2020年12月7日星期一

hemorrhoids or cancer,Introduction to Anorectal Disease

    The full name of "An's Therapy" is "Anorectal Disease An's Therapy" or "Anorectal Disease Therapy". The name is taken from the personal surname of Professor An Ayue, the inventor and founder of this therapy and a well-known expert in anorectology in China. The only professional therapy named after the surname.

    "An's Therapy" was completely formed in the late 1980s. It is a series of treatments for anorectal diseases created by Professor An Ayue based on the successful experience of predecessors, unremitting exploration, and his own clinical practice experience. This method is an integrated traditional Chinese and Western medicine treatment involving various common diseases and frequently-occurring diseases in the anorectal field. It has the characteristics of short operation time, small damage, quick recovery, no complications and sequelae, and is very good for many anorectal diseases. The curative effect has caused a sensation in the anorectal circles at home and abroad, and won the recognition and praise of colleagues.

    As early as 1991, this achievement was recommended by the National Science and Technology Commission to participate in the Brussels World Invention Expo. At the meeting, Professor An Ayue personally gave a demonstration of "Ang's Therapy" surgery. The magical method and immediate effect shocked the entire expo, winning three first prizes in one fell swoop, which was the highest award among all the previous medical invention projects in China. , He himself was hired as a judge of the medical expert group, and was included in the 40th Eureka Who's Who. Since then, "An's Therapy" has been selected as a national continuing medical education project by the State Administration of Traditional Chinese Medicine, the Chinese Medical Association, and the Chinese Society of Traditional Chinese Medicine. National promotion. In addition, "An's Anorectology" and "An's Anorectal Disease Diagnosis and Treatment Atlas" edited by Professor An Ayue mainly introduced "An's Therapy", which have been republished many times by People's Medical Publishing House. The only series of anorectal monographs published by Wei.

    At present, "Ang's therapy" has been clinically used for nearly 30 years and has been recognized by the majority of patients with anorectal diseases. The following will briefly introduce the characteristics and advantages of An's therapy in the treatment of various anorectal diseases

    1. Treatment of internal hemorrhoids with astringent and blood stasis method (Shaobei injection method)

    Internal hemorrhoid injection is a treatment method for internal hemorrhoids in which special drugs are injected into the hemorrhoids and directly act on the lesion. Injection therapy has been used in Western countries for nearly 150 years. In China, it emerged in the 1950s. After continuous development, there have been two treatments: necrosis and sclerotherapy and sclerosing and atrophy. The drugs used are different Known as necrotic agents and sclerosing agents, these two methods were widely used in clinical practice before the 1980s. Among them, the necrotic and kutuo method uses necrotic agents, on the one hand, it acts on the hemorrhoid tissue to directly cause protein denaturation and necrosis. On the other hand, it acts on blood vessels and blood formed elements to form thrombi and block the blood supply to the distal tissues, indirectly promoting local Tissue necrosis. After the necrotic hemorrhoids fall off, the wound can heal by itself. The law of sclerosing atrophy is to use the inflammatory effect of sclerosing agent to cause fibrosis in the hemorrhoids, and then occlude small blood vessels, atrophy and adhere to the hemorrhoids to achieve the purpose of treatment. In theory, these two methods can treat symptoms such as bleeding and prolapse caused by internal hemorrhoids, and clinical practice has indeed verified their better curative effect. However, the unavoidable problem is that these two methods also bring many complications. Symptoms and sequelae.

    The improper use of necrosis and kutuo method can cause wound ulcers, infection and secondary hemorrhage. After healing, scar contraction of the wound can also cause anal and rectal stenosis; the sclerosing and atrophy effect of sclerosing agent is to reduce the concentration of the drug on the basis of necrotic However, the difference between the two is only strong and weak, so it will inevitably cause complications such as infection, necrosis and bleeding, and excessive sclerosis can also lead to sequelae such as mucosal sclerosis and rectal cicatricial stenosis, and difficulty in defecation.

    In response to the above-mentioned problems, after consulting a large number of ancient Chinese medicine books and modern domestic and foreign documents, Professor An Ayue proposed the new treatment principle of internal hemorrhoids in the 1980s, "Convergence to remove blood stasis", and based on this treatment principle, In 1986, the "86-AN injection" composed of citric acid, gallic acid and paeoniflorin, which are the active ingredients of traditional Chinese medicine ebony, gallnut and red peony root, was developed. The name was the original name of Shaobei injection. 86" represents the successful development in 1986, and "AN" is the surname of Professor An. In the early 1990s, the drug began to be used in clinical applications as an in-hospital preparation under the name of "Anshi Huazhiye". In 2003, it passed the New Drug Approval of the National Medical Products Administration and obtained the National Class II Chinese Medicine New Drug Certificate, and was officially named "Shao Shao". "Bei injection", began mass production at the end of the same year and was promoted nationwide.

    Shaobei injection is an internal hemorrhoid injection made by purifying Chinese herbal medicines based on the method of astringent and removing blood stasis, and drawing on the successful prescriptions and medication experience of ancient and modern physicians. The drug is a softening and atrophic agent. A large number of clinical and basic studies have shown that it has the effects of astringent and atrophy, solidifying and removing blood stasis and hemostasis, and the drug itself has no toxic side effects, and will not cause infection, bleeding, local induration and anorectal stenosis after use. With standardized injection methods, it is a safe and effective injection for internal hemorrhoids. At present, Shaobei injection has been widely used in clinical practice. According to incomplete statistics, hundreds of thousands of patients receive injection treatment with Shaobei injection every year, and are praised by the majority of patients for its good curative effect and less pain.

    2. Treatment of mixed hemorrhoids by segmented external stripping and internal ligation plus Shaobei injection

    An's therapy for mixed hemorrhoids uses a segmented external stripping and internal ligation plus Shao Bei injection method. This method is suitable for all types of mixed hemorrhoids, even for ring-shaped mixed hemorrhoids known as "difficult and complicated diseases". treatment effect.

    The whole operation process is divided into three steps: "sectioned removal of external hemorrhoids", "ligation of internal hemorrhoids" and "injection of residual internal hemorrhoids". Compared with traditional external hemorrhoidectomy and external hemorrhoidectomy, segmented external hemorrhoidectomy has the characteristics of small incision, less bleeding, quick recovery, and light pain, and because most of the skin of the anal margin is preserved, it will not cause excessive skin damage. , Anal stenosis caused by excessive scars. The combination of ligation and Shaobei injection in the treatment of internal hemorrhoids can shorten the time for the ligation to fall off, and the wound after shedding is greatly reduced compared with the wound directly at the base of the ligation. Combined with the atrophy of hemorrhoids and venous blood vessels after injection of Shaobei injection, both It can achieve the purpose of curing internal hemorrhoids, shorten the recovery time, avoid the possibility of major bleeding, and will not cause excessive ligation and rectal stenosis caused by PPH surgery.

    3. Pathological tissue resection and sphincter relaxation for anal fissure

    This method is based on the traditional anal fissure resection and internal sphincterotomy, and based on the theory of "Combination zone". During the operation, only the hyperplastic and hypertrophic part of the lower edge of the internal sphincter is cut to achieve the purpose of relieving spasm and scarring. Therefore, the wound surface is shallow, bleeding is less, and the postoperative recovery is faster. And because the fibrotic sphincter has been loosened during the operation, even the anal stenosis caused by it can be removed, so there is no need to expand the anus after the operation, avoiding damage to normal muscle tissue.

    4. Treatment of perianal abscess and complex anal fistula by main focus incision and drainage

    The traditional radical treatment of perianal abscess and anal fistula is to cut all the internal mouth, abscess cavity, and fistula, and drain it smoothly. This method is especially suitable for those with small lesions. However, when the lesions are wide, they need to cause larger or more severe lesions. Complicated incisions often lead to slow healing and greater pain to the patient, and sometimes even deformity and displacement of the anus due to scar contracture after healing.

    "Main focus incision and drainage" was first used by Professor An Ayue in the treatment of perianal abscess in 1983 (see "Anorectal Journal" 1983 Vol. 3, Issue 2). After continuous improvement and perfection, gradually Applied to the operation of complex anal fistula. After years of clinical observation, the method has a definite effect, overcomes the shortcomings of the traditional method, and has the advantages of small tissue damage, fast wound healing, short treatment course, and small scars.

    As far as complex anal fistulas are concerned, the internal mouth and main fistula are the main links in the onset of the disease, as well as the key parts of treatment, and the main focus. Using different surgical methods for the main focus and the fistula can not only cure the anal fistula but also avoid excessive damage to the anal sphincter and affect anal function. The main stove is completely incised to completely open the inner mouth and main pipe, which is conducive to drainage; the branch pipe is left open and the outer mouth of the branch pipe is expanded to form a drainage with the incision of the main stove. The branch tube is healed, and it can also avoid multiple cuts of the sphincter muscle caused by cutting the tube. In addition, since the main incision and the external opening of the branch tube are radial with the anus as the center, the postoperative scar is smaller and anal deformity can be avoided. Throughout the entire surgical process, it embodies the principle of fistula treatment that maximizes the protection of the sphincter and does not affect the function and appearance of the anus.

    As far as perianal abscess is concerned, the internal mouth is the main focus, and the location and size of the main incision and other incisions are based on the principle of smooth drainage of the abscess cavity, which can also achieve the effect of reducing trauma and protecting anal function and appearance.

    5. Non-thread-attached therapy for high perianal abscess and anal fistula

    Traditional perianal abscess and anal fistula threading therapy is a treatment method that uses silk thread or rubber bands to chronically cut the abscess cavity or fistula to make it heal gradually. Under certain medical conditions, this is a good way to treat high abscesses and anal fistulas. However, it is undeniable that there are still some insurmountable disadvantages in thread-hanging therapy: ①The patient suffers a lot. The thread-hanging method relies on the continuous cutting of silk thread or rubber band to achieve the purpose of incision. This continuous pressure stimulation makes the anus pain severe ②Long healing time, the routine hanging thread falling off time is 7-15 days, if the thread is not cut due to loose thread, the thread needs to be tightened a second or even the third time, which not only aggravates the patient's pain, but also prolongs the healing time; ③It can cause anal deformity or abnormal function. The continuous streak stimulation of thread hanging can aggravate local inflammation and make the fibrous repair process abnormal. Even if the wound is healed, the anus often has groove-like defects and even incomplete incontinence; ④Relapse easily, due to hanging The linear therapy uses a stoma of the rectal wall and the operation is blind, so it is easy to miss the real source of infection (ie, the internal mouth) during the operation, resulting in postoperative recurrence.

    In view of the above shortcomings and shortcomings, Angle's therapy uses non-thread-attached low incision and high-position latex tube drainage to treat high abscess and anal fistula. Through clinical practice and observation, it not only avoids the long-term continuous cutting caused by traditional thread-drawing surgery. Sexual pain, less damage, and no risk of anal incontinence. And as long as the internal mouth and high lesions are fully opened and drained thoroughly, the postoperative recovery is generally faster without recurrence, and the scar after the wound is healed is also lighter and does not affect the appearance of the anus.

    6. Shaobei injection plus mucosal ligation for rectal prolapse

    Rectal prolapse refers to a disease in which the anal canal, rectal mucosa, full-thickness rectum, and even part of the sigmoid colon shift downward or even prolapse outside the anus. In children, it is a self-limiting disease, most of which can gradually return to normal with age, and the adult patients usually get worse with the onset time. Long-term repeated prolapse can cause nerve damage and lead to anal incontinence, as well as complications such as bleeding, edema, strangulation and necrosis, and skin eczema, so active treatment is required.

    The main method of treatment of this disease abroad is laparotomy and suspension fixation or prolapsed segment resection, so the complications (infection, intestinal obstruction) and sequelae (constipation, difficulty in defecation, anal incontinence, abdominal pain) of the operation cannot be avoided. Injection methods are mostly used in China, such as alum solution perirectal injection, Xiaozhiling submucosal plus perirectal space injection, etc. Although these sclerosing agent injection methods avoid the pain of surgical laparotomy, they require strict aseptic conditions during surgery. It is not easy to grasp the depth of the injection site, the patients are more painful after fasting and defecation, and the recurrence rate is also high. In particular, the complications of deep infections are inevitable, which makes the surgeon worry about the future.

    The basic method of An's therapy to treat rectal prolapse is spot and column injection of Shaobei injection. Because Shaobei injection is neither a necrotic agent nor a sclerosant, but a softening and atrophic agent, it can shrink the mucosa after injection and make Adhesion between the mucosal layer and the muscle layer can effectively avoid infection, necrosis, bleeding, and mucosal sclerosis, and many other sequelae. It has higher safety. The Shaobei injection method has been used for nearly 30 years since 1989, and no obvious side effects have been found. Reports. Not only that, the Shaobei injection method also has the characteristics of less pain, short course of treatment, simple operation, remarkable curative effect and reproducibility, and is easily accepted by patients.

    Seven, incision and injection method to treat cicatricial anorectal stenosis

    Anorectal stenosis is a narrowing of the anus or rectum cavity, which prevents the discharge of intestinal contents. Surgery for anorectal diseases is the main cause of cicatricial anorectal stenosis. Among them, hemorrhoid surgery is more common. For example, when treating external hemorrhoids, using corrosive drugs or circular resection can cause greater damage to the skin of the anal canal, and scar contracture after healing can cause anal stenosis; when treating internal hemorrhoids, a stapler Circumcision of the hemorrhoids (PPH) and ligation of internal hemorrhoids can cause rectal stenosis if the ligation points are too deep and on the same section.

    The traditional methods of threading, incision and expansion of the anus to treat cicatricial stenosis only temporarily sever the scar, but the severed part can form a new scar through fibrous repair, leading to the recurrence of the stenosis. Pathological studies have shown that Shaobei injection can cause protein coagulation and denaturation in a short time after local injection, while chymotrypsin can quickly decompose denatured protein. The two work together to reduce or even eliminate scars. In addition, Shaobei injection has anti- Inflammation and anti-infection can inhibit inflammatory irritation and new scar formation. According to clinical observations, this method has a definite effect and can effectively treat various scarred anorectal stenosis.

    8. Treatment of familial adenomatous polyposis with traditional Chinese medicine taken orally and externally

    Familial adenomatous polyposis is an autosomal dominant genetic disease. Its main pathological feature is multiple adenomatous polyps. The number is generally more than 100. The left colon has the most and the rectum is the least. About 5% of cases involve the stomach And duodenum. This is a recognized precancerous lesion, according to statistics, 40% to 50% can be transformed into adenocarcinoma. The main treatment methods include surgical treatment and endoscopic resection. The surgical method has a definite therapeutic effect, but it is necessary to open the abdomen to remove the diseased part of the bowel. In severe cases, even the rectum and colon are completely removed and a permanent ileostomy is performed. The functional effect is poor, so it is not accepted by some patients. Endoscopic resection has little effect on gastrointestinal function, but there are many adenomas, the resection process is cumbersome and omissions cannot be avoided, so it is only suitable for patients with larger tumors.

    An's therapy is mainly used to treat this disease by oral administration of traditional Chinese medicine and enema, which has a positive effect. This method can cure patients with small tumors in the early stage of the disease and save them from the pain of surgery; for patients with severe disease, it can also delay the development of the disease, improve systemic symptoms, and improve the quality of life.

    Professor An Ayue believes that the disease is caused by lack of congenital endowment, deficiency of qi and blood, which makes it easy to feel external evils. External evils enter the interior to transform heat, and heat toxins stagnate qi and blood in the intestines. Therefore, the treatment method should be to strengthen the body and eliminate the evil, and the oral administration is combined with the enema, and the internal and external treatments, attack and tonic, can be effective.

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