痔疮诊治指南Guideline for diagnosis and treatment of hemorrhoids.docx

痔疮诊治指南Guideline for diagnosis and treatment of hemorrhoids.docx

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痔疮诊治指南Guidelinefordiagnosisandtreatmentofhemorrhoids

痔疮诊治指南2006（Guidelinefordiagnosisandtreatmentofhemorrhoids2006）

Guidelineforclinicaldiagnosisandtreatmentofhemorrhoids（2006Edition）

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guidelinesforthediagnosisandtreatmentofhemorrhoidsXunyiwenyao

Hemorrhoidisacommonandfrequentlyoccurringdisease.Hemorrhoidstreatmentmethodsaremore,eachhasitsindicationsandcontraindications,ifnotproperlytreated,therewillbeseriouscomplicationsandsequelae.InJuly2006,theoriginal"hemorrhoidsclinicalguidelines（Draft）"onthebasisoftheChineseMedicalAssociationofcolorectalandanaldiseasecombinedwithSpecializedCommitteecolorectalsurgerysurgerybranchofChinaAssociationofChinesemedicinegroup,SpecializedCommittee,ChinaanorectaldiseaseoftraditionalChinesemedicineandWesternmedicine,againonthepathophysiologyofhemorrhoidsandhemorrhoidstreatmentwasrepeateddiscussionfurtherrevisedthe"clinicalguidelinesforthediagnosisandtreatmentofhemorrhoids（Draft）".

Classificationofhemorrhoids

Hemorrhoidsaredividedintointernalandexternalhemorrhoidsandmixedhemorrhoid.Istheinternalhemorrhoidanalcushion（analvascularpad）supportstructure,vascularplexusandarteriovenousanastomosisoccurredpathologicalchangeandshift;externalisthedentatelinedistalsubcutaneousvascularplexusexpansion,bloodstasis,thrombosisortissuehyperplasia,accordingtothepathologicalcharacteristicsoftissue,externalhemorrhoidscanbedividedintoconnectivetissue,andthromboticvaricoseveinsandinflammatoryexternalhemorrhoids4;mixedhemorrhoidsexternalhemorrhoidsandhemorrhoidsistheintegrationofthecorrespondingpartsofthevascularplexus.

Two、diagnosisofhemorrhoids

（I）clinicalmanifestation

1.:

themainclinicalmanifestationsofhemorrhoidsbleedingandprolapse,complicatedbythrombosis,incarceration,strangulationandbowelproblems.Accordingtotheseverityofsymptomsofhemorrhoids,dividedinto4degrees.Idegrees:

whentakingbloodandblooddrop,thenthebleedingcanstopbyitself;nohemorrhoidprolapse.II:

oftenhavehematochezia;defecationhaveprolapse,aftercanalsosatisfied.Thirddegree:

canhavehematochezia;defecationorlongstandingandcough,fatigue,weighthaveprolapse,handalsosatisfied.IV:

canhavehemorrhoidsprolapseorpersistenthematochezia;alsosatisfiedeasilyafterprolapse.

2.externalhemorrhoids:

themainclinicalmanifestationswereanalsofttissuemass,analdiscomfort,wetitchingorforeignbodysensation,suchasthrombosisandinflammationmayhavepain.

3.:

themainclinicalmanifestationsofmixedhemorrhoidshemorrhoidsandhemorrhoidssymptomsexistatthesametime,showedseverehemorrhoids.

（two）examinationmethod;

1.inspection:

checkwhethertheanushemorrhoidsprolapse,analnonvaricoseexternalhemorrhoids,thromboticexternalhemorrhoidsandskintags,squattingcheckwhennecessary.Toobservethelocationandsizeofinternalhemorrhoidsprolapseandhemorrhoidsbleedingandnomucosalhyperemiaandedema,erosionandulcer.

2.anorectalindications:

itisanimportantmethodofexamination.I,ii.

Hemorrhoidsreferstonoabnormalitiesofrecurrentprolapse;thirdandfourthdegreehemorrhoids,sometimesreferstotouchthedentatelinethefibrosisofhemorrhoids.Anorectalexaminationcaneliminateanorectaltumorsandotherdiseases.

3.:

anorectalmirrorcanclearthelocation,size,numberofhemorrhoidsandhemorrhoidsmucosableeding,edema,erosion,etc..

4.fecaloccultbloodtestisacommonlyusedscreeningmethod:

eliminationofdigestivetracttumor.

5.totalcolonoscopy:

Patientswithhemorrhoidshematochezia,familyhistoryofdigestivetracttumororpolypdisease,Ihaveover50yearsofage,positivefecaloccultbloodtestandirondeficiencyanemia,recommendedcolonoscopy.

Three、differentialdiagnosisofhemorrhoids

Evenwithhemorrhoidsshouldalsoidentifydiseases,sexuallytransmitteddiseasesandcolorectalcancer,analcancer,polyps,rectalprolapse,perianalabscess,analfistula,analfissure,hypertrophyofanalpapilla,anorectalandinflammatoryboweldisease.

Four、TCMsyndromedifferentiationofhemorrhoids

1.windinjuryintestinalcollaterals:

stoolbloodejection,orblood,bloodred,drystool,analitching,drymouthandthroat.Redtongue,yellowmoss,pulsefloatingnumber.Treatcoolingbloodtostopbleeding.

2.dampheatbetcard:

thenred,morequantity.Externalmass,swelling,burningpain,orswellingoftheanalmass.Dryorloose,shortredurine.Redtongue,yellowgreasymoss,pulsefloatingnumber.Curetoheatdampness.

Three

Qistagnationandbloodstasissyndrome:

thetumorisoutoftheanus,edema,thrombosis,orincarceration,thesurfaceofpurpledark,erosionandexudate,severepain,tendernessisobvious,analcanalcontraction.Constipation,urination.Darkpurpletongueorpetechiae,pulsestringorastringent.Promotingbloodcirculationtoreduceswelling.

4.spleendeficiencysyndrome:

Qistagnationwasanalprolapse,noteasyreduction,analbulge,defecatingweakness,thenredlight.Asmall,dizziness,lassitude,eatlessfatigue,lessgaslazywords.Paletongue,thinwhitefur,threadypulse.Treatingqitopromoteqi.

Five,thetreatmentofhemorrhoids

Treatmentprinciple:

asymptomatichemorrhoidswithouttreatment.Thepurposeoftreatmentistoeliminateandreducethesymptomsofhemorrhoids.Thesymptomsofliftinghemorrhoidsaremoresignificantthanthoseofchangingthesizeofthehemorrhoid,andshouldberegardedasthestandardoftherapeuticeffect.Thedoctorshouldadoptreasonablenon-surgicalorsurgicaltreatmentaccordingtothepatient'scondition,experienceandmedicalcondition.

（I）generaltreatment

Toimprovethediet,maintaindefecateunobstructed,payattentiontothetreatmentofanalcleaningandsoonallkindsofbathhemorrhoidsareeffective.

（two）drugtherapy

Drugtherapyisanimportantmethodforthetreatmentofhemorrhoids,hemorrhoids,IIIpatientsshouldbethedrugofchoicefortreatment.

1.topicalmedicationsincludesuppositories,creamsandlotions.Thesuppositoryandcreamcontainingtherepairing,protectingandlubricatingcomponentoftheangleacidmucosahavegoodtreatmenteffectonthehemorrhoid.Drugscontainingsteroidderivativescanrelievesymptomsintheacutephase,butshouldnotbeusedforlong-termandprophylacticuse.

2.systemicdrugtreatment:

commonlyuseddrugsincludeintravenousenhancer,anti-inflammatorypainmedicine.

（1）intravenousenhancerarecommonlyused:

micronisedpurifiedflavonoidingredients,MelilotusExtractTablet,Ginkgobilobaextract,canrelievethesymptomsofacutehemorrhoids,butthenumberofintravenousenhancercombinedwithnoobvioussuperiority;

（2）:

anti-inflammatorydrugscaneffectivelyrelievethehemorrhoidsandhemorrhoidsthrombuscausedbypain;（3）Chinesemedicinedialecticaltherapy.

（three）sclerosingagentinjectiontherapy

Submucosalinjectionofsclerosingagentiseffectivemethodintreatmentofinternalhemorrhoids,mainlyusedinI,seconddegreehemorrhoids,significantshort-termeffect.Complicationsincludelocalpain,burningpainintheanus,tissuenecrosis,ulcerationoranalstenosis,hemorrhoids,thrombosis,submucosalabscessandinduration.Externalhemorrhoidsandhemorrhoidsduringpregnancyshouldbedisabled.

（four）appliancetherapy

The1.part:

rubberringligationtherapyissuitableforvarioushemorrhoidshemorrhoidsandmixedhemorrhoid,especiallyingradeII,accompaniedbybleedingand/orprolapse.Theligationsiteinthedentatelinearea,discomfortandcomplicationsofrectaltenesmus,pain,apronslippage,delayedbleeding,analedema,skinulceration,thromboticexternalhemorrhoids,pelvicinfectionetc..

2.Chinesemedicinelineligation:

woundintherootsofhemorrhoidsmedicinelinewrappedwithsilkthread,paperormedicine,thehemorrhoidsnecrosis,woundrepairandhealingby.

3.physicaltherapy,includinglasertreatment,cryotherapy,directcurrenttherapyandcopperionelectrochemistrytherapy,microwavecoagulationtherapy,infraredcoagulationtherapy,etc..ThemainindicationsforI,II,grade.Themaincomplicationswerebleeding,edema,woundhealing,delayandinfection.

（five）surgicaltreatment

Indications:

hemorrhoidshasdevelopedtothethirdandfourthdegree,seconddegreeorwithseriousbleedinghemorrhoids;acuteincarceratedhemorrhoids,hemorrhoids,mixedhemorrhoidsandnecrotizingexternalhemorrhoidssymptomsandsignsofsignificant;nonoperativetreatmentisinvalidandnooperativecontraindications.

Hemorrhoidssurgeryisdividedintothefollowing.

1.hemorrhoidectomy:

completeresectionorpartialPrincipleNohemorrhoidsoperation:

（1）thewoundopenMilliganMorgan（Milligan-Morgan）operation;

（2）asemiopenwound（Parks）surgery;（3）thewoundclosedsurgery（Ferguson）;（4）MilliganMorganhardeningagentinjection;（5）theringhemorrhoidsurgery,includingsemiclosedloophemorrhoidectomy（Toupetsurgery）,closedloophemorrhoidectomy（Whiteheadsurgery）,butduetocomplications,theclinicalhasbeenbasicallyabandoned.

Reasonableattentionshouldbepaidtothelocationandquantityofskinbridge,mucousmembranebridgeandthetimeofwoundhealing.

2.procedurefor,prolapsed,hemorrhoid,PPH）upperhemorrhoidalmucosaresection:

therectalmucosaandsubmucosaltissuewereremovedbystaplerthroughtheanus.Suitablefortheannularprolapseofthethirdandfourthdegreehemorrhoidsandrecurrentbleedinghemorrhoidsii.Attentionshouldbepaidtothepreventionandtreatmentofbleeding,swelling,analstenosis,infectionandothercompl