2021年1月28日星期四

hemorrhoids and anal fissures,Rectal Tumors-Speaking from Digital Anal Examination

    With the strengthening of medical care and prevention awareness, regular physical examinations have become an indispensable and commonplace thing for the whole society. According to the author’s observations, people seem to pay more attention to various medical problems (such as blood pressure, heart rate, liver function, blood sugar, etc.) during physical examinations, while surgical examinations are often "taken away", especially when the surgeon smiles and asks you to do it. During the digital rectal examination" (more popularly speaking, "touch the anus"), many comrades were quite disapproving, or were embarrassed: "Is it necessary?", "That's too uncomfortable", "It won't happen. , I will not do it". You obviously lack a correct understanding of the purpose and necessity of digital rectal examination. But there are also those who are willing to accept this inspection and have a serious attitude. Some people even said to the doctor with a solemn expression: "You should check it out. Last year, someone in our unit found out the problem-rectal cancer was discovered!"

    Yes, rectal cancer. A disease that can be found by simple digital rectal examination in most cases; a disease that has unique clinical symptoms and is easily overlooked, leading to misdiagnosis and treatment; a disease that requires surgical treatment but involves whether the anus can be preserved A disease in which patients are suffering and entangled; at the same time, it is also a disease with continuous improvement in treatment methods and continuous increase in cure rate, which is full of challenges and hopes. The author has been engaged in the clinical basic research of rectal cancer for more than 30 years, and found that there are still many cognitive deficiencies and misunderstandings in the diagnosis and treatment of rectal cancer. I take this opportunity to write an article to share some experience and experience with readers.

    One. Definition and etiology of rectal cancer

    Anatomically, the rectum is about 12 to 15 cm in length. The upper part is connected to the sigmoid colon, and the lower part is connected to the anal canal. The boundary line between the rectum and the anal canal is called the dentate line, which is about 37.5px from the anal edge. Rectal cancer refers to cancer from the junction of the sigmoid colorectal to the dentate line, and is one of the most common malignant tumors in the digestive tract. The etiology of rectal cancer is not yet clear, but its related high-risk factors are gradually recognized, such as excessive animal fat and animal protein diet, lack of fresh vegetables and fiber foods, lack of moderate physical activity, etc., as the domestic standard of living improves As well as the adjustment of diet, the incidence of rectal cancer is increasing year by year and tends to be younger. Genetic susceptibility also plays an important role in the incidence of rectal cancer. The incidence of rectal cancer is higher among first-degree or second-degree relatives, and awareness of prevention should be improved. Rectal cancer is closely related to rectal polyps, and there is an evolutionary sequence of polyps-adenoma-adenocarcinoma. This process usually takes several years and therefore provides the possibility for prevention. Once rectal polyps or adenomas are found, they should be dealt with in time and should not be delayed.

    two. Clinical manifestations of rectal cancer

    Early rectal cancer lesions are more limited, the symptoms are not obvious, and sometimes only positive stool occult blood. As the cancer progresses, patients with rectal cancer may have some typical clinical manifestations. In one sentence, it can be summarized as "changing stool habits and traits." Specifically, it can be manifested as rectal irritation, such as frequent bowel movements, increased bowel movements, and diarrhea; accompanied by incomplete defecation and anal falling. This condition is called "tenesmus". Another important symptom is blood in the stool, dark red blood and sometimes mucus during defecation. When the cancer is ulcerated and infected, pus and blood can be discharged in the stool. If the bowel is narrowed due to cancer invasion, the stool will become thin and deformed at the beginning, and there will be pressure marks on the surface of the stool. When the bowel is partially obstructed, there will be abdominal pain, abdominal distension, active bowel sounds, and difficulty defecation. Rectal cancer patients also often experience tumor consumption such as anemia, weight loss and weight loss.

    It should be said that the clinical manifestations of rectal cancer still have certain characteristics. If people have sufficient knowledge of the above symptoms and heighten their vigilance, they should be able to diagnose and treat in time. Unfortunately, due to the similarity in symptoms between rectal cancer and other diseases, it is easy to cause misdiagnosis and mistreatment. In particular, there are countless examples of rectal cancer being misdiagnosed as hemorrhoids and treated. Hemorrhoids is a benign disease that can occur at any age. Its pathogenesis is the rectal venous plexus congestion, dilated and flexed venous masses and lead to bleeding. Therefore, hemorrhoids and rectal cancer have similarities in symptoms-blood in the stool. However, if you carefully distinguish, you will find that the two are actually quite different in the way and characteristics of blood in the stool. Hemorrhoids often manifest as intermittent blood after defecation. Patients often drip fresh blood in the toilet or find fresh blood on toilet paper. If hemorrhage is heavy, it can be spray-like. Hemorrhoids are often caused by triggers such as constipation, drinking, and ingestion irritation. Food, etc., bleeding can stop automatically after removing the inducement or after treatment. The blood in the stool of rectal cancer is mostly dark red bloody or pus-blooded stools, accompanied by mucus, and the blood is often mixed with stool. After general treatment, it does not improve and can be aggravated, accompanied by rectal irritation.

    People often say "nine hemorrhoids in ten people" because hemorrhoids are a common disease with a high incidence. Many people have experienced bleeding episodes. At the same time, people tend to seek advantages and avoid disadvantages and avoid diseases. The first thing that makes patients with blood in the stool think of "innocent" hemorrhoids, rather than "unbearable" rectal cancer. "It's fine to endure it for a while", "Go to the pharmacy to buy some medicine and treat it twice by yourself". This practice often leads to a delay in the course of the disease and misses the best time for treatment. Therefore, both patients and medical workers need to carefully distinguish the nature of blood in the stool, pay attention to changes in stool habits, and go to a qualified hospital in time. Often a simple digital rectal examination can be used to identify the disease.

    three. How to check for rectal cancer

    The simplest clinical examination method is the digital rectal examination, which we emphasize. Human low rectal cancer accounts for a high proportion, accounting for about 70% of rectal cancers. The vast majority of cancers can be palpable during digital rectal examination; according to statistics, 85% of delayed rectal cancer diagnoses are due to failure to undergo digital rectal examination. . Therefore, once the patient has symptoms such as blood in the stool and changes in bowel habits, a digital rectal examination should be performed. It can detect the location of the cancer, the distance from the anal margin, the size and scope of the cancer, and the relationship with the surrounding organs.

    Endoscopy includes simple anoscope and sigmoidoscopy that can be performed in the clinic. However, colonoscopy must be performed during the diagnosis process to clarify the condition of the entire colorectal, except for multiple tumors, and some tissues for pathological diagnosis. In recent years, the development of rectal cavity ultrasound examination uses a fiber endoscope with an ultrasound probe to detect and image the lesion area, which can clearly show the depth of the cancer invading the rectal wall. Some early rectal cancer can also be removed endoscopically to avoid the trauma of transabdominal surgery.

    Rectal cancer patients should also undergo CT or magnetic resonance (MRI) examination. Through thin-layer scanning and 3D reconstruction technology, it can clearly show the location and size of the cancer, its relationship with the bladder, uterus and other adjacent organs, and whether there is liver metastasis And so on, is conducive to preoperative staging of rectal cancer.

    four. Surgery for rectal cancer

    Surgical resection is the main treatment for rectal cancer. Surgery should strive to achieve a standardized "radical resection". The scope of resection should include cancer, sufficient intestinal segments at both ends, total mesentery and surrounding tissues that may be infiltrated. The most commonly used surgical methods include two: transabdominal low anterior resection of rectal cancer (Dixon operation) and transabdominal perineum combined radical resection of rectal cancer (Miles operation). After Dixon surgery, after the tumor is removed, the intestines at both ends of the tumor are anastomosed to preserve the anus; Miles surgery requires removal of all the rectum and surrounding tissues, and a permanent sigmoid colostomy is performed in the left lower abdomen.

    Rectal cancer is one of the common tumors of the digestive tract. It is not difficult to make a clinical diagnosis based on medical history, physical examination, imaging and endoscopy, and the accuracy rate can reach more than 95%. However, most cases often have varying degrees of delays in the diagnosis and treatment process. Among them, patients do not pay enough attention to symptoms such as blood in the stool and changes in bowel habits. There are also reasons why doctors are not vigilant. Those over the age of 40 who have any of the following manifestations should be classified as high-risk groups: ①Class I relatives with a history of rectal cancer; ②A history of cancer or intestinal adenoma or polyps; ③Stool occult blood test positive; ④Mucous blood in the stool, Those who have rectal irritation such as diarrhea. For high-risk groups, relevant examinations should be actively carried out, and digital rectal examination should be emphasized to achieve early diagnosis and treatment.

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