2020年10月26日星期一

hemorrhoids and anal fissures,Analysis of curative effect of three-dimension thread-drawing in treatment of iatrogenic anal stenosis

    Iatrogenic anal stenosis is a stenosis of the anal canal caused after anal surgery. It is also a common complication after anal canal surgery. With the increase of patients with anal diseases, the number of anal operations is gradually increasing, especially for patients with hemorrhoids. , Irregular surgical treatment will cause this complication and increase patient suffering. Since 2016, our department has treated 50 patients with iatrogenic anal stenosis. The three-division thread-hanging treatment was used to achieve satisfactory results and greatly relieve the pain of patients. The summary is as follows:

    1. Materials and methods

    1.1 Clinical data From January 2016 to September 2017, our department treated 50 patients with anal stenosis caused by anal surgery such as hemorrhoids and anal fissure. The medical history, symptoms and signs all met the relevant diagnostic criteria. The patient has a history of hemorrhoids and other operations. The patient is diagnosed from one month to six months after the operation. The patient is nervous, has a sense of fear of defecation, and has difficulty defecation. The anus is painful during defecation, and the stool is thin and can be discharged. When the stool is dry, it is difficult to discharge and the pain increases. , Stool becomes thin, defecation is like squeezing residual toothpaste, anal obstruction, and sometimes enema is needed to assist defecation. Anal examination revealed anal scar formation, or accompanied by unhealed incisions, anal tightening, difficulty in the digital anal examination or only allowing one index finger to pass, the patient had obvious pain, palpable anal canal tension increased, anal canal was ring-shaped stenosis, anal sphincter Inelastic, malignant lesions were excluded by colonoscopy. Fifty patients were randomly divided into observation group and control group. There were 25 cases in the observation group, 15 males and 10 females, aged 18-68 years, one month to six months after the operation; 25 cases in the control group, 18 males and 7 females Cases, aged 20-67 years, one month to six months after surgery.

    1.2 Treatment methods

    1.2.1 In the control group, patients who underwent external anal sphincter and scarotomy at the median posterior anus were taken from the thoracic and knee positions, routinely disinfected and draped, underwent perianal infiltration anesthesia, and radial incisions were made at the median posterior of the anus 1.5cm from the anal margin. Approximately 0.5cm, deep into the skin, hold the blood vessel clamp into the incision to pick out part of the sphincter muscle bundle and cut off the stenosis scar. The trimming incision is V-shaped. After the stump is ligated and hemostasis is complete, the anal canal is built in a drainage tube and pressurized.

    1.2.2 Patients in the observation group who underwent anal three-dimension thread-hanging surgery took the thoracic and knee positions, routinely disinfected the towel, and underwent perianal infiltration anesthesia. The anus was rounded, and the anus was divided into three equal parts at 12, 4, and 8 o'clock. Make a 0.5cm incision at the outer edge of the anal stenosis scar at 12 o’clock. The curved vascular forceps pass through the vertical stenosis ring at the base of this mouth, penetrate the mucosa at the upper edge of the stenosis ring, and pull back the rubber band with the clamp , Lift both ends of the rubber band, tighten the rubber band tightly against the narrow ring, treat the 4 o'clock, 8 o'clock position with the same method, after the operation, the anal canal has a built-in drainage tube and pressurized bandaging.

    Patients in both groups were given a semi-liquid diet, intravenous infusion of antibiotics for 7 days, routine dressing was changed the next day, nepeta fumigated lotion was bathed, and anus tai suppository was given.

    1.3 Efficacy criteria: cure The patient has unobstructed defecation, unaffected by the nature of stool, no sense of obstruction in the anus, healing of the anal incision, unobstructed entry of the anal finger and index finger, and no spasm of the sphincter. Improvement The patient's defecation is still smooth, there is a sense of obstruction when the stool is dry, but it can be discharged smoothly, the incision is healed, and the anal finger can enter smoothly. Ineffective No significant change compared with before treatment.

    2 results

    After the treatment, the clinical efficacy was observed and followed up for 3 months. With the exception of one patient, the symptoms and signs of the patient were significantly improved, the patients were able to defecate smoothly, and the anus was not obstructed. The cure status of the two groups is shown in the table below:

    Table 1 Comparison of postoperative curative effect between the two groups

    Group Number of cases Cure improved Ineffective Cure rate

    Observation group 25 25 0 0 100%

    Control group 25 21 3 1 84%

    The cure rate, improvement and ineffectiveness of the observation group were significantly higher than those of the control group.

    3 Discussion

    Iatrogenic anal stenosis is often caused by the treatment of hemorrhoids. There are many treatment methods for hemorrhoids. If the doctor lacks professional theoretical knowledge and clinical practice experience, does not pay attention to aseptic operation, and the treatment method is not appropriate, it is easy to cause this complication. It is common in clinical practice that the anus is not fully expanded before hemorrhoid surgery, too much skin is removed during the operation, the wound is too large, the skin bridge is not retained, the corresponding protection of the anal canal skin is lacking, and the sphincter is not released in time during the operation; or the internal hemorrhoids are injected improperly, Inadequate injection disinfection, high drug concentration, or excessive drug dosage, or injection site below the tooth line or deep into the muscle layer can cause infection and cause stenosis (1). In addition, the increase in the application of PPH, irregular application during surgery, low purse string suture position, too much suture tissue, and failure to expand the anus in time after surgery can also cause this complication.

    Through clinical observations, it is found that the three-division thread-drawing therapy for iatrogenic anal stenosis is simple, safe and effective, which not only avoids the brittle and bleeding characteristics of scar tissue, but also loosens scar tissue to the maximum extent and reduces the incision . By cutting the narrow scar ring of the anal canal, it can fully relieve the tension of the anal canal, loosen the anal sphincter, increase the elasticity of the anal sphincter, reduce the pressure in the rectum during defecation, restore the compliance of the anal canal, thereby returning to normal defecation and eliminating the anal sphincter The spasm can effectively promote the healing of the anal incision and avoid the risk of anal incontinence caused by excessive cutting of the sphincter. The surgical trauma is small, the postoperative bleeding is small, the patient's pain is low, and the hospital stay is short, which greatly reduces the patient's psychological and economic burden, and is suitable for clinical operations.

    1 Huang Naijian. Chinese Anorectology. Jinan. Shandong Science and Technology Press. 1996.825.

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