Inverted "v" incision stripping and flap fixation combined with Huoxue Tongluo recipe for treatment of 58 cases of female mixed hemorrhoids
Zheng Jinjian Tan Hong Zheng Junying
(Liuzhou People's Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi 545001)
Abstract: [Objective] To explore the clinical advantages and curative effects of the treatment of female mixed hemorrhoids in front of the anus. [Method] 58 female patients with mixed hemorrhoids were treated with inverted "v" incision stripping and flap fixation plus Huoxue Tongluo Decoction. [Result] All were cured clinically. [Conclusion] This method is effective in treating female mixed hemorrhoids in front of the anus, and after healing, it can effectively prevent anal skin defects, anal stenosis, and residual epidermal external hemorrhoids, shorten the treatment course, alleviate the pain of the patient, and have good recovery of anal function, satisfactory results, and worthwhile Clinical application.
Keywords: anterior median mixed hemorrhoids; "v" incision stripping and flap fixation; Huoxuetongluo prescription
Anterior median mixed hemorrhoids refer to large-area mixed hemorrhoids that occur in the anterior position of the anal canal. The external hemorrhoids are mostly connective tissue external hemorrhoids, which are a special type of hemorrhoids. The hemorrhoids have a large base area and are distributed in a semi-circular shape in the anus. It is difficult to treat. Due to differences in physiology and anatomy, female lesions are often more common than males. When such mixed hemorrhoids are treated with conventional external peeling and internal ligation, the mixed hemorrhoids are difficult to remove, and it is very easy to have local edema after the operation to form epidermal external hemorrhoids. After trimming, it is still easy to reappear local edema, severe pain and wounds. It is difficult to heal. If all hemorrhoids are removed, complications such as skin defect of the anal canal and anal stenosis will easily occur. From July 2008 to December 2013, our department used inverted "v" incision stripping and flap fixation plus Huoxue Tongluo Decoction to treat 58 cases of female anterior median mixed hemorrhoids. The clinical effect is good.
1 General information
The 58 cases were all female, aged from 23 to 65 years, with an average age of 38.5 years, and the course of disease was 2 to 15 years, with an average of 8.5 years. The 58 cases collected were all female mixed hemorrhoids in front of the anus. The diagnostic criteria for mixed hemorrhoids are in accordance with the "Interim Standards for Diagnosis and Treatment of Hemorrhoids"  formulated by the Anorectal Surgery Group of the Chinese Medical Association in 2004.
2 Treatment method
2.1 Surgical treatment: Routinely clean the enema 1 time before the operation. After the lumbar epidural or spinal anesthesia is successful, take the left side lying position. After the perianal skin and anal canal are fully disinfected, spread sterile perforated towels, and disinfect the rectum. Clamp the top part of the anterior median mixed hemorrhoid with skin forceps, and cut the tissue at the top of the external hemorrhoids near the tooth line to make an inverted "V"-shaped incision to cut the skin. Keep the inverted "V"-shaped flaps. ""-Shaped skin flap and free the skin flap, strip the subcutaneous tissue and venous plexus bluntly along the subcutaneous, free to the base of the external hemorrhoids, free "V"-shaped skin flap for use. Peel the external hemorrhoid tissue upwards between the venous plexus of the external hemorrhoid and the internal sphincter to the tooth line, cut off the peeled subcutaneous tissue and venous plexus, fully expose the muscle layer, and pay attention to adequate hemostasis. Large curved forceps were used to clamp the internal hemorrhoids vertically, and the internal hemorrhoids were ligated with a 7-gauge silk thread. According to the size, length and width of the wound, trim the “V”-shaped flap, and trim the flap left by the inverted “V”-shaped incision into a pedicled flap with subdermal vascular network. Use 3 on different levels of the tooth line. -No. 0 absorbable thread is fixed on the wound surface of the inverted "V"-shaped incision in situ, the edge of the wound is trimmed and flat, and the edge of the wound can be sutured or not sutured according to the situation to facilitate drainage. Vaseline gauze was applied to the wound, and the pressure bandaging and fixation of the tower-shaped square yarn was completed.
2.2 Chinese medicine treatment The Chinese medicine sitz bath was given on the second day after the operation, and the Chinese medicine sitz bath was twice a day until the wound healed. The composition of the prescription for promoting blood circulation and dredging collaterals: 60g cassia twig, 60g red peony root, 60g astragalus 60g, 100g hematoxylin, 100g spatholobi, 60g frankincense, 60g myrrh, 100g chuanxiong, 100g Weilingxian, 60g rhubarb, etc. Decoction and sitz bath method: soak the top with 5000 ml of clean water, wait for 20 minutes and then decoct on medium heat, boil for about 20 minutes to remove slag, put the medicine in a special bidet, and let the patient sit when the water temperature is about 40"C Bathe for 15 to 20 minutes. During the sitz bath, the patient is instructed to slowly do levator anus exercises 5 to 8 times, and the sitz bath 2 times a day, starting on the second day after the operation.
3 Curative effect standards and treatment results
3.1 Efficacy standards According to the standards formulated by the State Administration of Traditional Chinese Medicine  in 1994, cure: symptoms disappear, hemorrhoids disappear; improvement: symptoms improve, hemorrhoids shrink; unhealed: symptoms and no changes.
Mixed hemorrhoids have always been one of the refractory diseases in the anorectal department. The traditional external stripping and internal ligation does not protect the anal margin and the skin of the anal canal. Improper operation can easily cause anal stenosis, anal canal defect, mucosal ectropion, and intestinal fluid overflow. .When traditional external stripping and internal ligation are used to treat mixed hemorrhoids in the anterior middle of the anus, the blood and lymph circulation channels in the anus are often blocked after part of the anal hemorrhoid tissue is removed, and the local anatomy and pressure of the anus are changed. Microcirculation is impaired, and the osmotic pressure of blood vessels in the anus is often increased, so postoperative anal edema and severe pain of anal wound are prone to occur. And the female anatomy is different, the blood circulation in the front of the anus is poor in women, and the local tissues in the anus are looser. Postoperative lymphatic and venous return reconstruction is more difficult than that of women, and it can also lead to postoperative anal wound edema. Due to the particularity of female physiological anatomy, the urethral orifice, vaginal orifice are adjacent to the anus, and the mixed hemorrhoids in the middle part of the anus after routine external peeling and internal ligation, urine and vaginal secretions are easy to wet the wound, which can easily cause local anal The infection of the wound aggravates the edema of the wound after the operation. Therefore, edema of the anterior anus in female patients is a difficult postoperative problem in anorectal surgery.
Since 2008, we have used inverted "v" incision stripping and flap fixation to treat female anterior median mixed hemorrhoids. This is an improvement on the basis of traditional mixed hemorrhoids external stripping and internal ligation. Part of the external hemorrhoids has an inverted "v"-shaped incision and stripping. The "v"-shaped skin flap is peeled to the tooth line, and the internal hemorrhoids are ligated with No. 7 silk thread. The "v"-shaped flap is trimmed according to the size, length and width of the wound, so that the inverted "v" incision retains the subdermal blood vessel The mesh flap is fixed in situ, which makes up for the shortcomings of external hemorrhoids and internal ligation. At the same time, it avoids the shortcomings of post-healing contractures, scars or skin flap edema after external hemorrhoids and external hemorrhoids. It is a good solution to external hemorrhoids. The existence of this accelerates the healing of the wound. Therefore, postoperative patients have less pain, less bleeding, less occurrence of edema, short wound healing time, and less leftover epidermis on the anal margin. Because this operation retains enough normal skin, the anus looks smooth and elastic after the operation, which avoids the occurrence of anal skin defects and anal stenosis. In order to achieve a one-time resection, the traditional external stripping and internal ligation must make the external incision larger, which is easy to damage the skin of the anal canal, so there is more bleeding, severe pain, and it is very easy to cause anal fissure, anal stenosis and even anal skin. Defect. If the incision is too small, there are too many residual external hemorrhoids, accompanied by edema and pain, the cure will not be achieved.
According to clinical observations, the following aspects should be paid attention to during and after the operation: (1) The suture of the inverted "v" flap and the dentate thread should not have tension. If the tension is large, the suture thread after the stool will cut and make the skin The flap is not firmly fixed, resulting in a valgus flap. (2) The inverted "v"-line flaps should not be too long or too wide. Excessive skin tags will be formed after the operation is too long or too wide, which will affect the appearance of the anus. (3) The suture of the edge of the flap should not be too tight. Generally, the flap should be close to the normal skin of the wound. If it is too tight, avascular necrosis is likely to occur, and the wound will open during stool. (3) No gaps should be left under the skin flaps, and the drainage should be unobstructed to avoid infection by intestinal contents immersion or hematocrit. (4) After the operation, pay attention to keeping the stool soft, avoid hard stool, and avoid squatting or squatting to cause the wound to open. (5) The stitches should be removed 6 to 7 days after surgery. The stool should be removed before the stitches, and then the stool will be removed the next day to prevent the premature stool from causing the wound to tear or the skin flaps are not firmly fixed.
Our department's self-made Huoxuetongluo Recipe after surgery uses traditional Chinese medicine to stimulate the local skin of the anus, dilate the subcutaneous blood vessels, promote blood and lymph circulation, and improve the microcirculation of the anus. It can also reduce swelling and blood stasis, clear heat and detoxify, dispel rot and build muscle, reduce inflammation and relieve pain, thereby speeding up wound healing. In the prescription, Guizhi promotes blood circulation, relieves pain, helps yang, transforms qi and promotes water; red peony promotes blood stasis, relieves pain, cools blood and reduces swelling. Modern pharmacological research has proved that paeoniflorin has good antispasmodic, analgesic, sedative, antibacterial and antipyretic effects. Paeonia lactiflora has strong antibacterial effect on Shigella dysentery. In addition, it can inhibit Staphylococcus and Pseudomonas aeruginosa. . Frankincense promotes blood circulation, promotes qi and relieves pain, reduces swelling and carbuncle, removes saprophyte and promotes muscle; Myrrh promotes blood circulation and relieves pain, reduces swelling and promotes muscle. The efficacy of this product is similar to that of frankincense, but myrrh is biased towards dispersing blood and removing blood stasis, treating sores and ulcers that are not closed for a long time and all the syndromes of stasis. It is often used in conjunction with frankincense and has a very good effect. Sumu Huoxue heals wounds, removes blood stasis and relieves menstruation; Astragalus replenishes qi and promotes Yang, relieves swelling, promotes sore muscles; Caulis spatholobi nourishes blood and removes wind, clears meridians and collaterals; Lingxian dispels rheumatism, clears meridians, eliminates phlegm and saliva, disperses Ringworm accumulation; Rhubarb promotes blood circulation and reduces inflammation; and the combined use of Astragalus, Chuanxiong, Weilingxian, Caulis spatholobi, Rhubarb, etc. can nourish qi, activate blood and nourish blood, clear up damp-heat, and promote qi in the blood; combined use of various drugs can promote blood circulation and remove blood stasis. The power to relieve swelling and relieve pain. The traditional Chinese medicine sitz bath allows the medicine to reach the sick place directly, and the effect is fast and the effect is obvious. In addition, the warming effect can speed up the circulation of blood and blood, relieve pain, and solve the problems of postoperative anal edema and swelling pain. The “heat” of the sitz bath itself can dilate local blood vessels, improve blood circulation, reduce tissue congestion and edema, reduce painful nerve excitability, relax the muscles and ligaments of the anus, thereby reducing pain and promoting wound healing. The thermostatic hot seat bath of traditional Chinese medicine exerts the synergistic effect of "heat" and "medicine", the heat helps the medicine directly reach the lesion, and the operation is simple and the effect is accurate.
Precautions for Huoxuetongluo prescription traditional Chinese medicine sitz bath liquid: The temperature of the sitz bath liquid must be strictly controlled. When the sitz bath, the liquid medicine should be warmed to the steam, but not overheated to avoid scalding the skin and mucous membranes, and not too cold , So as not to produce bad stimulation. Steam fumigation of the part first, sit in it when the temperature of the liquid medicine reaches the set temperature of about 40℃, and instruct the patient to do levator anus exercises. When taking a bath for the elderly, weak or diabetic patients, they should always ask the patient how they feel, and grasp the temperature of the liquid medicine to avoid burns. The sitz bath time is 15-20 minutes, and the time should not be too long to avoid prostration and bleeding from the wound. If necessary, prepare warm water and drink it slowly during the sitz bath. When taking a bath in winter, keep warm and ventilate in summer to ensure safety after medication.
Our department uses inverted "v" incision stripping and flap fixation plus Huoxue Tongluo Decoction to treat female anterior midline mixed hemorrhoids. On the first day after surgery, Huoxue Tongluo Decoction begins to take a bath and makes full use of traditional Chinese medicine to eliminate swelling and stasis , Heat-clearing and detoxification, detoxification, detoxification, anti-inflammatory and analgesic effects, reducing incision edema, pain, postoperative epithelial residual, anal stenosis and other complications, reducing the recurrence rate of hemorrhoids, and the appearance of the anus is flat, improving the quality of surgery, and the clinical effect is better it is good.
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