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

1、痔疮诊治指南Guideline for diagnosis and treatment of hemorrhoids痔疮诊治指南2006（Guideline for diagnosis and treatment of hemorrhoids 2006）Guideline for clinical diagnosis and treatment of hemorrhoids (2006 Edition)2009 09, 30 large, medium and smallTags: guidelines for the diagnosis and treatment of hemorrhoid

2、s 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)

3、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, ag

4、ain 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.

5、 Is the internal hemorrhoid anal cushion (anal vascular pad) support structure, vascular plexus and arteriovenous anastomosis occurred pathological change and shift; external is the dentate line distal subcutaneous vascular plexus expansion, blood stasis, thrombosis or tissue hyperplasia, according

6、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 plexu

7、s.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: wh

8、en 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 satisfie

9、d. 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.: th

10、e main clinical manifestations of mixed hemorrhoids hemorrhoids 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

11、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

12、 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

13、 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 occu

14、lt 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,

15、 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. Tr

16、eat 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 synd

17、rome: 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 r

18、educe 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 tr

19、eatment 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 a

20、s the standard of therapeutic effect. The doctor should adopt reasonable non-surgical or surgical treatment according to the patients condition, experience and medical condition.(I) general treatmentTo improve the diet, maintain defecate unobstructed, pay attention to the treatment of anal cleaning

21、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 cr

22、eam containing the repairing, protecting and lubricating component of the angle acid mucosa have 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 treatme

23、nt: 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 e

24、nhancer 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

25、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

26、 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 / or prolapse. The ligation site in the dentate line area,

27、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,

28、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 complic

29、ations 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

30、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 -

31、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 t

32、o 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 compl