The treatment of anal fissure with integrated traditional Chinese and western medicine and new developments at home and abroad
Li Kai Jilin City Integrated Traditional Chinese and Western Medicine Anorectal Hospital
[Keywords] Anal fissures will not be cured for a long time, and it will also cause wounds and ulcers, repeated inflammation, and pain that is difficult to heal. Long-term blood in the stool can cause blood to accumulate under the skin, form a raised hematoma, and form thrombotic external hemorrhoids; fibrous tissue hyperplasia on the anal fissure wound can form scars and cause anal stenosis; wound infection and inflammation often lead to anal papillary hypertrophy and even perianal abscess, which in turn leads to Anal fistula. These add a lot of difficulty to thorough treatment. Therefore, it is best for patients with anal fissures to be treated in time without delay. :
Anal fissure is a common disease. The incidence of anorectal diseases ranks second, second only to hemorrhoids. Because the symptoms are similar to hemorrhoids, it is difficult for ordinary people to distinguish. The difference between anal fissure and hemorrhoids is: 1. The amount of bleeding from hemorrhoids Generally more than anal fissures; two, anal fissures have more severe pain, although external hemorrhoids can also be painful during acute attacks, but unlike the pain of anal fissures, there are obvious regularities. anal fissures are divided into acute and chronic types, and acute is In the early stage of anal fissure, the condition is mild; chronic anal fissures are deep and do not heal repeatedly, and scar tissue is formed around the fissures, or accompanied by external hemorrhoids, anal papillary hypertrophy, and anal fistulas. Why anal fissures are formed and the internal anal sphincter is acidic The spasm caused by the stimulation of the substance and the intestinal lumen dirt, resulting in ischemia of the anal canal; at the same time, because the anal canal cannot dilate normally during defecation, the discharge of stool is obstructed, and forced discharge will aggravate the anal fissure. The sensitivity of the internal sphincter in young people is higher. In addition, there are more constipation due to irregular diet and life, so the incidence is high. Children's anal sphincter is not yet mature, there are fewer vegetables and crude fiber food in the diet, and the stool is thicker, and it will also be more frequent. Women have more perineal sphincter Weakness, especially during menstruation and pregnancy, pelvic congestion and poor reflux, coupled with the use of force during childbirth, resulting in ischemia and easy tearing of the anal canal, so the incidence is higher than that of men. How to prevent anal fissure? First of all, we must correct Constipation; secondly, the diet should be light and vegetarian to prevent the bad irritation of the anus from irritating stool; finally, keep the anus clean and hygienic to prevent infection. If you have anal fissure, you should treat it in time, otherwise, the acute can be transformed into If it is chronic, it can be cured with drugs and it has become a necessity for surgery. If it has developed into a chronic condition without treatment, it will cause constipation, spasm, and anal fissure to interact and aggravate each other, and even cause gastrointestinal disorders and anorectal nerves. Dysfunction, etc.
Anal fissures can not be cured for a long time, and it can also cause wounds and ulcers, repeated inflammation, and pain that is difficult to heal. Long-term blood in the stool can lead to blood stasis under the skin, forming a raised hematoma, and forming thrombotic external hemorrhoids; fibrous tissue hyperplasia on the anal fissure wound can form scars, causing anal stenosis; wound infection and inflammation often lead to anal papillary hypertrophy and even perianal abscess, which in turn leads to Anal fistula. These add a lot of difficulty to thorough treatment. Therefore, it is best for patients with anal fissures to be treated in time without delay. :
, The treatment of anal fissure: can be divided into integrated traditional Chinese and western medicine treatment. Traditional Chinese medicine divides anal fissure into three syndrome types: according to different syndrome types, 1, blood heat and dry intestine syndrome: stool for two or three days, one line, dry quality , Bleeding or staining of toilet paper, pain in the anus, fullness of the abdomen, yellowishness, reddish mouth, reddish tongue, yellowish dry coating, dry pulse. Treatment: Clearing heat and purging fire, increasing fluid and laxative. Recommended prescription: Liangxue Dihuang Decoction. 2. Yin Deficiency and Jin Deficiency Syndrome: Dry stools for a few days, blood dripping during stool, dry mouth and throat, five upset and hot, deep red mouth, red tongue, little or no moss, thin pulse. Treatment: cooling blood and nourishing blood, increasing fluid and laxative. Recommended prescription: Runchang pills 3. Qi stagnation and blood stasis syndrome: anal tingling, especially after defecation, anus tightening, dark purple color of the crack, dark purple tongue, stringy or astringent pulse. Treatment: Promoting qi and blood circulation, moistening the intestines and laxative. Recommended prescription: Liumo Tang.
(2) Partial posterior internal sphincterectomy: cut off the lower edge of the internal sphincter directly from the anal fissure, and sometimes also cut the lower part of the internal sphincter. If there is inflammation, anal fistula, hypertrophic anal papilla can be removed at the same time, the incision is open, the healing is slow, and sometimes there is lock Hole deformity. Specific operation method: The patient takes the stone cutting position, routinely disinfects after sacral anesthesia or local anesthesia, and cuts the skin in a "△" shape on both sides of the anal fissure. The low end starts at 1.5cm outside the anal margin, and the top ends at 0.3 on the tooth line. cm, the bottom width is about 0.5cm. Use tissue forceps to lift the skin of the bottom incision, sharply separate the hard fibrotic tissue external hemorrhoids (sentinel hemorrhoids) and hypertrophic anal papilla under the skin, and remove them together.
(3) Anal fissure thread-hanging surgery: It is suitable for anal fissure accompanied by a sneaky fistula. In order to avoid postoperative pain, it can be injected locally and incorporated analgesics. It is suitable for outpatient treatment. Specific operation method: After successful anesthesia, take the stone cutting position: sterilize and spread an empty sterile towel, perform a digital examination first, and then gently expand the anus to accommodate the three transverse fingers, and make a radial incision in the skin outside the anal fissure, about 1.5cm in length. The ball-tip probe is inserted through a small incision through the lower part of the external sphincter skin and the internal sphincter. Under the guidance of the left index finger in the anus, look for the posterior anal sinus. Press the probe tip and gently pass through the anal sinus at the upper end of the cleft. , The probe is bent and fixed, the skin of the anal margin is cut, the comb membrane is removed, and the skin tags, sentinel hemorrhoids, hypertrophic anal papilla and subcutaneous fistula are removed on both sides of the anal fissure.Make the wound surface "△" type. Hang the wire coil with the rubber band on the spherical probe, and then withdraw it, lead to the outside of the anus, tighten the inner and outer ends of the rubber band, clamp, and ligate the thick wire under the clamp.
After operation, oral in-hospital preparations (10 Chinese herbal medicines such as Gongying, Diding, Alisma, Polyporus) were given to clear away heat and detoxify, reduce swelling, relieve urination, and treat various postoperative anal fissures, edema, diarrhea, Difficulty in urination, etc. Xiaoyanyin (11 Chinese herbal medicines such as cork, scutellaria, anemarrhena, pollen, etc.) for clearing away heat, dampness, purging fire and detoxification, treating various postoperative anal fissures, and topical lotion, jade gauze, full hemorrhoid cream, chloramphenicol suppository , Zhixue Shengji San and so on. The effect is remarkable.
Step 2: Many anal fissure patients think that even if the symptoms of anal fissure are relieved, even if the anal fissure is cured, this understanding is wrong. To cure anal fissure, one should not forget the "source" of anal fissure-constipation. If the constipation is not eliminated, the constipation will aggravate and a new anal fissure will be induced again. Therefore, it is best to eliminate the constipation while treating the anal fissure. For the treatment of constipation, Jinan Anorectal Hospital adopts large intestine hydrotherapy, which uses sterilized and filtered 38-degree constant temperature sterile purified water to clean the entire intestine. By removing intestinal stool and toxins, and cultivating the growth of beneficial bacteria to improve the intestinal environment, restore the normal peristaltic function of the intestine, enhance autoimmune function, and completely eliminate constipation. If there is anal fissure caused by other diseases, check in time and actively treat the original disease.
"Minimally invasive painless ablation of anal fissure treatment technology", minimally invasive painless ablation of anal fissure treatment technology for anal fissure treatment is an internationally advanced new technology for the treatment of anal fissures. It successfully uses the Korean Dr.camscope anorectoscope system, the sixth generation can Depending on medical video and imaging technology, image acquisition of the lesion site allows both doctors and patients to understand the condition clearly and intuitively, avoiding misdiagnosis and mistreatment; the operation is simple, the time is short, the damage is small, and the postoperative pain is greatly reduced. Minimally invasive surgery, no need to be hospitalized and normal defecation every day after surgery. This is a breakthrough in minimally invasive and painless ablation of anal fissure surgery. It will not affect the fine control of the anus's bowel function and greatly shorten the healing time. The surgical accuracy is high. The operation basically does not affect daily life. In addition, minimally invasive painless ablation of anal fissures can be cured at one time for some very difficult diseases, such as mixed hemorrhoids, circular hemorrhoids, severe hemorrhoid prolapse, anal prolapse, and anal fissure. It has been called an epoch-making operation in the history of anal fissure surgery by the medical community.
References: 1. [Colle and Anal Disease] No. 4, 1995
2. [Standards for Diagnosis and Treatment of Anal Fissure] National Key Special Diseases
3. The seventh edition Chinese medicine textbook