2021年1月27日星期三

hemorrhoids external,external hemorrhoids

    External hemorrhoids occur below the dentate line and are diseases caused by enlarged varicose external hemorrhoidal venous plexus or rupture of external hemorrhoidal venous plexus or repeated proliferation of inflammatory fibers. Its surface is covered by skin and it is not easy to bleed. It is characterized by conscious anal swelling, pain, and foreign body sensation. Due to the different clinical symptoms and pathological characteristics and processes, they can be divided into varicose external hemorrhoids, thrombotic external hemorrhoids and connective tissue external hemorrhoids.

    1. External hemorrhoids of connective tissue

    External connective tissue hemorrhoids refers to the repeated stimulation of acute and chronic inflammation, which causes connective tissue hyperplasia and hypertrophy in the skin of the anal fold, and there are no varicose veins in the hemorrhoids. Including sentinel hemorrhoids and epidermal hemorrhoids Anal foreign body sensation is its main symptom.

    【Cause and Pathogenesis】

    Anal laceration, internal hemorrhoids repeated prolapse or childbirth efforts, leading to evil toxins invaded, damp and hot betting, local Qi and blood flow is not smooth, muscles and veins are blocked, stasis is not scattered, and it becomes skin tags over time.

    【diagnosis】

    The neoplastic flap at the edge of the anus gradually enlarges and has a soft texture. It is generally painless and does not bleed. It only feels foreign body sensation in the anus. It is often swollen due to poisoning, and feels painful. After the swelling disappears, the epidermis still exists. If the external hemorrhoids occur at 6 or 12 o'clock in the lithotomy position, they are often caused by anal fissure, also called sentinel hemorrhoids or split hemorrhoids; if they occur at 3, 7, or 11 o'clock, they are usually accompanied by internal hemorrhoids; the epidermis is ring-shaped Or shaped like a flower crown, which is more common in postpartum women.

    【treatment】

    Generally, no treatment is required. When the external hemorrhoids are poisoned, swollen and shiny, and swelling painful, the method of fumigation and washing can be used, and the prescription of Kushen decoction is added or subtracted, or the external hemorrhoid ointment, Huanglian ointment, etc.

    For those with repeated inflammation or large epidermis, which affects cleanliness, surgical resection without inflammation can be considered.

    2. Varicose external hemorrhoids

    Varicose external hemorrhoids are soft masses formed on the anal margin due to enlarged varicose veins in the external hemorrhoidal plexus below the dentate line. The main symptom is the discomfort of anal bulging.

    【Cause and Pathogenesis】

    It is mostly caused by repeated prolapse of hemorrhoids in stage II and III, or increased abdominal pressure during labor or weight-bearing, resulting in transverse dissolution of tendons and veins and stasis.

    【diagnosis】

    Occurs in the anal canal or under the skin of the anal margin, with oval or elongated masses locally, soft to the touch. When the abdominal pressure increases during defecation or squatting, the tumor enlarges and turns dark purple. It is harder to press, and the tumor shrinks and becomes soft after defecation or massage. Generally, it is not painful, but feels discomfort when the anus is swollen. If the mass does not shrink after defecation, it may cause edema of surrounding tissues and cause pain. Patients with varicose veins and external hemorrhoids often have internal hemorrhoids.

    【treatment】

    Generally, internal treatment is not required. If you are infected, you can treat it according to the following syndrome types.

    1. Treatment based on syndrome differentiation

    (1) Internal governance

    Hot and damp betting After the stool, the swelling of the anal margin does not shrink, and the swelling is obvious, even if it is burning and painful, constipation, red tongue, red tongue, yellow greasy coating, slippery pulse.

    Treatment method to clear away heat and remove dampness, promote blood circulation and disperse blood stasis

    Recipe: Addition and subtraction of Yinxuehuadu Decoction and Huoxue Sanyu Decoction.

    (2) External treatment For patients with swelling and pain, use Sophora Decoction plus or minus fumigation and washing, and topical Huanglian ointment.

    2. Other therapies

    Thorough treatment should be venous plexectomy.

    Indications Varicose external hemorrhoids

    Operation method Take the lateral position or the stone cutting position. Local disinfection and drape, local anesthesia. Lift the external hemorrhoid tissue with tissue forceps, make a vertical "V"-shaped incision in the center of the hemorrhoid from the lower edge to the tooth line, and then use scissors to separate the varicose vein plexus, remove the skin and subcutaneous tissue together, and use petroleum jelly to cover Drain the wound and wrap it with sterile gauze. Use 1:5000 potassium permanganate solution to sit in the bath after defecation every day and change the dressing.

    3. Thrombotic external hemorrhoids

    Thrombotic external hemorrhoids are blood clots formed by rupture of the external hemorrhoidal veins and blood accumulation under the skin. It is characterized by sudden severe pain in the anus and dark purple blood clots. It usually occurs at 3 or 9 o'clock in the bladder lithotomy position.

    【Cause and Pathogenesis】

    It is caused by rupture of the external hemorrhoid veins of the anal margin due to defecation struggle or weight-bearing.

    【diagnosis】

    Sudden severe pain in the anus, a tender mass under the skin of the anal margin, defecation, sitting, walking, and even coughing can make the pain worse. During the examination, there was a dark purple round hard nodule on the skin surface of the anal margin. The boundaries are clear and painful to touch. Sometimes the blood clot is absorbed by itself after 3 to 5 days, the pain relieves and heals itself.

    【Differential diagnosis】

    1. Incarceration of internal hemorrhoids Prolapse and incarceration of internal hemorrhoids on the dental line, the pain lasts for a long time, the skin flap is edema, and fades slowly, and the hemorrhoid surface erosion is accompanied by secretions and smells when infected.

    2. Anal fissure Anal pain is periodic, blood in the stool, and a longitudinal slit at 6 or 12 o'clock can be seen on local inspection.

    【treatment】

    1. Treatment based on syndrome differentiation

    (1) Internal governance

    Blood-heat stasis syndrome

    Symptoms: Anal swelling is protruding, its color is dark purple, the pain is severe and unbearable, and the anus is swollen. Accompanied by thirst, constipation, purple tongue, thin yellow fur, astringent pulse.

    Treatment: Clearing heat and cooling blood, dissipating blood stasis and reducing swelling.

    Recipe: Liangxue Dihuang Decoction and Huoxue Sanyu Decoction Modified

    (2) External treatment: Fumigate and wash with Sophora flavescens decoction, and apply externally Xiaozhi ointment.

    2. Other therapies

    When necessary, external hemorrhoids thrombus dissection is performed.

    Indications: Thrombosis and external hemorrhoids are large, blood clots are not easily absorbed, and inflammatory edema is limited.

    Operation method: take the side lying position, the sick side is below, local disinfection. After local anesthesia, a radial or fusiform incision is made in the center of the hemorrhoid, and the blood clot is separated and removed with a hemostatic forceps. Trim the skin flaps on both sides of the wound to make the wound open. Use petroleum jelly gauze to plug it, cover it with sterile gauze, and fix it with wide tape. Wash and change dressing after defecation every day.

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