Abstract Objective: To observe the curative effect of finger cutting combined with external washing with Xiaozhiye in treating old anal fissures. Methods: 236 cases of this disease were treated with external washing with xiaozhiye (rhubarb, mirabilite, gall and red peony, etc.) by cutting fingers and expanding surgery. Result: The total effective rate is 100%. Tip: This method has a significant effect on the treatment of old anal fissures.
Subject headings: incision and expansion, Xiaozhiye, old anal fissure
Old anal fissure is a common and frequently-occurring disease. It is characterized by periodic pain, bleeding, and constipation in the anus. Pathological changes include anal ulcers, anal papillary hypertrophy, sentinel hemorrhoids, subcutaneous fistula, anal sinusitis, and sphincter spasm during defecation. There are many kinds of clinical treatments. From 2006 to 2008, we used cut finger expansion combined with external washing with Xiaozhiye to treat 236 cases of old anal fissure. The results are satisfactory. Now the report is as follows:
1 Clinical data
1.1 General information: 112 males and 124 females in this group; aged 16 to 60 years; course of disease 3 months to 12 years, disease location: 180 cases at 6 o'clock in the lithotomy position, 45 cases at 12 o'clock in the morning, 11 cases at other sites, concurrent sentinel There were 206 cases of hemorrhoids, 197 cases of anal papillary hypertrophy, and 16 cases of subcutaneous fistula.
1.2 treatment method
2.1 Preoperative preparations: fasting soy milk, radish and other flatulence foods for three days before surgery; routine blood picture, coagulation four items, electrocardiogram examination; fasting 4h before surgery, clean enema 2h before surgery.
The patient takes the lithotomy position, routinely disinfects the drape, cleans the anal canal after sacral anesthesia or local anesthesia, makes a 1.0cm radial incision at the lithotomy position 1.5cm from the anal edge at 3 o'clock, and inserts the left index finger of the operator into the anus Guided internally, the right hand holds the curved mosquito forceps through the sphincter groove through the sphincteric groove, and separates upward to 1 cm above the dentate line. The separation height cannot exceed the dentate line. The internal sphincter is picked out from the incision and cut off. The inner sphincter that can be palpable and cut at the tube is retracted to a degree of depression, and the incision is sutured with 1-2 stitches. Extend the anus with fingering for 4~6min to relax the anus to accommodate 2~3 fingers. Do not repeat clockwise and counterclockwise dilation around the anus to avoid multiple lacerations of the anal canal, which will affect the combined sentinel hemorrhoids, anal nipple hypertrophy, The subcutaneous fistula is also removed, trimming the edge of the anal fissure and removing the hardened tissue at the base. Check the operation field, completely stop the bleeding, after the operation, the anus is filled with vaseline gauze, and the tower gauze is pressure-wrapped and fixed.
2.3 Stool can be discharged the next day after surgery without fasting. After taking antibiotics for 3 to 5 days after the operation, you can wash it with Xiaozhiye after defecation , the main medicine composition: rhubarb 15g, Glauber's salt 15g, gall, red peony root, dragon blood, catechu, Chinese pepper each 10g, borneol 6g, After grinding the fine powder into boiling water, wash it outside. Ma Yinglong hemorrhoids embolize the anus; those with dry stool can be treated with Maren pills to moisturize the bowel; and the Shengjiyuhong ointment can be changed until the wound heals smoothly. After the operation, he was given anti-infection, daily bathing, dressing change and symptomatic treatment. The incision was removed 5 days after the operation.
3.1 Criteria for evaluation of curative effect: Healing: the wound is healed without pain and secretions in the anus; improvement: the wound is basically healed with occasional pain and a small amount of secretions; invalid: the wound does not heal, with obvious tenderness, and there are still more secretions.
3.2 Treatment results: 236 cases were treated, of which 227 were cured, 19 cases improved, and 0 cases were invalid. The total effective rate is 100%. The treatment time was 10-20 days, with an average of 14 days. No complications and sequelae occurred. Some cases were followed up for 1 to 3 years without recurrence and anal dysfunction.
4 Discussion Anal fissure belongs to the category of hook-intestinal hemorrhoids in traditional Chinese medicine. It is mainly characterized by damp-heat injection, stagnation of qi and blood stasis or dry intestines with blood deficiency, and pain and bleeding as the main symptoms. The main cause of old anal fissure is internal sphincter spasm, which leads to repeated lacerations of the posterior or anterior median of the anal canal during stool, and local repeated infections are difficult to heal by itself. The old anal fissure is an ischemic ulcer, which is induced by internal sphincter spasm. The blood supply after the anus is severely insufficient. Internal sphincterotomy to relieve the vicious circle of sphincter ischemia-spasm-more ischemia is an effective method for the treatment of old anal fissures (chronic anal fissures) . At present, there are many surgical methods to treat old anal fissures. The principle is to cut off the internal sphincter. We use partial lateral internal sphincterotomy and digital expansion to maximize the decomposition of the anal canal scar tissue and the spasm internal sphincter, while avoiding The original surface of the anal fissure is opened, and the internal sphincter is severed under the mucosa, reducing the chance of infection. After the internal sphincter is separated and broken, the fingering method to expand the anus is mainly to fully leave the broken internal sphincter fiber to prevent re-adhesion, hyperplasia, and postoperative recurrence. After the operation, the dilatation of the anus is adjusted to make the bowel movement unblocked, and the symptoms of anal fissure can be immediately relieved. Strict attention should be paid to aseptic operation during the operation to prevent postoperative incision infection, local abscess and anal fistula; when picking the internal sphincter, the action should be light to prevent damage to the anal canal and rectal mucosa; finger expansion should be slow, gentle, and hard. Be uniform and avoid rough movements that may paralyze the anal stent muscles or damage the skin of the anal canal, resulting in temporary incontinence after surgery.After the operation, the traditional Chinese medicine Xiaozhiye is washed externally, rhubarb, gallnut, etc. all have the effects of clearing away heat, detoxifying, permeating menstruation, reducing swelling and relieving pain; pepper has obvious anesthetic and analgesic effects; red peony root, dragon's blood, and catechu can promote blood circulation The effect of swelling and pain relief; Borneol is fragrant and flees, clearing heat and relieving pain. Timely dressing change after operation is the guarantee of rapid wound healing. The embolization of Ma Yinglong hemorrhoids in the anus can inhibit bacteriostasis, anti-inflammatory and analgesic effects, and promote wound healing; comprehensive treatment shortens the course of treatment, with an average healing time of 14 days.
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