"Chrysanthemum Terrace": Your tears are weak and wounded, and the pale moon crooks the past. The night is so long that it has condensed into frost, who is desperate in the cold of the attic? The rain flicked the vermilion window, and my whole life was chaotic on paper. The dream turns into a ray of incense in the distance, blowing away from you in the wind. The chrysanthemum is wounded on the ground, your smile has turned yellow... the chrysanthemum is wounded on the ground, your smile has turned yellow, the flowers have fallen to the heart...
For rectal cancer, many patients have to undergo anal resection and permanent colonic fistula (diversion) due to the late discovery. It is really a chrysanthemum wound all over the floor, and the quality of life after surgery is very poor. Your smile has turned yellow and the flowers have fallen to the ground Heartbroken...
One of the terrible reasons for the misdiagnosis of rectal cancer-not having a digital rectal examination
According to relevant statistics, the misdiagnosis rate of rectal cancer is 30%. There are many reasons for misdiagnosis. One of the important reasons is that patients and doctors are not very vigilant and did not perform digital rectal examination. Statistics have confirmed that 85% of the delayed diagnosis of rectal cancer is due to the lack of early digital rectal examination. Human low rectal cancer (located below the peritoneal reflex) accounts for 60%-75% of all rectal cancers, and for this part of patients, as long as the digital rectal examination can be diagnosed; early rectal cancer has no obvious symptoms, when the cancer ruptures Rectal irritation, intestinal stenosis, and tumor ulceration symptoms, such as changes in bowel habits, pus and blood in the stool, increased bowel frequency, constipation, and tenesmus, occur when ulcers and infections or obstructions occur. At this time, if you do not have anal examination, It is most likely to be misdiagnosed as internal hemorrhoid bleeding, polyp bleeding, bacillary dysentery, rectal inflammation, etc. Delays in treatment have disastrous consequences.
Digital anorectal examination is a method by which a doctor touches the patient’s anus and rectum to diagnose diseases. It is an important method for diagnosing diseases of the anus, rectum, and pelvic floor. It is also a basic skill for surgeons. Here I call it "chrysanthemum One finger Zen".
Digital anorectal examination plays a very important role in the diagnosis and treatment of anorectal diseases. A variety of anal, rectal and pelvic floor diseases can be assisted in the diagnosis. In particular, about 80% of rectal cancers occur in the parts that can be touched by the fingers. An important method for early detection of rectal cancer is also the most economical and practical examination method. It is intuitive and reliable and can provide an important basis for further treatment.
What diseases can be found on digital anorectal examination?
1. Anorectal diseases: such as rectal cancer, rectal polyps, internal hemorrhoids, anal fistula, anorectal abscess, rectal prolapse, rectal carcinoid, pelvic floor tumor, ulcerative colitis, rectal mucosal prolapse, rectal protrusion, Pelvic floor muscle spasm syndrome and puborectalis syndrome, internal anal sphincter dysfunction, rectal isolated ulcer syndrome, etc.
2. Urinary system diseases: such as prostatic hyperplasia, prostate cancer, prostatitis, etc.
3. General surgical diseases: such as acute appendicitis, intussusception, pelvic abscess, pelvic metastatic implant tumor, etc.
4. Gynecological diseases: such as ovarian follicle or corpus luteum rupture, chronic adnexitis, pelvic inflammatory disease, endometriosis, etc.
How to practice excellent "Chrysanthemum One Finger Zen"?
1. Choose a suitable posture: the commonly used postures include left lateral position, knee-thoracic position and lithotomy position, as shown in the figure below
2. Make an explanation with the examinee before the examination. It should not be carried out rashly when the patient is not mentally prepared. The full cooperation of the patient is the key factor for obtaining a correct diagnosis.
3. Before the digital examination, carefully observe whether the anus has redness, swelling, stains, fistulas, external hemorrhoids, warts, ulcers, lumps and prolapses, etc., in order to analyze and judge the nature of the disease, and lay a good foundation for the digital examination.
4. Pay attention to several steps: ①Wear gloves on your right hand and apply paraffin oil, then gently massage the anus to check for tenderness, fistulas and external hemorrhoids, and check whether the intersphincter groove is normal. ②Gently extend the fingers along the anus. Don't suddenly enter it and cause the patient's pain. At the same time, ask the patient to open his mouth to breathe to reduce abdominal pressure and anal tension. ③In the inspection process, a clockwise or counterclockwise sequence is generally adopted, and the anal canal and rectum are completely inspected for one week. During the inspection, test the tightness of the anal sphincter, the condition of the anorectal ring, whether the rectal wall mucosa is smooth and intact, whether there are ulcers, lumps and stenosis, and check whether the rectal wall has tenderness and fluctuation. ④The anterior wall of the rectum is 4-5cm away from the anal margin. Men can touch the prostate outside the rectal wall, women can touch the cervix, and the coccyx and sacrum can be touched posteriorly. Don't be misdiagnosed as a pathological mass. ⑤For female patients, do double consultation (anus and vagina) if necessary to further understand the nature and scope of the disease. ⑥ Ask the patient to do bowel movements during the process of pulling out the fingers, to understand whether the anorectal angle is widened, the anus laxity, the size of the rectal protrusion, and observe whether the finger cuffs have blood stains and mucus.
5. For patients with rectal cancer, "One Finger Zen Power": ①Typical digital diagnosis of rectal cancer, where damage to the rectal mucosa can be felt, showing that the mucosa has hard ulcers and indurations, or the surface is uneven and cauliflower-like The lumps, accompanied by pus, necrotic tissue and dark red blood, have a fishy smell, and feel that the intestinal cavity is narrow, and the finger cots are also stained with dark red blood.②Accurately determine the location of the lesion (front, back, left and right of the rectum, etc.), size (upper and lower diameter, the size of the circumference of the intestinal cavity), shape (ulcer type, protruding type, infiltrating type), hardness, whether it can be pushed and pelvic The relationship between the bottom organs is of great help in judging tumor staging, choosing treatment methods and judging prognosis. Generally speaking, the prognosis of tumors located in the anterior wall of the rectum is relatively poor; ③If the tumor can be promoted and has a certain degree of mobility, it indicates that the depth of tumor invasion is not deep, and may be limited to the mucosal layer, submucosal layer or superficial muscle layer (stage I-II) If the tumor is immobilized, or the potential gap between the pelvic side wall, sacrum, prostate, and vagina disappears, it means that the tumor is late (stage III-IV) and is generally not suitable for surgery. Consider surgery first after neoadjuvant radiotherapy and chemotherapy. ④ If the rectal bladder depression or rectal uterine depression disappears, or the induration is touched, it is generally considered that the tumor has surrounding invasion or planting metastasis, and neoadjuvant radiotherapy and chemotherapy should be performed first before surgery. ⑤Accurately judge the distance between the tumor and the anal margin. Generally speaking, the closer the tumor is to the edge of the anus, the smaller the chance of surgery to preserve the anus. Conversely, the greater the chance of anus preservation. In my experience, generally the tumor is more than 3cm away from the anal edge, it is feasible to preserve the anus. ⑥ Accurate relationship between tumor and anal sphincter. If the anal sphincter groove is present and the anorectal ring is intact, it means that the tumor does not invade the anal sphincter, and the chance of anus preservation is greater. On the contrary, the chance of anus preservation is small.
Rectal cancer is very common. Don't ignore it as hemorrhoids. Early visit to the doctor for digital examination, chrysanthemum has a strong smile without injury!