, combined with modern technology, using copper needle electrodes to quickly release complexes similar to the foreign body stimulation of the hemorrhoid nail, and produced by the method and theory of electrochemical therapy. The emergence of technology rejuvenated the treatment concept of kuehemorrhoids nail therapy and demonstrated the charm of traditional Chinese medicine surgery to treat diseases. ECTCI is treated by iontophoresis and electrification, and the complex formed as a foreign body stimulus and electric current together cause local microthrombosis and vascular wall epithelial cell edema, promote aseptic inflammation, tissue organization, vascular occlusion and lead to surrounding tissue fibrosis , So as to achieve the purpose of eliminating hemorrhagic lesions of submucosal blood vessels and preventing prolapse. This therapy produces curative effects under the combined influence of physical, chemical, and foreign body stimulation. Including: (1) The blockage of small blood vessels leads to the interruption of blood supply to hemorrhoids, which promotes the atrophy of congested and swollen hemorrhoids, and achieves the effect of hemorrhoidectomy in the sense of hemostasis. (2) Effectively and safely cause aseptic inflammation and further promote the fibrosis of Treitz muscle rupture, so that the loose supporting tissues can be adhered, fixed, and lifted, leading to further atrophy of hemorrhoid tissue or anal pad. The trace copper ion itself is non-toxic, stable and safe, which makes up for the shortcomings of traditional methods. Therefore, the copper ion electrochemical treatment is suitable for the treatment of mixed hemorrhoids and internal hemorrhoids. For the external hemorrhoids, we advocate resection together, which is the same as the treatment of PPH.
This study shows that the operation of ECTCI plus external resection is simple, the operation time is short, with an average of about 20 minutes, and the requirements for patient tolerance are extremely low. Especially when the curative effect is equal to or better than that of PPH and external stripping and internal ligation surgery, it has the characteristics of less pain, quick postoperative recovery, and no obvious complications. It has less disturbance to the patient's physiology, life, and work, and can be used as an elderly person. , The first choice for the treatment of frail and severely ill patients.