Open classification: medical treatment, science, disease, medicine, hemorrhoids
Clinical manifestations of internal hemorrhoids
1. occurred above the anal tooth line, and the lithotomy position was 3,7, 1 1 point.
2. The main symptom is bleeding or hemorrhoid prolapse during defecation.
3. In the early stage (construction period), the hemorrhoid core is small and soft, and the hemorrhoid surface is bright red or blue-purple. When defecating, the hemorrhoid core does not protrude from the anus. Bleeding, dripping or spraying during or after defecation, bright red blood, mixed feces, intermittent attacks.
In the middle stage (stage ⅱ), the hemorrhoid nucleus is large and bulging, and it will come out of the anus when defecating, and it will recover itself after defecation. There is less bleeding after defecation than at the beginning.
In the later stage (stage ⅲ), the hemorrhoid nucleus is large, hard in texture and slightly gray in surface. When defecating, even when walking, coughing, sneezing or standing, hemorrhoids will come out of the anus and cannot be returned by themselves. You must push it back by hand, or you can lie down and apply hot compress, with little or no bleeding in stool.
4. Generally, there is no pain, and there may be anal swelling and itching in the middle and late stages. Such as prolapse and incarceration of hemorrhoid nucleus, can cause swelling and pain, erosion, necrosis, and even suppuration, secondary anal fistula and other syndromes.
5. Generally, there are no systemic symptoms. In the later stage, some patients may have symptoms such as anemia, difficulty in defecation and difficulty in urine emptying.
6. This disease should be differentiated from the following anal diseases.
Polyp hemorrhoid: a polyp born at the lower end of rectum, with delicate texture, thin pedicle and bright red color. Generally single shot, occasionally a string of twenty or thirty, like grapes. It may come out of the anus when defecating, which is more common in children.
Anal hemorrhoid: the tumor can not protrude from the anus, and the palpation quality is hard and uneven. When I was in anal stenosis, my stool became thinner, or my stool was like dysentery, and the frequency increased, and it was urgent first and then heavy, and sometimes there was foul sewage. More common in middle-aged and elderly people over 40 years old.
Anal fissure: generally occurs at 6 o'clock and 12 o'clock in the lithotomy position. There is a fissure in the anus and a small amount of bleeding. Pain during defecation, sometimes it can last for hours after defecation.
Rectal prolapse: ① Rectal prolapse Rectal prolapse: The prolapse is reddish, spiral, layered and hard. More common in frail children and the elderly. ② Rectal mucosal prolapse and proctoptosis: annular or partial mucosal prolapse, bright red in color, soft in quality, without hemorrhoid prolapse and slight oozing. More common in the elderly, occasionally seen in patients with internal hemorrhoids after surgery.
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Symptoms of internal hemorrhoids
This disease is mainly caused by improper diet, overeating, spicy cold stimulation, or abnormal hunger and satiety, or due to inattention in daily life, sedentary standing for a long time, heavy load travel, excessive atrioventricular, or long-term diarrhea and dysentery, long-term constipation, pregnancy and childbirth, abdominal tumor oppression, etc. , can make rheumatism endogenous, qi and blood imbalance, make the meridians impassable, blood stasis and turbid gas into the anus, forming internal hemorrhoids. It is characterized by painless hematochezia and hemorrhoid prolapse in the later stage.
The four main symptoms of this disease are blood, swelling, itching, prolapse and constipation. Blood in stool is caused by blood collateral damage, but due to different constitutions, there are differences in pathogenic factors and differences in excess and deficiency. True blood is bright red, or red and dirty, such as dripping water, constipation and abdominal pain. The blood color of deficiency syndrome is reddish and thin, or dim but not fresh, accompanied by mental fatigue. The swelling and itching pain is caused by damp-heat in the lower energizer, anal agglomeration, disorder of qi and blood, transverse collapse of tendons and veins, and blood stasis, which leads to swelling and itching pain of hemorrhoids. If both qi and blood are deficient, qi deficiency is unable to lift, and hemorrhoid nucleus prolapse is the main cause, which is not easy to recover; If qi deficiency is not absorbed and blood is not collected, the blood color will be light and large.
Patients with internal hemorrhoids may defecate frequently because of the feeling of anal fullness, or they are afraid to defecate for fear of bleeding, resulting in poor viscera and constipation. Constipation can also be divided into deficiency and excess. The secret is excess calories, burning body fluids, making the gastrointestinal tract dry and difficult to solve, and abdominal pain. Secret deficiency is qi deficiency, lung failure, large intestine conduction weakness, or blood deficiency and body fluid deficiency, gastrointestinal dryness, abdominal distension and constipation, palpitation and spontaneous sweating. The treatment is mainly to clear away heat and moisten dryness, cool blood and stop bleeding, and replenish qi and converge.
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Treatment of internal hemorrhoids
Blood collateral injury type
The evidence shows that the patient's blood color is bright red, or red and dirty, and the stool is uncertain and the amount is different, such as dripping and shooting. Hemorrhoid prolapse has bright red color, dry stool, abdominal pain and dry mouth, yellow and dry fur and strong pulse.
People with deficiency syndrome will have pale red and thin blood color, or dull but not fresh, persistent pain in anus, fatigue, pale tongue and weak pulse.
Treatment of excess syndrome should clear heat and cool blood, and deficiency syndrome should strengthen spleen and replenish blood.
Herbs on the prescription
1. Principal party
(1) Qingre Liangxue recipe is modified with Liangxue Huangtang (Qi Kun's Surgery Dacheng).
Prescription: Radix Rehmanniae 15g, Radix Paeoniae Rubra 9g, Fructus Aurantii 9g, Scutellariae Radix 9g, Flos Sophorae Immaturus 12g, Radix Sanguisorbae 12g, Rhizoma Coptidis 9g, Herba Schizonepetae 9g, Radix Glycyrrhizae 6g, Radix Saposhnikoviae 6g and Cortex Moutan 9g. Decoct with water, daily 1 dose.
Fructus Trichosanthis 12g (dozen) and Fructus Cannabis 12g (dozen) are added for constipation patients.
(2) Guipi Decoction (strictly used and Jisheng Decoction) is selected for Jianpi Buxue Recipe.
Prescription: Radix Codonopsis 30g, Poria cocos12g, Atractylodis Macrocephala 9g, Radix Astragali15g, Radix Angelicae Sinensis 9g, Rhizoma Bletillae 9g, Scutellariae Radix 6g, Notoginseng 3g (orally), Sophora japonica 9g and Colla Corii Asini 6g (orally). Decoct with water, daily 1 dose.
2. Chinese patent medicine
(1) zanglian pills, 9g each time, twice a day, taken with warm boiled water. Suitable for empirical research.
(2) Dandou Pills, 3 pills each time, twice a day, with warm boiled water. Suitable for empirical research.
(3) Guipi Pills, 9 grams of honey pills each time, 6 grams of honey pills each time, three times a day, with warm boiled water. Applicable to deficiency syndrome.
(4) Shiquan Dabu Pills, 9 grams of honey pills each time, 6 grams of honey pills each time, 3 times a day, with warm boiled water. Applicable to deficiency syndrome.
3. One-sided prescription
(1) Compound Canglian Pill (Chen Songshan Fang)
Prescription: Sanguisorba officinalis charcoal 156g, Coptidis Rhizoma 150g, Scutellaria baicalensis Georgi 150g, Saposhnikovia divaricata 150g, rhubarb 150g, Schizonepeta tenuifolia charcoal 150g, Sophora japonica 250g and Fructus Cannabis 250. Grinding the medicine into fine powder, and making into honeyed pills, such as the size of buttonwood, with 20g in each bag. Take 5g each time, twice a day, 10 day is 1 course of treatment. Suitable for internal hemorrhoid bleeding, prolapse, embolism, internal hemorrhoid, external hemorrhoid, etc.
(2) Xiaozhi decoction (Lingchaoguang syndrome)
Prescription: Mume10g, Galla Chinensis10g, Sophora flavescens15g, Belamcanda rhizome10g, prepared pangolin scales10g, roasted oysters 30g and Fructus Cannabis10g. Decoct with water, daily 1 dose.
Sanguisorba charcoal and Platycladus orientalis leaves are added for patients with hematochezia. For patients with severe inflammation, Cortex Phellodendri and Rhizoma Coptidis can be added. For constipation, senna leaf is added. For patients with severe pain, add Olibanum and Rhizoma Corydalis. Radix aucklandiae and Fructus Aurantii are added for anal dilatation. Radix Astragali, Radix Puerariae and Cimicifugae Rhizoma are added for patients with spleen deficiency and subsidence. Suitable for hemorrhoid bleeding, swelling and pain, prolapse.
Damp-heat type lower coke
This syndrome is characterized by hemorrhoid nucleus protruding from anus, purple and wet color, pain in anus, like urgency of urination, and then heavy feeling. The stool is uncomfortable, accompanied by bleeding, and the urine is Huang Chi. Red tongue, yellow fur, thick and greasy, slippery or stringy pulse.
Treatment: clearing away heat and toxic materials, expelling wind and removing dampness.
Herbs on the prescription
1. Principal party
(1) Fangfeng Longdan Decoction (authentic surgery by Chen Shigong).
Prescription: Radix Saposhnikoviae 9g, Radix Gentianae Macrophyllae 15g, Radix Angelicae Sinensis 9g, Radix Rehmanniae 15g, Radix Paeoniae Rubra 9g, Poria 12g, Fructus Forsythiae 9g, Areca catechu 9g, Sanguisorba officinalis 12g, Fructus Sophorae 12g and Fructus Aurantii 9g. Decoct with water, daily 1 dose.
(2) Damp-heat with blood stasis, swelling, pain and itching can be relieved with Shentang (Janice et al. Golden Mirror of Medical Records).
Prescription: Gentiana macrophylla 15g, Rhizoma Atractylodis 9g, Semen Persicae 12g, Fructus Gleditsiae Abnormalis 9g, Radix Saposhnikoviae 9g, Cortex Phellodendri 9g, angelica tail 9g, Alismatis Rhizoma 12g, Areca catechu 9g and Radix et Rhizoma Rhei 9g. Decoct with water, daily 1 dose.
2. Chinese patent medicine
(1) Sanguisorba Sophora japonica Pill, 9g each time, twice a day, taken with warm boiled water.
(2) Su Zhining, 9g each time, twice a day, with warm water.
3. Unilateral refers to unilateral blood collateral injury.
Deficiency of both qi and blood
Hemorrhoid nucleus prolapse, it is difficult to recover. Patients with qi deficiency have a feeling of anal distension, shortness of breath, laziness, lack of food and fatigue, and bloody stool; Blood deficiency is pale, dizzy, pale, exhausted and flustered. Pale tongue and weak pulse.
Treatment: benefiting qi and lifting, nourishing blood and softening liver.
Herbs on the prescription
1. Principal party
(1) Add and subtract Buzhong Yiqi Decoction (Ten Books of Dongyuan) and Xiaoyao Powder (Taiping Huimin Mixture by Chen et al.)
Prescription: Radix Astragali 30g, Radix Codonopsis 30g, Rhizoma Cimicifugae 9g, Radix Bupleuri 6g, Rhizoma Atractylodis Macrocephalae 9g, Radix Angelicae Sinensis 9g, Radix Paeoniae Alba 9g, Poria 9g, Radix Glycyrrhizae 6g, Flos Sophorae Immaturus 9g and Radix Rehmanniae12g. Decoct with water, daily 1 dose.
(2) If the deficiency of both qi and blood is serious, add and subtract Shiquan Dabu Decoction (Chen's Hejiju Formula).
Prescription: Radix Astragali 30g, Radix Codonopsis 30g, Rhizoma Atractylodis Macrocephalae12g, Poria12g, Rhizoma Chuanxiong 6g, Radix Angelicae Sinensis 9g, Radix Rehmanniae Preparata18g, Radix Paeoniae Alba 9g, Radix Glycyrrhizae Preparata 6g, Fructus Jujubae 9g, Colla Corii Asini 9g (taken in solution) and Radix Aucklandiae 9g (below). Decoct with water, daily 1 dose.
2. Chinese patent medicine
(1) Buzhong Yiqi Pill, 9g honey pills each time, 6g honey pills each time, three times a day, taken with warm boiled water.
(2) Shiquan Dabu Pills, 9 grams of honey pills each time, 6 grams of honey pills each time, 3 times a day, with warm boiled water.
3. Unilateral refers to unilateral blood collateral injury.
Intestinal dryness constipation type
If the syndrome is full and painful, the patient will refuse to press, dry mouth and foul breath, and be upset. The fur is yellow and the pulse is strong. Abdominal pain, abdominal distension, dizziness, palpitation and spontaneous sweating. Pale lips and tongue, thready pulse.
The secret of treatment is clearing fu-organs and purging heat; Secret deficiency should moisten the intestines and relax the bowels.
Herbs on the prescription
1. Principal party
Prescriptions for clearing fu-organs and purging heat were selected (1) to modify Dachengqi decoction (Treatise on Febrile Diseases by Zhang Zhongjing).
Prescription: raw rhubarb (bottom) 9g, mirabilite 9g, immature bitter orange 9g, magnolia officinalis 9g, Sophora japonica 9g, radish seed15g, honeysuckle 9g and licorice 6g. Decoct with water, daily 1 dose, in order to reduce the swelling degree.
(2) The formula of Runtang Tongbian is Zengye Chengqi Decoction (Wu Jutong's Treatise on Febrile Diseases) and Wuren Pill (Wei Yilin's Jiebing Formula).
Prescription: Radix Scrophulariae 9g, Radix Rehmanniae 12g, Radix Ophiopogonis 9g, Radix et Rhizoma Rhei 9g, Radix Glycyrrhizae 6g, Semen Armeniacae Amarum 9g, Mume Fructus 12g, Fructus Cannabis (broken) 12g, Pericarpium Citri Reticulatae 9g, Fructus Sophorae Immaturus 9g and Fructus Aurantii Immaturus 9g. Decoct with water, daily 1 dose.
2. Chinese patent medicine
(1) Niuhuang Jiedu tablets, 3 tablets each time, 3 times a day, with warm boiled water. Suitable for real secrets.
(2) Geliang Powder, 9- 15g daily, with L pieces of bamboo leaves and a little honey, and decocted in water twice. Suitable for real secrets.
(3) Runchang Pill, 9g each time, twice a day, taken with warm boiled water, is suitable for virtual secret.
(4) Maren Zipi Pill, 65438±00g each time, twice a day, with warm boiled water. Suitable for virtual secrets.
3. Unilateral refers to unilateral blood collateral injury.
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External treatment of internal hemorrhoids
1. Fumigation and washing of internal hemorrhoids in each stage can be boiled with drugs in water, first smoked and then washed. The commonly used prescription is gallnut soup or Sophora flavescens soup, or mirabilite, honeysuckle, forsythia, Sophora flavescens, Sanguisorba officinalis, purslane, Sichuan pepper 1 ~ 2 soup for fumigation and washing. Fumigation and washing can promote blood circulation, reduce swelling, clear away heat and relieve pain, and relieve itching.
2. In the later stage of external application of internal hemorrhoids, if the surface of hemorrhoid nucleus is eroded and oozing blood, and surgery cannot be performed for the time being, the affected area can be fumigated and washed by the above method, and then externally applied with gallnut powder, hemorrhoid-removing powder and dried alum powder. External application has the functions of clearing away heat, reducing swelling, relieving pain, astringing and stopping bleeding, and can shrink hemorrhoid nucleus and heal ulcer surface.
3. If it is inconvenient to take medicine for internal hemorrhoids in stage I, II and III after operation, the medicine can be made into ointment or suppository and stuffed into anus to achieve the purpose of clearing away heat, reducing swelling, relieving pain and stopping bleeding. Jiuhua Ointment and Zicao Ointment can be selected as the plug medicine.
4. Dry hemorrhoid method
Insert the medicine strip or nail into the hemorrhoid core to make the hemorrhoid core dry and necrotic, fall off and heal. At present, the commonly used are seven fairy strips, Huang Er cool finger nails and other myrrh nails.
Indications: stage Ⅱ and Ⅲ internal hemorrhoids, internal hemorrhoids and external hemorrhoids.
Contraindications: patients with acute diseases, severe chronic diseases, acute anorectal inflammation, diarrhea, malignant tumors and bleeding, and those who are allergic to arsenic.
Operation method: clean enema before operation, take lateral position or lithotomy position, and fully expose anus. After washing with normal saline. Turn the hemorrhoid core out of the anus, fix the hemorrhoid core with the index finger and middle finger of the left hand, and disinfect the surface. Pinch the tail section of the nail with the thumb and forefinger of the right hand, insert it into the center of submucosal hemorrhoid nucleus at a distance of 0.3-0.5 cm from the tooth line, and rotate it with the longitudinal axis of the intestinal wall as 250.350, with a depth of about 1 cm. Generally, 4 ~ 6 people are inserted into each nucleus at a time, or depending on the size of hemorrhoid nucleus. The spacing is 0.3 ~ 0.5 cm. Then cut off the extra drug nail exposed outside the hemorrhoid nucleus, and the nail root is exposed about 1 mm, which is too short to cause alveolar bleeding and difficult to fix; Too long time is easy to damage the contralateral intestinal wall. Then push the hemorrhoid nucleus back to the anus. Treat other hemorrhoids in the same way, at most 3 at a time. At the same time of each nail insertion, Huanglian ointment or Zicao ointment is stuffed. Generally, the hemorrhoid nucleus atrophies and falls off in about 7 days.
Note: nails should not overlap, and the depth should be appropriate. Too deep will cause sphincter injury and necrosis, causing infection and pain; Too shallow drug nails are easy to fall off, causing alveolar bleeding and failing to achieve the therapeutic purpose. Insert the small hemorrhoid nucleus first, then the large hemorrhoid nucleus, or insert the hemorrhoid nucleus with bleeding point first, and insert 1 nail at the bleeding point to stop bleeding. When inserting nails, we should correctly grasp the distance from the tooth line, too close will cause pain. The total number of nails inserted at a time shall not exceed 20.
Postoperative treatment: defecation will not be solved within 24 hours after operation to prevent the drug nail from slipping and bleeding. If the hemorrhoid nucleus comes out after defecation, it should be pushed back immediately to avoid severe pain caused by edema and incarceration, and drugs should be used to stop bleeding, reduce swelling and moisten the intestine. If arsenic-containing nails are used, patients should be instructed to drink more boiled water or take honeysuckle and mung bean soup orally to facilitate arsenic excretion. At the same time, pay attention to observe whether the patient has high fever, abdominal pain, vomiting, oral ulcer and other poisoning situations, so as to deal with them in time.
ligate
Ligation of hemorrhoid root with medicated thread or thick silk thread or apron can block the blood supply of hemorrhoid and make it ischemic, dry, necrotic and fall off, so as to achieve the purpose of cure. The commonly used methods are ligation and rubber ring ligation.
(1) Puncture method: Puncture the hemorrhoid root with silk thread to block the qi and blood circulation of the diseased part, so that the hemorrhoid nucleus will be necrotic and fall off.
Indications: stage ⅱ and ⅲ internal hemorrhoids, especially fibrous internal hemorrhoids, are more suitable.
Contraindications: acute and chronic perianal inflammation, acute and chronic dysentery, diarrhea, invasive tuberculosis, severe liver and kidney diseases, hypertension, patients with various blood diseases, and pregnant women in labor.
Operation method: routine skin preparation, clean enema, Shu Yao anesthesia or local anesthesia. Take the lateral position or lithotomy position, fully expose the anus, routinely disinfect and spread a towel. The operator crosses his forefinger with both hands, slowly dilates the anus, relaxes the sphincter and fully exposes the hemorrhoid nucleus. Clamp the hemorrhoid base with an arc-shaped vascular clamp, gently pull out the anus with your left hand, thread the thick silk thread 10 with your right hand slightly above the center of the hemorrhoid base with an arc-shaped needle, then cut a superficial incision along the tooth line with scissors, and tie a knot around the hemorrhoid base in an 8-shape. Inject 15% alum solution or Xiaozhiling injection into the ligated hemorrhoid, or press the hemorrhoid to accelerate the necrosis and shedding of the hemorrhoid. Finally, cut the thread short and leave about three. 5 cm, and then push the hemorrhoid back to the anus. After operation, Zicao ointment was injected and covered with gauze for fixation. Generally treat 3 hemorrhoids at a time. If it is an annular internal hemorrhoid, the hemorrhoid core can be divided into several hemorrhoid blocks, and the mucosa can be clamped by two hemostatic forceps on one side of the hemorrhoid block. Cut from the middle, treat the opposite hemorrhoid in the same way, then tie the hemorrhoid into an "8" shape, and treat the rest hemorrhoid in the same way.
Note: when ligating, it should be small first and then large. When the suture needle passes through the base of hemorrhoid nucleus, it should not penetrate into the muscle layer, so as to avoid muscle layer necrosis or perianal abscess. No defecation is allowed on the day after operation. If the hemorrhoid nucleus prolapse after defecation, it should be pushed back into the anus immediately to avoid edema and aggravation of pain. 7 ~ 14 days after operation is the period of hemorrhoid core shedding, so patients should be advised to reduce their activities as much as possible and not to use force when defecating to prevent massive bleeding.
(2) Rubber ring ligation: insert a small latex ring into the hemorrhoid root with the aid of instruments, and the contraction force of the rubber ring after expansion blocks the blood supply of the hemorrhoid, making it ischemic and necrotic.
Indications: internal hemorrhoid stage Ⅱ and Ⅲ, external hemorrhoid and internal hemorrhoid.
Contraindications: same as ligation.
Operation method: before operation, ask the patient to empty stool or clear soup, and take lateral position or knee-chest position. Firstly, insert an inclined anoscope, determine the position and number of hemorrhoids, and select the ligation site; Fully expose the hemorrhoid core area. Disinfect with 0. 1% bromogeramine cotton ball. Then, the assistant fixes the anoscope, the operator holds the ligator in his left hand and the wheat forceps in his right hand, clamps the hemorrhoid root through the ligating ring, and pulls the hemorrhoid into the ligator. Press the handle of the ligator to move the cuff to the hemorrhoid root; Then push out the ferrule and stick it on the root of hemorrhoids. Then loosen the wheat forceps and exit together with the ligator, and then slowly exit the anoscope.
Note: Same as ligation.
6. Endoscopic injection therapy
(1) Injection of Sclerosing Atrophy Injection: Injecting Sclerosing Atrophy Injection into the space of submucosal venous plexus of hemorrhoid nucleus causes chemical inflammatory reaction, and varicose venous plexus is gradually occluded due to phlebitis and progressive fibrous tissue hyperplasia, so as to achieve the purpose of sclerosing and atrophy of hemorrhoid nucleus.
Indications: internal hemorrhoids in stage I, II and III, anemic internal hemorrhoids unsuitable for other therapies, and internal hemorrhoids of internal and external hemorrhoids.
Contraindications: incarceration of internal hemorrhoids; Internal hemorrhoids are accompanied by acute and chronic inflammation and diarrhea; Severe tuberculosis, hypertension, liver and kidney diseases and blood diseases; Internal hemorrhoids, external hemorrhoids caused by abdominal tumors, pregnant women in labor and patients with severe prostatic hyperplasia.
Commonly used drugs: Xiaozhiling, 6% ~ 10% alum solution, 5% sodium morrhuate, 5% ~ 10% carbolic acid glycerol, etc.
Operation method: Take lateral position or lithotomy position, and disinfect anal canal and intestinal cavity with 0. 1% bromogeramine after local anesthesia. After anal dilatation, the liquid medicine was extracted with a skin test needle and injected under the anus endoscope. The liquid medicine should be injected into the submucosa of hemorrhoids at a distance of 0.5 cm from the tooth line, and the angle of injection is 65438+050. 0.5 ~ 1 ml liquid medicine was injected into each nucleus, and the color of the swollen surface of hemorrhoids remained unchanged. No more than 3 hemorrhoids are injected each time, and the total dose is no more than 3 ~ 4 ml. If a needle fails to heal, it can be injected every 7 days 1 time, usually 3-4 times to heal.
(2) Xiaozhiling four-step injection method: it is also a kind of sclerosing atrophy injection method, and its principle is the same as that of sclerosing atrophy injection method. Indications: varicose internal hemorrhoids and external hemorrhoids are further developed from internal hemorrhoids, and bleeding and internal hemorrhoids are stage III. 2 contraindications: incarcerated inflammation of internal hemorrhoids; Accompanied by acute enteritis and dysentery; Skin diseases and external hemorrhoids. ③ Operation method: Take the lateral position or lithotomy position, use 0.5% e chlorhexidine cotton ball for local disinfection, fully expose the affected part, use 1% procaine 10- 15 ml for local anal anesthesia, and then use 0.5% o chlorhexidine cotton ball to disinfect the anal internal hemorrhoid area. Expand the anus by hand, carefully find out the position, quantity and size of internal hemorrhoids under comb anoscope, and then touch the hemorrhoid area with your index finger to determine the injection site. Then the Lexus solution was sucked out with a No.5 needle and a 5 ml syringe, and injected with low concentration and high dose in four steps under the anoscope. The following describes the specific operation.
Injection into superior rectal artery area: To avoid tissue necrosis and bleeding caused by concentration of liquid medicine, the liquid medicine diluted by Xiaozhiling liquid according to the ratio of L: 1 was injected into 1% procaine, and 2 ~ 3 ml was injected at each point.
Hemorrhoid submucosa injection: To prevent tissue necrosis, Xiaozhiling was injected into the muscle layer from the middle of hemorrhoid nucleus with the diluted liquid medicine of 1 procaine 2: 1. When muscle resistance occurs, the needle is pulled out and injected, and then injected in a fan shape, so that the liquid medicine is evenly filled into the submucosa tissue. The injection dose can be regarded as diffuse swelling of hemorrhoid nucleus, and the injection dose per nucleus is 4-6 ml.
Injection of hemorrhoid mucosa lamina propria: when the second injection is completed, slowly withdraw the needle. When you feel disappointed, enter the hemorrhoid mucosa lamina propria and slowly inject the medicine, 2-3 ml per core. After injection, we can see that the mucosa of hemorrhoid nucleus is cystic, and the tiny blood vessels of mucosa can be seen.
Cavernous vein injection: finally, the injection is made at the lowest point of internal hemorrhoid slightly higher than the tooth line, that is, the starting point of cavernous vein. In order to avoid the pain caused by the liquid medicine spreading below dental floss, the liquid medicine is diluted to L: L concentration. Expose the lower part of the internal hemorrhoid under the anoscope or with fingers, insert the needle at the position of 0. 1 cm on the tooth line, and the needle tip will pierce the oblique upper part of the internal hemorrhoid for sector injection, and each core will be injected with 1-3 ml. The dosage of one needle for stage ⅲ internal hemorrhoids is 20 ~ 45 ml (diluted dosage). Finally, vaseline gauze with a length of 3 cm and a width of 1 cm was placed in the anus to fix the internal hemorrhoids to prevent incarceration. External gauze fixation. In principle, all internal hemorrhoids are injected once. After injection, internal hemorrhoids become foreign bodies due to atrophy and dryness of tissues. This method generally has no adverse reactions. If there is slight pain after injection, it is not necessary to deal with it. There may be low fever, and a few cases have high body temperature, which can be treated symptomatically and returned to normal in 3-5 days. Precautions: strict disinfection should be carried out during injection, and the needle should be disinfected every time to prevent infection. Fine needle must be selected to avoid bleeding due to too large pinhole. After the needle is inserted, a blood return test should be done. If the blood does not return, the medicine can be slowly pushed. Needles should not be pricked in all directions in the hemorrhoid, so as not to damage the blood vessels in the hemorrhoid and bleed, resulting in hematoma in the hemorrhoid, increasing local exudate and prolonging the time of hemorrhoid atrophy. The injection depth should be moderate, too shallow can easily cause mucosal ulceration, and too deep can harden the muscle layer. Do not inject the liquid medicine into the external hemorrhoid area, or the injection position is too low, so as to avoid the liquid medicine spreading to the anal canal and causing perianal edema and pain. It is not advisable to defecate 24 hours after injection and reduce activities.
(3) Necrosis and collapse injection method: corrosive liquid is injected into the hemorrhoid core, so that the hemorrhoid core tissue is necrotic and exfoliated, and the wound surface is repaired and healed.
Indications: stage Ⅱ and Ⅲ internal hemorrhoids.
Contraindications: injection hardening and atrophy.
Commonly used drugs: Kuzhi oil and Xin No.6 injection.
Operation method: Shu Yao anesthesia or local anesthesia, take the lithotomy position, fully expose the anus, and disinfect with 0. 1% bromogeramine cotton ball. Turn the internal hemorrhoid out of the anus, hold a mosquito-type hemostatic forceps in the left hand to clamp and fix a part of the hemorrhoid nucleus, hold a prepared liquid medicine syringe in the right hand to pierce the submucosa of the hemorrhoid nucleus at a position of 0.3-0.5 cm on the tooth line, and slowly inject the liquid medicine into the hemorrhoid nucleus in a column from low to high, with the slight swelling and discoloration of the hemorrhoid nucleus as the degree. After the injection, push the hemorrhoid nucleus back to the anus. Hemorrhoid nucleus died, dried up and fell off in about 7 ~ 14 days. No more than 3 hemorrhoids are injected at a time; If the hemorrhoid nucleus is larger or more, it can be injected by stages, every 2 weeks 1 time. If dry hemorrhoid oil is injected, each nucleus is injected with 0.5 ~ 1 ml, and the total amount is not more than 4 ml.
Precautions: Injection hardening and atrophy. 7- 14 days after injection, reduce activity to prevent bleeding when hemorrhoid nucleus falls off.
7. Postoperative complications of internal hemorrhoids and their treatment.
Pain: oral painkillers, or block the middle or lower jaw with 1% procaine 10 ml, 5 ml on each side. You can also choose Shaofu Zhuyu Decoction (Wang Qingren's Yilingaicuo), and add honeysuckle 15g, forsythia suspensa 10g and dandelion 20g to promote blood circulation and relieve pain, and clear away heat and toxic materials.
Bleeding: If the ligation of internal hemorrhoids is not firm, or the hemorrhoid nucleus withers and bleeding appears on the wound surface, vaseline gauze can be used to compress and stop bleeding, and hemostatic powder can also be used externally. If the arteriole bleeds, it should be sutured to stop bleeding when the bleeding point is fully exposed; Yunnan Baiyao can be taken orally after operation to prevent bleeding.
Fever: Fever caused by absorption of tissue necrosis. The body temperature is usually not high (below 38℃) and generally does not need treatment. Watch carefully. If it is high fever caused by local infection, you should take heat-clearing and detoxicating drugs, and choose Huanglian Jiedu Decoction (Wang Dao's Secret Recipe of Waitai) plus honeysuckle, forsythia and Patrinia.
Edema: Nitrate 30g, Cortex Phellodendri 30g, Flos Lonicerae 15g, Flos Carthami 15g, Herba Taraxaci 20g, and Alum 3g can be decocted in water for fumigation and washing, 1-2 times a day 1 time. Or take a hot bath with 1: 5000 potassium permanganate, and apply hemorrhoid cream after the bath. Lighter people can use hot water bottles for hot compress.
Urinating is a small benefit: instruct patients to drink plenty of water, or take 30 grams of plantain seeds and 30 grams of winter melon skin instead of tea; Acupoints such as Sanyinjiao, Shuishui, Guanyuan and Zhongji can also be used, or closed with 10 ml L% procaine, or hot compressed with a hot water bottle.
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How to treat internal hemorrhoids?
1. Acupuncture therapy
Acupuncture and Moxibustion: It is mainly suitable for internal hemorrhoids during construction, or those who cannot be operated temporarily in the second and third stages of internal hemorrhoids. Key points: Changqiang, Chengshan and octagonal. Matching points: perineum, Zusanli, Sanyinjiao and Dachangshu. Purging method is used for damp-heat patients, and reinforcing method is used for spleen deficiency patients.
Hemorrhoid-picking therapy: it is suitable for internal hemorrhoids in stage ⅱ and ⅲ. You can choose points such as Dachangshu and Erxiu, and you can also look for hemorrhoids on both sides of the patient's back and spine, that is, small red or grayish white papules that protrude from the epidermis and do not fade. After routine disinfection, puncture the hemorrhoid epidermis with a coarse needle, and then pick out a few white fibers under the skin. Covered with sterile gauze after operation.
2. Diet therapy
Banana water spinach porridge: peeled banana 100g is mud, water spinach 100g is tip, and japonica rice 50g. Boil japonica rice in water until cooked, add water spinach tip and banana puree, and add a little salt or sugar to make porridge, which is the staple food for breakfast. Suitable for hemorrhoids and fistula with excess heat.
Gongying Patrinia Pig Intestine Soup: Wrap 50 grams of fresh dandelion (25 grams of dried product) and 25 grams of Patrinia in cloth, stew them with 250 grams of pig intestines in a casserole until cooked, take them out of the cloth, season them with salt, and eat them with pig intestines twice. It is suitable for hemorrhoids and fistula with excess heat syndrome.
Stewed pork lean meat with Codonopsis pilosula and Ficus carica: 50 grams of Codonopsis pilosula, 250 grams of Ficus carica and 500 grams of pork lean meat, stewed together until the meat is cooked thoroughly, seasoned with salt and served in soup. It is suitable for treating hemorrhoids and fistula for a long time, and it is weak in qi and blood.
Jujube and mullet soup: 50 grams of jujube (denuded) and 500 grams of mullet, stew in casserole until cooked, add a little salt and ginger, and eat separately. It is suitable for hemorrhoids and fistula deficiency syndrome.
3. Prevention and care
Develop good eating habits, eat regularly and quantitatively, and avoid spicy and mellow.
Life should be regular. Workers who stand for a long time should change their posture in time.
Pay attention to anal hygiene, develop good defecation habits, and always keep defecation unobstructed.
Timely treatment of diarrhea, constipation, dysentery and other diseases.
The postoperative diet of internal hemorrhoids should be light, and semi-liquid or total liquid diet can be given when necessary.
During the period of hemorrhoid nucleus shedding after operation, try to reduce activities and stay in bed.
After each defecation, take a sitz bath with light salt water or 1: 5000 potassium permanganate solution, and then change the dressing.
Pay attention to patients' postoperative reaction. If you have symptoms such as fever, pain, dysuria and bleeding after defecation, you should find out the reasons in time and handle them properly.
If the hemorrhoid nucleus prolapse after operation, it should be pulled back to the anus in time to prevent edema and incarceration.
Prevention of hemorrhoids
Traditional theory holds that hemorrhoids are soft lumps caused by varicose veins at the lower end of rectum, anal canal and anal margin or hyperplasia of connective tissue, while modern theory holds that hemorrhoids are pathological changes caused by downward movement or hypertrophy of anal cushion. The main symptoms of hemorrhoids are hematochezia, anal swelling and prolapse, and anal swelling and pain during infection. Diet is an important factor to prevent hemorrhoids, relieve symptoms of hemorrhoids and reduce the recurrence of hemorrhoids. Usually, when hemorrhoids have the above symptoms, you should first go to the hospital for specific diagnosis and targeted treatment. At the same time, according to the different symptoms of hemorrhoids, supplemented by some diet therapy to help the body recover.
1. Hemorrhoid bleeding: Hemorrhoid hematochezia is usually bright red, often dripping, or bloody after defecation, and in severe cases, there may be jet bleeding. Frequent bleeding can cause hemorrhagic anemia, and severe cases can lead to hemorrhagic shock. Go to the hospital for treatment in time. In terms of diet therapy, if the bleeding is reddish, accompanied by dizziness and fatigue, the face is pale. Most of them are hemorrhoids with long bleeding time and deficiency of both qi and blood. Codonopsis pilosula and Astragalus membranaceus 20g, Lycium barbarum and Jujube10g can be used. Add 200g lean pork or 200g chicken, or 1 squab, peanut oil and salt (the same below) and make soup. If the bleeding is bright red, the mouth is bitter, and constipation can be 30 grams of hay, 20 grams of Sophora japonica and 20 grams of dried land. Add 1 fat sausage. Make soup and drink clothes.
2. Internal hemorrhoid prolapse. If internal hemorrhoid prolapse is accompanied by anal swelling and pain, bitter mouth, red tongue and yellow fur, it is mostly caused by damp heat in the large intestine. Radix Puerariae 30g, Cimicifuga rhizome 10g and Flos Sophorae Immaturus 20g can be used. Add 1 fat sausage. Make soup and drink clothes. If prolapse of internal hemorrhoids is accompanied by proctoptosis, dizziness and fatigue, the face is pale. Deficiency of both qi and blood, deficiency of middle qi. 20 grams of Radix Codonopsis, 20 grams of Radix Astragali and 20 grams of Fructus Rosae Laevigatae can be used. Cimicifuga, Angelica each 10g. Add lean pork or chicken, or pigeon soup.