1 Hemorrhoids treatment principle
The purpose of hemorrhoid treatment is to eliminate symptoms. The prerequisite for anal cushion to evolve into hemorrhoids is anal cushion hyperemia, arteriovenous anastomotic tube expansion, tissue hyperplasia, and anal cushion hypertrophy. There are two main reasons for the anal cushion congestion: the normal anal cushion supporting muscles cannot retract the anal cushion into the anal canal after defecation, or the tightened anal sphincter hinders the blood return in the anal cushion. Generally, general treatment should be used first. General treatment includes changing the diet, drinking more water, adding more dietary fiber, maintaining smooth stool, preventing diarrhea, warm water bathing, keeping the perineum clean, etc., which are necessary for the treatment of various hemorrhoids. The doctor should adopt the treatment method that is most beneficial to the patient based on experience and equipment conditions. If the general treatment fails, medication or surgery can be used.
2 treatment method
2.1 Basic treatment
Changing the dietary structure and developing good bowel habits are the basic treatments of various treatment methods. Diet structure is closely related to the incidence of hemorrhoids. Studies have shown that there is a significant difference in the incidence of hemorrhoids between people living in rural areas and those living in cities. This is because of their different dietary structure. People who live in the country are rich in dietary fiber, and the incidence of hemorrhoids is low. People living in cities have a significantly higher incidence of hemorrhoids. Therefore, changing the diet as a basic treatment for hemorrhoids is very effective. Constipation is related to the onset of hemorrhoids. People who have difficulty in defecation, need to work hard, or read newspapers, magazines and novels for a long time during defecation, can cause congestive damage to the anal cushion. These people have a high incidence of hemorrhoids. Therefore, develop good bowel habits. Increase the dietary fiber in food, improve the symptoms of constipation, and help the treatment of hemorrhoids.
2.2 Drug therapy
It is mainly suitable for internal hemorrhoids of degree I and II. Including suppositories, ointments, oral medications and various other therapies to protect the mucous membranes.
The purpose of treatment of hemorrhoids is to eliminate symptoms. More than 80% of symptomatic hemorrhoids can be cured by non-surgical treatment. Therefore, non-surgical therapy occupies an important position in the treatment of hemorrhoids. Non-surgical treatments include internal medicine and external medicine. There are many oral medicines, such as the traditional Chinese medicine Huaijiao Pills, Huazhi Pills, Zanglian Pills and the western medicine Maizhiling, Xiaotuozhi, hemorrhoids treatment, hemorrhoids and so on.
New oral medicine: Maizhiling, which is currently used clinically, is mainly used for the acute onset symptoms of internal and external hemorrhoids caused by hemorrhoidal varicose veins, itching, blood in the stool, and pain. The main effects are to reduce swelling, relieve pain, and improve local blood circulation. It can speed up wound healing and can be used for the adjuvant treatment of pre- and post-operative anorectal diseases.
External medicines include anal suppositories, topical ointments, steaming lotions and so on. Such as Zhichuang Ningshuan, wild chrysanthemum suppository, Mayinglong hemorrhoid ointment and so on. The Taining Suppository (Titan Eine Suppository: Compound Carrageenate Suppository) produced by the French Martin Company recently introduced by Xi'an Janssen contains a unique ingredient carrageenate, which forms a gluey membrane on the surface of the anal mucosa at the end of the rectum Cover, resist the mechanical or chemical damage of feces, can stop bleeding, reduce inflammation and provide a good healing environment for hemorrhoid mucosa, and can quickly eliminate symptoms.
At present, Zhichuangning suppository is a better external suppository. Its functions and purposes: various internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal inflammation and swelling, fistulas, anal fissures, pain relief after anorectal surgery and elimination of urinary retention. Containing orycosyl alcohol ester can better improve the microcirculation of the surgical site, reduce swelling and relieve pain, and accelerate wound healing.
Compound Xiaozhi Suppository is a traditional Chinese medicine preparation, composed of Galla Chinensis, Rhubarb, etc. It has astringent and hemostasis effect. It is used to treat hemorrhoids in various periods and is an auxiliary drug for postoperative hemorrhage treatment.
Rongchang Kangtai Suppository: cooling blood to stop bleeding, clearing away heat and toxins, removing dampness and relieving sore, reducing swelling and pain, used for hematochezia, swelling and pain in internal hemorrhoids, external hemorrhoids and mixed hemorrhoids.
Jieyoushen long-acting antibacterial agent is a safe and invisible dressing dressing for wound dressing after various operations in the anorectal department. It can play a long-lasting antibacterial effect and accelerate wound healing without adverse reactions.
2.3 Anal pad fixation and repair
Suitable for loose hemorrhoids (internal hemorrhoids) supporting the anal cushion. Including sclerosing agent injection method, necrosis agent injection method, rubber sleeve tying method, dry hemorrhoid nail method, infrared coagulation, bipolar diathermic electrocoagulation, cryotherapy, etc. The sclerosing agent injection method is still an effective method widely used in the world. The only difference is the change of the injection drug composition and the improvement of the operation method. The principle of injection therapy is by no means vascular embolism, but sclerosing injection causes local aseptic inflammation and fibrosis of the submucosal tissues, so that the expanded arteriovenous anastomosis tube in the anal cushion is reduced and restored to normal, and the prolapsed anal cushion is attached. Effective on the muscle surface. Commonly used injections are: 5% carbolic acid vegetable oil (Chen’s hemorrhoid oil), 5% sodium morrhuate, 5% urea hydrochloride quinine aqueous solution, 4% alum aqueous solution and so on. Sclerosing agent injection therapy is particularly suitable for I and II degree internal hemorrhoids and anal discharge; necrosis agent injection can be used for various and various degrees of hemorrhoids, especially suitable for I and II degree internal and external hemorrhoids. Apron band ligation is an effective therapy between drug therapy and surgical therapy, and it has been widely used at home and abroad. Necrosis agent injection therapy and band ligation therapy are simple, effective, and low-cost. Because the ligation point is more than 1 cm above the tooth line, it is usually painless. After the necrosis agent is injected, because it is fast-acting necrosis, the diseased tissue is isolated from the normal tissue, and the nerve is cut, it is usually painless. These two methods are to remove the damaged, irreparable, and irreversible excessive tissue of the anal cushion.
2.3.1 "Sclerotherapy injection therapy: applicable to grade I and II internal hemorrhoids, the drug is injected into the submucosa at the base of the mother hemorrhoids, aseptic inflammation occurs, small blood vessels are occluded, fibrous proliferation in hemorrhoids, hardening and atrophy. Commonly used sclerosing agents are Xiaozhiling injection, Chen's Xiaozhi oil, 5% sodium morrhuate, compound alum injection, 5% phenol glycerin solution and so on.
Operation method: The patient empties stool, reveals the hemorrhoids under the thoracic and knee position under the anal mirror, after disinfection, pierces the submucosal layer on the dentinal line and injects medicine, and injects 1~2ml of each hemorrhoid.
2.3.2 "Necrosis agent injection method: suitable for hemorrhoids (including incarcerated internal hemorrhoids), external hemorrhoids, mixed hemorrhoids, single rectal polyps, anal fissures, anal vegetations, etc. in each period. Operation method: The patient emptied the stool, exposed the hemorrhoids under the thoracic and knee position under anal mirror. After disinfecting the local anesthesia, clamp the base of the hemorrhoids with hemostatic forceps and insert a needle at the most prominent point of the hemorrhoids, pierce the submucosa with the needle inclined upward. After the needle is inserted, gently lift the mucosal layer with the needle, slowly push the medicine, and the medicine solution infiltrates the base. In about 5 minutes, the drug-impregnated part is all purple-black, and the drug-impregnated surface is about 0 3 cm away from the normal basal mucosa. Stop pushing the drug and press the needle point with a dry cotton ball for a while to prevent the outflow of the drug solution. One injection should not exceed 4 cm. One hemorrhoid, necrotic hemorrhoids should be sent into the anus, and the total amount of medicine should not exceed 4ml. Drugs: Hemorrhoids and roots injection and hemorrhoids holographic injection are new types of drugs for hemorrhoids, which have the dual effects of hemorrhoids and pain relief.
2.3. 3 Cryotherapy: It is suitable for patients with hemorrhoid bleeding that does not stop, recurrence after operation, the elderly and infirm, or those with heart, lung, liver, kidney disease, etc. that are not suitable for surgery. Liquid nitrogen is used to contact the hemorrhoids through the cryoprobe (-196℃) to make The tissue is dead and shedding.
Operation method: The preoperative preparation and posture are the same as the injection therapy. The cryoprobe is directly contacted with the center of the hemorrhoid through an anoscope for 2 minutes to make the whole hemorrhoid into a white ice ball. There will be no special treatment. Hemorrhoids will be necrotic in 5-7 days, necrotic and decayed in 10-14 days, and the epithelium will grow at the same time. After healing, there will be white and thin scars. The cure rate can reach 70%.
2.3.4 dry hemorrhoid nail therapy: suitable for internal hemorrhoid bleeding or prolapse bleeding.
Method of operation: Insert the hemorrhoids into the hemorrhoids with two pointed fusiform tablets the size of a matchstick, causing the hemorrhoids to undergo acute inflammation, corrosion and necrosis, and finally fibrosis. The hemorrhoids nails contain alum, gallnut, berberine, notoginseng, borneol and other drugs. Before inserting the nail, prepare the same injection therapy. It is required to insert the nail under direct vision. It should not be too deep or too shallow. If it is too deep, it can be inserted into the muscle layer or penetrate the intestinal wall, which will cause infection around the rectum. If it is too shallow, it can cause mucosal necrosis and bleeding.
2.3.5 "Infrared coagulation method: suitable for small internal hemorrhoids of degree I and II. Operation method: the probe focus is on the mucosa of the upper anal canal at the base of the hemorrhoids, and the protein is coagulated in 15 seconds, and each hemorrhoid is coagulated with 6 small spots. There is often a small amount of bleeding after surgery, but more operations are required.
2.3.6 Laser therapy: Use light and heat energy to carbonize and fall off the diseased tissue to eliminate the disease. It is only suitable for external hemorrhoids, and internal hemorrhoids must be combined with ligation therapy.
2.3.7 "Electric ion therapy and capacitive field therapy: The use of high-frequency electric field to make electric ions oscillate, generate heat, dry tissue, tissue necrosis, and then naturally fall off. At present, the representative is the ZZ type anorectal comprehensive treatment instrument developed by Hangzhou Hercules Medical Instruments Co., Ltd. The nano electronic therapeutic device developed by the Bosch Institute of Medical Instruments has a good effect on internal and external hemorrhoids, anal fistulas, rectal polyps, and rectal cancer. Use shock and heat generation to dehydrate tissues, dry tissues, and naturally fall off. It can be used for hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal papillary fibroma, anal fissure, anal fistula, abscess incision, inflammatory external hemorrhoids, local infection, swelling and pain, perianal eczema, itching, flat warts, condyloma acuminata, phimosis, prepuce Long, underarm odor, etc.
2.3.8 Adhesive band ligation method: Put a special latex snare of 0 2 ~ 0 3 cm wide on the root of the hemorrhoid to make the hemorrhoid ischemic necrosis and fall off, and there is the possibility of subsequent bleeding after the operation. If there is no band ligator, two hemostatic forceps can also be used instead.
2.4 "Surgical treatment" is mainly suitable for patients with Ⅰ and Ⅱ degree internal hemorrhoids, mixed hemorrhoids, and non-surgical curative effects including external hemorrhoid thrombosis or hematoma. Regardless of the surgical method, the purpose is to repair the damaged anal cushion or to remove the irreparable anal cushion. Care should be taken to avoid complications such as postoperative bleeding, anal stenosis, anal insufficiency, and urinary retention.
2.4.1 ligation method: ligate the hemorrhoid root with thick silk thread to make the hemorrhoid ischemia, necrosis and fall off. Need to pay attention to secondary bleeding after surgery.
2.4.2 Hemorrhoidectomy: suitable for isolated prolapsed hemorrhoids. Under anesthesia, expand the anus to reveal the hemorrhoids, incise the skin and mucous membrane, peel off the varicose veins, ligate and excise, the mucosa on the dentition line can be sutured, and the skin incision is open for drainage. The treatment of Ⅰ and Ⅱ degree prolapsed internal hemorrhoids is mainly based on surgery. The surgical method is usually external stripping and internal ligation. The surgical method is simple, the radical cure effect is good, and the recurrence rate is low, but the postoperative pain in the anal area is long and the wound is Slow healing, anal incontinence and anal canal stenosis and other complications also occur.
2.5 "New progress in treatment" A new operation to protect the anal cushion is a stapler circular hemorrhoidectomy.
In 1998, Italian scholar Longo proposed a new method (PPH) for the treatment of I and II degree prolapsed internal hemorrhoids through circular resection of the lower rectal mucosa and submucosal tissues. Because this operation does not have an incision in the perianal skin, the postoperative pain is lighter. The pad is retained, the ability to control stool is not affected after surgery, and there is no complications such as anal stenosis and fecal incontinence. It is quickly promoted internationally.
Stapling hemorrhoidectomy is to remove the rectal mucosa and submucosal tissues close to the anal cushion above the tooth line in a circular shape, and suspend the tissues of the anal cushion and anal canal as a whole to prevent it from moving down and prolapse, and cut off at the same time The blood vessels in the mucosa and submucosa that supply the anal cushion reduce the blood supply of the anal cushion after the operation, and the hemorrhoids gradually atrophy. On the one hand, it relieves the symptoms, and on the other hand, it effectively retains the fine bowel control ability of the anal canal. Therefore, stapled hemorrhoidectomy is significantly better than various traditional hemorrhoid surgeries. The use of imported disposable staplers is expensive and difficult to popularize. The domestic Changzhou New Energy Stapler General Factory has used PPH devices for many times, and the anastomotic equipment (stapler and anal canal dilator) can be used repeatedly, which greatly reduces patient costs. The surgical field was well exposed, the resection and anastomosis were successful at one time, the length and depth of the removed tissue were moderate, and no recurrence, anal stenosis, fecal incontinence and other sequelae were found in follow-up. Therefore, it is feasible to use the domestic 33mm tubular stapler for stapled hemorrhoidectomy, and the effect is satisfactory.
2.6 "Prevention" Hemorrhoids are in a static and asymptomatic state most of the time. You only need to pay attention to your diet to keep your stool smooth to prevent complications. ①Develop the habit of defecation regularly every day to prevent constipation and long defecation time; ②Pay attention to dietary hygiene, eat more vegetables, eat less irritating foods such as peppers, and avoid heavy drinking; ③Exercise regularly and adhere to physical activities. People who stand for a long time, sit for a long time, or are old and weak should insist on inter-work exercises; ④Keep the anus clean and treat the anorectal inflammatory diseases in time.