2020年12月29日星期二

hemorrhoids and anal fissures,Anal carbuncle (perirectal abscess) diagnosis and treatment plan (Chinese medicine)

    1. Diagnosis

    (1) Disease diagnosis

    1. Diagnostic criteria of traditional Chinese medicine: refer to the Chinese medicine industry standard of the People's Republic of China "Diagnostic Efficacy Standards of Disease and Syndrome of Traditional Chinese Medicine" (ZY/T001, 7-94)

    Local symptoms: sudden onset, swelling and pain around the anus, severe pain during the stool, followed by ulceration and pus discharge for a long time.

    Systemic symptoms: head and body pain, fatigue, constipation, yellow urine.

    2. Western medicine diagnostic criteria: refer to the seventh edition of "Surgery" (edited by Wu Zaide et al., People's Medical Publishing House, 2008).

    (1) Anal burning or throbbing pain, aggravated during defecation or walking, and a small number of patients have dysuria.

    (2) It may be accompanied by symptoms such as chills, fever, and general malaise.

    (3) Perianal ultrasound can detect the abscess cavity.

    (4) The counts of white blood cells and neutrophils may increase in varying degrees.

    (5) There are induration or lumps around the anus, local temperature increase, tenderness or fluctuating feeling.

    Abscesses located below the levator ani muscle have severe local red, swollen, hot, and painful symptoms but mild systemic symptoms; abscesses located above the levator ani muscles have mild local symptoms but severe systemic symptoms, and can be palpable tenderness on digital rectal examination Lump, perianal puncture can extract pus.

    When necessary, assist in rectal ultrasound examination, CT or MRI examination can confirm the diagnosis.

    (2) Disease stages

    1. Acute phase: Induration or mass formation around the anorectal canal, pain, swelling, and continuous aggravation:

    2. Pyogenic stage: severe pain, enlarged lumps, redness, swelling and fever, central fluctuation, discomfort, and systemic symptoms, such as chills and fever, fatigue, loss of appetite, constipation, yellow urine, etc.;

    3. Ulceration stage: the mass shrinks, the formation of induration gradually softens or the abscess ruptures, forming a fistula, which does not heal for a long time.

    (3) Disease classification

    1. Low abscess (abscess below the levator ani muscle): including perianal subcutaneous abscess, ischiorectal fossa abscess, retroanal abscess.

    2. High abscess (abscess above the levator ani muscle): posterior rectal space abscess, pelvic rectal space abscess, submucosal abscess.

    (4) Syndrome diagnosis

    1. Fire poison accumulation syndrome: Sudden swelling and pain around the anus, continued to aggravate, accompanied by aversion to cold, fever, constipation, and sunburn. Perianal swelling, obvious tenderness, hard texture, and burning surface. Red tongue, thin yellow coating, pulse count.

    2. Excessive heat and toxin syndrome: severe anal swelling and pain, which can last for several days, pain like a chicken pecking, restless sleep sound at night, accompanied by chills and fever, dry mouth, constipation, and difficulty in urination. Perianal redness and swelling, fluctuating sensation or pus after puncture. Red tongue, yellow coating, slippery pulse.

    3. Yin deficiency and poison love syndrome: anal swelling, pain, burning, red epidermis, difficult to catch after ulceration, accompanied by afternoon hot flashes, upset dry mouth, night sweats. Red tongue, little coating, fine pulse.

    2. Treatment plan

    (1) Surgical treatment

    Incision and thread-drawing of anorectal abscess

    1. Indications: Applicable to high abscess.

    2. Operation method: After the conventional anesthesia is satisfied, perform a radial incision or arc incision in the center of the abscess. Use a hemostatic forceps to bluntly separate the tissue interval to fully elicit the pus. Then use the index finger to separate the abscess cavity, flush the abscess cavity, and use a ball tip probe Insert from the incision, and gently and carefully explore the anus along the bottom of the abscess cavity, while using the other index finger to guide the anus to find the inner opening. If it is not penetrated, pass through the highest point of the abscess cavity and the thinnest part of the mucous membrane, hang a rubber band, pass one end out of the abscess cavity and pass the other end out of the anus, and then close the two ends of the rubber band to make it tight Later, ligate and fix. If the abscess is large, it is feasible to cut more than two u and place rubber sheets for drainage. Trim the edge of the wound, check if there is no active bleeding point, insert the Vaseline gauze into the wound, press the gauze, fix the Ding Ning tape, and end the operation.

    You can choose:

    Incision and drainage of anorectal abscess

    1. Indications: Applicable to high abscess.

    2. Operation method: After the conventional anesthesia is satisfied, perform a radial incision or arc incision in the center of the abscess. Use a hemostatic forceps to bluntly separate the tissue interval to fully elicit the pus. Then use the index finger to separate the abscess cavity, flush the abscess cavity, and place gauze. drainage. Trim the edge of the wound, check if there is no active bleeding point, insert the Vaseline gauze into the wound, and finally bandage.

    3. Postoperative treatment:

    (1) Fumigating and washing the sitz bath twice a day after the operation, or after each bowel movement.

    (2) Dressing for wounds is changed 1 to 2 times a day.

    (3) According to the condition and clinical reality, anorectal comprehensive treatment instrument, ultrasonic atomization fumigation instrument, fumigation bed (sitting), intelligent perianal fumigation instrument, etc. can be selected.

    (2) Choose oral Chinese medicine decoctions and proprietary Chinese medicines

    l, Chinese medicine decoction

    (1) Fire poison accumulation syndrome

    Treatment method: clearing away heat, purging fire and detoxification

    Recommended prescriptions: Xianfang Huoming Yin addition and subtraction, Angelica dahurica, Fritillaria, Fangfeng, Red peony root, Angelica tail, Licorice knot, Saponaria saponaria (stir-fried), Pangolin (sunburn), Trichosanthes, Frankincense, Myrrh, Honeysuckle, Tangerine peel.

    (2) Excessive heat and poison

    Treatment method: clearing away heat, detoxifying and penetrating pus

    Recommended prescriptions: Touyu powder modified, Astragalus, Shanjia (stir-fried), Chuanxiong, Angelica, Sanjiao needle.

    (3) Yin deficiency and poison love syndrome

    Treatment method: nourish yin, clear away heat and detoxify

    Recommended prescriptions: Artemisia annua Biejia Decoction plus or minus: Artemisia annua, Biejia, Shengdi, Zhimu, Danpi.

    2. Chinese patent medicine

    (1) Suppositories: Mayinglong Musk Hemorrhoid Suppository, Kangtai Suppository, Zhichuangning Suppository and Puji Hemorrhoid Suppository can be used.

    (2) External use of Chinese medicinal ointment: Mayinglong Musk Hemorrhoid Ointment, Dragon Ball Ointment, Kangtai Ointment, etc. can be used.

    (3) Acupuncture and physical therapy

    (1) Pain

    Acupuncture Changqiang, Chengshan, Zusanli, Huantiao acupoints, or procaine for long-term pain relief, and seal Changqiang acupoint.

    (2) Urinary retention

    Acupuncture Guanyuan, Shiji, Qihai, Sanyinjiao, Waterway, Yangling Spring through Yinling Spring.

    (3) Fecal impaction

    Needle Zhigou, Zusanli, Qihai, Hegu, and Quchi.

    (4) Shiyao fumigation and washing therapy: use Shiyao fumigation and washing according to the syndrome differentiation.

    (5) Basic treatment: For the treatment of complications such as infection, fever, and pain, antibiotics can be used.

    (6) Nursing: syndrome differentiation nursing, emotional nursing, diet nursing.

    1. Syndrome differentiation nursing: The physique of patients with anal carbuncle is mostly yin deficiency and partial heat. This factor should be considered first in the overall nursing. When arranging hospital beds, pay attention to the direction of the ward, and appropriately reduce clothing. Attention should be paid to the use of integrated traditional Chinese and Western medicine nursing measures. It is necessary to comprehensively consider the impact of the patient's disease itself, mood disorders, improper diet, and improper adjustments on health.

    2. Emotional care: Because most patients with anal carbuncle are admitted to the hospital with local pain as the main symptom, accompanied by fever and other symptoms, they are prone to irritability, anxiety and other tensions. Therefore, nurses are required to do a good job in both body and mind nursing work, reduce the patients' unfamiliarity with the hospital, and enhance their confidence in overcoming the disease. At the same time, the patient’s social background, cultural level, organizational structure, family internal situation and the patient’s personality should also be understood to carry out comprehensive care.

    3. Diet care: Diet plays an extremely important role in the treatment and rehabilitation of anal carbuncle. Advise patients to avoid alcohol and tobacco, and refrain from eating spicy food. It is advisable to enter a nutrient-rich, light, low-residue, and digestible diet. Eat more vegetables and fruits to prevent constipation. Don't be overworked. Take ten medicines for laxative and laxative to make you recover as soon as possible.

    3. Efficacy evaluation

    (1) Evaluation criteria:

    Refer to the "Ten Medical Diseases and Syndrome Diagnostic Efficacy Standards" promulgated by the National Ten Medical Administration in 1994

    Cure: The symptoms and signs disappear, the wound is healed, and the score is lower than before treatment by ≥ 2/3

    Improvement: Symptoms improved, lesions or wounds shrunk, and points were reduced by ≥1/3 compared to before treatment

    Unhealed: There is no change in symptoms and signs, and the score is less than 1/3 lower than before treatment

    (2) Evaluation method

    1. Symptom evaluation indicators: refer to the "Guiding Principles for Clinical Research of Ten Drugs and New Drugs" promulgated by the Ministry of Health in 2004.

    Bleeding

    Level 0: Normal 0 points

    Level 1: Mild 2 points with blood

    Level 2: Moderate 4 points Drop of blood

    Level 3: Severe 6 points ejection

    pain

    Level 0: Normal 0 points

    Level 1: Mild 2 points Mild pain, tolerable

    Level 2: Moderate 4 points Obvious pain, relieved by medication

    Level 3: Severe 6 points Severe pain, unbearable

    Secretions

    Level 0: None 0 points

    Level 1: Yes 1 point

    2. Syndrome evaluation indicators: refer to the "Guiding Principles for Clinical Research of New Chinese Medicines" promulgated by the Ministry of Health in 2004.

    Red tongue, yellow coating

    Level 0: None

    Level 1: Yes

    Pulse or slip

    Level 0: None

    Level 1: Yes

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