2021年2月7日星期日

hemorrhoids diagnosis,Diagnosis and efficacy criteria of hemorrhoids

    Uniform standards formulated by the National Anorectal Academic Conference in 1975

    For the needs of clinical, teaching and scientific research, the Hunan Hengshui Conference in 1975 established unified standards for the diagnosis and treatment of the above-mentioned common anorectal diseases, and subsequent conferences have also made certain amendments to certain diseases, such as the two in 1992 and 1994. Anal fissure conferences, etc. Through the formulation of standards, a consensus has been formed in the anorectal academia, which has played an important guiding role in clinical diagnosis and treatment, scientific research, and writing academic papers.

    One, hemorrhoids

    1. Diagnostic criteria for internal, external, and mixed hemorrhoids

    (1) Internal hemorrhoids are divided into three stages:

    The first stage: no obvious conscious symptoms, bloody phenomenon can only be seen in the stool, anal endoscopic examination, the mucosa is visible as nodular protrusions above the dentate line.

    The second stage: intermittent blood, dripping or ejection during defecation, internal hemorrhoids prolapse out of the anus during defecation, and return by themselves after defecation.

    The third stage: Hemorrhoids prolapse during defecation, or when you are tired, walking for a long time, or coughing, you cannot take it back by yourself. You must support it with your hand or rest in bed.

    (2) There are four types of external hemorrhoids:

    1) Inflammatory external hemorrhoids: After anal skin injury or infection, anal skin folds are formed, showing redness, swelling, and heat pain.

    2) Thrombotic external hemorrhoids: Thrombosis in the anal venous plexus and subcutaneous bulging pain due to inflammation of the anal veins or excessive force during the stool.

    3) Connective tissue external hemorrhoids: due to the stimulation of chronic inflammation, repeated episodes of local skin fibrosis, connective tissue hyperplasia, and the formation of skin tags are also called epidermal external hemorrhoids.

    4) Varicose external hemorrhoids: When squatting or attracting for a long time, the anus swells under the skin, and there is a group of varicose veins, which cannot dissipate immediately.

    (3) Mixed hemorrhoids:

    The rectum (superior hemorrhoid venous plexus) and the anus (inferior hemorrhoid venous plexus) in the same position from the dentate line are expanded, flexed, mutually anastomosed, and the intersphincter groove disappears, so that the upper and lower parts form a whole. The diagnosis of mixed hemorrhoids must indicate:

    1) What is the pathological nature of the external hemorrhoids?

    2) The position and size are marked according to the four quadrants of the circle.

    2. Efficacy standards

    (1) Recovery: The symptoms (blood in the stool, prolapse or pain) disappeared, check the hemorrhoids have disappeared.

    (2) Improvement: After treatment, the symptoms have improved significantly, and the hemorrhoids have been significantly reduced after examination.

    (3) Invalid: the symptoms and morphology have not changed from before treatment.

    3. Long-term efficacy standards

    Two to three years after treatment, no recurrence was found at the original surgical site, which was a long-term cure.

    4. Postoperative response observation criteria

    Pain: Degree I: Slight pain in the anus, no need to deal with it.

    Degree Ⅱ: Anal pain, no obvious painful expression, can be relieved by taking general painkillers.

    Degree Ⅲ: The anal pain is severe, and there is a painful expression. Meperidine (dulantin) is needed to relieve the pain.

    Edema: Degree I: local mild edema, which does not affect activities.

    Degree Ⅱ: Local edema is obvious and movement is blocked.

    Bleeding: degree I: blood on the toilet paper or a small amount of blood on the stool after defecation.

    Degree II: Excretion of more blood and blood clots in the stool, normal treatment can stop bleeding.

    Degree III: In addition to the above symptoms, hemorrhagic shock also occurs, requiring special treatment.

    Fever: Body temperature below 38℃ or above 38℃.

    Urinary disorders: Difficulty urinating or catheterization.

    Interim criteria for diagnosis and treatment of hemorrhoids

    Editor's note Hemorrhoids are a common disease in humans. People have a long history of hemorrhoids. Since the 1970s, people have had a deeper understanding of hemorrhoids and the concept has been updated. In order to better regulate the diagnosis and treatment of hemorrhoids, the editorial board of "Chinese Journal of Surgery" and the Anorectal Surgery Group of the Chinese Medical Association Surgery Branch have formulated the "Interim Standards for Diagnosis and Treatment of Hemorrhoids", hoping that the majority of surgeons will refer to and apply them in clinical practice. Further amendments.

    1. Definition of hemorrhoids:

    Hemorrhoids are masses formed by pathological hypertrophy and displacement of the anal pad and stagnant blood flow in the subcutaneous vascular plexus perianal.

    2. Classification of hemorrhoids: (1) Internal hemorrhoids: anal pad displacement and pathological hypertrophy. Including vascular plexus expansion, fiber support structure relaxation, breakage. (2) External hemorrhoids: refers to vascular external hemorrhoids. That is, the perianal subcutaneous vascular plexus expands, showing up as a soft mass. (3) Mixed hemorrhoids: the internal hemorrhoids and the external hemorrhoids in the corresponding part are fused.

    3. Clinical manifestations and indexing of internal hemorrhoids (1) The indexing and clinical manifestations of internal hemorrhoids. Degree I: bleeding, dripping or jet-like bleeding in the stool, without prolapse of internal hemorrhoids, bleeding can stop automatically after stool. Degree II: Bloody, dripping or jet-like bleeding in the stool, accompanied by prolapse of internal hemorrhoids, can be taken back by itself after the stool. Degree III: Bloody or dripping in the stool, prolapse of internal hemorrhoids or standing for a long time, cough, fatigue, prolapse of internal hemorrhoids during weight bearing, need to be taken back by hand. Degree IV: Internal hemorrhoids prolapse and cannot be taken back. Internal hemorrhoids may be accompanied by strangulation and incarceration. (2) Clinical manifestations of external hemorrhoids: anal discomfort, dampness and uncleanness, which may be accompanied by thrombosis and subcutaneous hematoma. (3) Clinical manifestations of mixed hemorrhoids: The symptoms of internal hemorrhoids and external hemorrhoids can exist simultaneously.

    4. Diagnosis of hemorrhoids: based on medical history and physical examination of the anus, digital anorectal examination and anoscopy, the diagnosis is made with reference to the classification of hemorrhoids and the scale of internal hemorrhoids. If a little suspicious, further examination should be performed to exclude benign and malignant tumors and inflammatory diseases of the colon, rectum and anal canal.

    5. The treatment principle of hemorrhoids: asymptomatic hemorrhoids do not need treatment. Symptomatic hemorrhoids are hemorrhoids and require treatment. The purpose of treatment is to reduce and eliminate the main symptoms, not to cure them. Relieving the symptoms of hemorrhoids is more meaningful than changing the size of hemorrhoids and should be regarded as the standard of treatment effect. Generally, general treatment should be used first. General treatment includes changing diet, drinking more water, adding more dietary fiber, maintaining smooth stools, preventing diarrhea, warm bathing, keeping the perineum clean, etc. These are necessary for the treatment of various hemorrhoids. The doctor should adopt the treatment method that is most beneficial to the patient based on experience and equipment conditions. If general treatment fails, medication or surgery can be used.

    (1) Non-surgical treatment: Mainly suitable for I and II degree internal hemorrhoids. Including suppositories, ointments, oral medications to protect mucous membranes, injections of sclerosing agents and various other therapies. (2) Surgical treatment: mainly suitable for patients with grade III and IV internal hemorrhoids, mixed hemorrhoids, and non-surgical effects including external hemorrhoid thrombosis or hematoma. No matter what kind of surgery is used. Care should be taken to avoid complications such as postoperative bleeding, anal stenosis, anal insufficiency, and urinary retention.

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