痔疮诊治指南2006（Guideline for diagnosis and treatment ofhemorrhoids 2006）Guideline for clinical diagnosis and treatment of hemorrhoids (2006 Edition)2009 09, 30 [large, medium and small]Tags: guidelines for the diagnosis and treatment of hemorrhoids XunyiwenyaoHemorrhoid is a common and frequently occurring disease. Hemorrhoids treatment methods are more, each has its indications and contraindications, if not properly treated, there will be serious complications and sequelae. In July 2006, the original "hemorrhoids clinical guidelines (Draft)" on the basis of the Chinese Medical Association of colorectal and anal disease combined with Specialized Committee colorectal surgery surgery branch of China Association of Chinese medicine group, Specialized Committee, China anorectal disease of traditional Chinese medicine and Western medicine, again on the pathophysiology of hemorrhoids and hemorrhoids treatment was repeated discussion further revised the "clinical guidelines for the diagnosis and treatment of hemorrhoids (Draft)".Classification of hemorrhoidsHemorrhoids are divided into internal and external hemorrhoids and mixed hemorrhoid. Is the internal hemorrhoid anal cushion (anal vascular pad) support structure, vascular plexus and arteriovenous anastomosis occurred pathological change andshift; external is the dentate line distal subcutaneous vascular plexus expansion, blood stasis, thrombosis or tissue hyperplasia, according to the pathological characteristics of tissue, external hemorrhoids can be divided into connective tissue, and thrombotic varicose veins and inflammatory external hemorrhoids 4; mixed hemorrhoids external hemorrhoids and hemorrhoids is the integration of the corresponding parts of the vascular plexus.Two 、 diagnosis of hemorrhoids(I) clinical manifestation1.: the main clinical manifestations of hemorrhoids bleeding and prolapse, complicated by thrombosis, incarceration, strangulation and bowel problems. According to the severity of symptoms of hemorrhoids, divided into 4 degrees. I degrees: when taking blood and blood drop, then the bleeding can stop by itself; no hemorrhoid prolapse. II: often have hematochezia; defecation have prolapse, after can also satisfied. Third degree: can have hematochezia; defecation or long standing and cough, fatigue, weight have prolapse, hand also satisfied. IV: can have hemorrhoids prolapse or persistent hematochezia; also satisfied easily after prolapse.2. external hemorrhoids: the main clinical manifestations were anal soft tissue mass, anal discomfort, wet itching or foreign body sensation, such as thrombosis and inflammation may have pain.3.: the main clinical manifestations of mixed hemorrhoidshemorrhoids and hemorrhoids symptoms exist at the same time, showed severe hemorrhoids.(two) examination method;1. inspection: check whether the anus hemorrhoids prolapse, anal non varicose external hemorrhoids, thrombotic external hemorrhoids and skin tags, squatting check when necessary. To observe the location and size of internal hemorrhoids prolapse and hemorrhoids bleeding and no mucosal hyperemia and edema, erosion and ulcer.2. anorectal indications: it is an important method of examination. I, ii.Hemorrhoids refers to no abnormalities of recurrent prolapse; third and fourth degree hemorrhoids, sometimes refers to touch the dentate line the fibrosis of hemorrhoids. Anorectal examination can eliminate anorectal tumors and other diseases.3.: anorectal mirror can clear the location, size, number of hemorrhoids and hemorrhoids mucosa bleeding, edema, erosion, etc..4. fecal occult blood test is a commonly used screening method: elimination of digestive tract tumor.5. total colonoscopy: Patients with hemorrhoids hematochezia, family history of digestive tract tumor or polyp disease, I have over 50 years of age, positive fecal occult blood test and iron deficiency anemia, recommended colonoscopy.Three 、 differential diagnosis of hemorrhoidsEven with hemorrhoids should also identify diseases, sexually transmitted diseases and colorectal cancer, anal cancer, polyps, rectal prolapse, perianal abscess, anal fistula, anal fissure, hypertrophy of anal papilla, anorectal and inflammatory bowel disease.Four 、 TCM syndrome differentiation of hemorrhoids1. wind injury intestinal collaterals: stool blood ejection, or blood, blood red, dry stool, anal itching, dry mouth and throat. Red tongue, yellow moss, pulse floating number. Treat cooling blood to stop bleeding.2. damp heat bet card: then red, more quantity. External mass, swelling, burning pain, or swelling of the anal mass. Dry or loose, short red urine. Red tongue, yellow greasy moss, pulse floating number. Cure to heat dampness.ThreeQi stagnation and blood stasis syndrome: the tumor is out of the anus, edema, thrombosis, or incarceration, the surface of purple dark, erosion and exudate, severe pain, tenderness is obvious, anal canal contraction. Constipation, urination. Dark purple tongue or petechiae, pulse string or astringent. Promoting blood circulation to reduce swelling.4. spleen deficiency syndrome: Qi stagnation was anal prolapse,not easy reduction, anal bulge, defecating weakness, then red light. A small, dizziness, lassitude, eat less fatigue, less gas lazy words. Pale tongue, thin white fur, thready pulse. Treating qi to promote qi.Five, the treatment of hemorrhoidsTreatment principle: asymptomatic hemorrhoids without treatment. The purpose of treatment is to eliminate and reduce the symptoms of hemorrhoids. The symptoms of lifting hemorrhoids are more significant than those of changing the size of the hemorrhoid, and should be regarded as the standard of therapeutic effect. The doctor should adopt reasonable non-surgical or surgical treatment according to the patient's condition, experience and medical condition.(I) general treatmentTo improve the diet, maintain defecate unobstructed, pay attention to the treatment of anal cleaning and so on all kinds of bath hemorrhoids are effective.(two) drug therapyDrug therapy is an important method for the treatment of hemorrhoids, hemorrhoids, I II patients should be the drug of choice for treatment.1. topical medications include suppositories, creams and lotions. The suppository and cream containing the repairing, protecting and lubricating component of the angle acid mucosahave good treatment effect on the hemorrhoid. Drugs containing steroid derivatives can relieve symptoms in the acute phase, but should not be used for long - term and prophylactic use.2. systemic drug treatment: commonly used drugs include intravenous enhancer, anti-inflammatory pain medicine.(1) intravenous enhancer are commonly used: micronised purified flavonoid ingredients, Melilotus Extract Tablet, Ginkgo biloba extract, can relieve the symptoms of acute hemorrhoids, but the number of intravenous enhancer combined with no obvious superiority; (2): anti-inflammatory drugs can effectively relieve the hemorrhoids and hemorrhoids thrombus caused by pain; (3) Chinese medicine dialectical therapy.(three) sclerosing agent injection therapySubmucosal injection of sclerosing agent is effective method in treatment of internal hemorrhoids, mainly used in I, second degree hemorrhoids, significant short-term effect. Complications include local pain, burning pain in the anus, tissue necrosis, ulceration or anal stenosis, hemorrhoids, thrombosis, submucosal abscess and induration. External hemorrhoids and hemorrhoids during pregnancy should be disabled.(four) appliance therapyThe 1. part: rubber ring ligation therapy is suitable for various hemorrhoids hemorrhoids and mixed hemorrhoid, especially in grade II, accompanied by bleeding and / orprolapse. The ligation site in the dentate line area, discomfort and complications of rectal tenesmus, pain, apron slippage, delayed bleeding, anal edema, skin ulceration, thrombotic external hemorrhoids, pelvic infection etc..2. Chinese medicine line ligation: wound in the roots of hemorrhoids medicine line wrapped with silk thread, paper or medicine, the hemorrhoids necrosis, wound repair and healing by.3. physical therapy, including laser treatment, cryotherapy, direct current therapy and copper ion electrochemistry therapy, microwave coagulation therapy, infrared coagulation therapy, etc.. The main indications for I, II, grade. The main complications were bleeding, edema, wound healing, delay and infection.(five) surgical treatmentIndications: hemorrhoids has developed to the third and fourth degree, second degree or with serious bleeding hemorrhoids; acute incarcerated hemorrhoids, hemorrhoids, mixed hemorrhoids and necrotizing external hemorrhoids symptoms and signs of significant; non operative treatment is invalid and no operative contraindications.Hemorrhoids surgery is divided into the following.1. hemorrhoidectomy: complete resection or partial PrincipleNo hemorrhoids operation: (1) the wound open Milligan Morgan (Milligan - Morgan) operation; (2) a semi open wound (Parks)surgery; (3) the wound closed surgery (Ferguson); (4) Milligan Morgan hardening agent injection; (5) the ring hemorrhoid surgery, including semi closed loop hemorrhoidectomy (Toupet surgery), closed loop hemorrhoidectomy (Whitehead surgery), but due to complications, the clinical has been basically abandoned.Reasonable attention should be paid to the location and quantity of skin bridge, mucous membrane bridge and the time of wound healing.2. procedure for, prolapsed, hemorrhoid, PPH) upper hemorrhoidal mucosa resection: the rectal mucosa and submucosal tissue were removed by stapler through the anus. Suitable for the annular prolapse of the third and fourth degree hemorrhoids and recurrent bleeding hemorrhoids ii. Attention should be paid to the prevention and treatment of bleeding, swelling, anal stenosis, infection and other complications.3. Doppler guided hemorrhoidal artery ligation using special Doppler probe, in 2 - 3 cm above the dentate line detected above the hemorrhoid artery direct ligation of hemorrhoids, blocking the blood supply to achieve the purpose of relieving symptoms. For the second one fourth degree hemorrhoids.4. other: I, second degree bleeding internal hemorrhoids with internal sphincter in the high tension of the patients, can be used for the operation of the internal anal sphincter, including manipulation or device with a balloon dilatation of anus and anal sphincter in the posterior or lateral incision. The main complications were anal mucosal laceration, mucosalprolapse and anal incontinence.Perioperative management of hemorrhoids:Routine physical and laboratory examinations should be routinely performed before surgery. Preoperative bowel preparation with oral lavage solution, enema or other promoting defecation etc.. Prophylactic antibiotics can be used before surgery.Prevention and treatment of postoperative complications:1. bleeding: all kinds of hemorrhoids surgery, there may be bleeding, some patients may have delayed bleeding after surgery. Attention should be paid to careful hemostasis during operation and postoperative observation. Hemostasis is necessary if necessary.2. urinary retention: emptying the bladder before operation, controlling the amount of infusion and the speed of transfusion, and choosing the proper way of anesthesia can prevent the occurrence of urinary retention. Such as the occurrence of urinary retention by Acupuncture Sanyinjiao and Guanyuan, treatment methods can also be used to Yin, ear pressure, internal medicine, necessary catheterization.3. pain: the local mucosal protective agent and the use of analgesics can relieve pain after hemorrhoids surgery, including compound lidocaine, compound menthol, antipyretic suppository, nitroglycerin ointment topical and mucosal protective agent controlled analgesia pump; Herbal Fumigationwith blood swelling and pain, can also use acupuncture, two white, 28 baihuanshu or anal stimulation.4. perianal edema: bath, medicine, surgical treatment when necessary.5. anorectal stenosis: because of the possibility of anal stenosis after hemorrhoid surgery, the operation should pay attention to retaining the anal canal skin. Treatment involves expanding the anus and forming the anal canal.6. anal incontinence: excessive anal dilatation, anal sphincter injury, internal sphincterotomy and other treatment prone to anal incontinence. The risk of anal incontinence increases in patients with preexisting anal canal dysfunction, irritable bowel syndrome, obstetric trauma, and neurological disorders.7. other complications include delayed wound healing, eversion of rectal mucosa, perianal skin lesions, infection, and so on.(six) treatment of special patients;1. acute Incarcerated Hemorrhoids: it is an emergency of hemorrhoids. Manual reduction or surgical treatment can be performed according to the patient's condition. Early surgery does not increase the risk of surgery and complications; for a long time, Incarcerated Hemorrhoids or surface erosion bad dead, can relieve spasm of the sphincter of the local drug application; for incarcerated hemorrhoid reduction failure, long time of incarceration and strangulation necrosis,surgical treatment should be taken to relieve the incarceration and removal of necrotic tissue, prevent infection.The 2. is the acute thrombotic external hemorrhoids: hemorrhoids. For early onset, severe pain, no shrinking trend of the tumor, emergency surgery can be performed. More than 72 hours after onset, conservative treatment should be adopted.3., pregnancy, early postpartum hemorrhoids: first choice conservative treatment. For patients with severe complications of hemorrhoids and ineffective drug treatment, simple and effective surgical procedures should be selected. Disable the hardener injection.4. hemorrhoids complicated with anemia: attention should be paid to the elimination of anemia caused by other diseases, should be taken sclerosing agents, injections, surgery and other treatment.FiveHemorrhoids combined with immunodeficiency: the presence of immunodeficiency (AIDS, myelosuppression, etc.) is a contraindication for sclerotherapy and apron ligation. Antibiotic prophylaxis should be used during surgical treatment.6., the elderly, hypertension, diabetes patients with hemorrhoids: non surgical treatment based, serious cases should be related to disease treatment, to its stability, as appropriate, select a simple surgical treatment.。
