Over treatment of anorectal diseases(from Zhang Qingru)After years of clinical practice of anorectal disease, we see some anorectal doctors
Over treatment of anorectal diseases
(from Zhang Qingru)
After years of clinical practice of anorectal disease, we see some anorectal doctors on common anorectal excessive treatment, not only increased in the treatment of patients suffering and economic burden, and often caused undue complications. Some of the medical journals or society can be seen overtreatment when experience, age, considerable harm, I five years ago have raised the question, at present, this phenomenon is still prominent, so again for a discussion, discuss with colleagues.
Common anorectal diseases: refers to hemorrhoids, anal fistula, rectal prolapse, anal fissure, rectal polyp, perianal condyloma and other anorectal diseases.
The treatment is contrary to physiology.
The treatment of overkill.
Repeated treatment (tedious treatment).
The treatment beyond the objective conditions (including equipment, technology, economy, with overall situation and intention).
The treatment of fraud.
Fraudulent treatment has three characteristics:
In order to get money for the purpose.
False advertising as bait.
By means of overtreatment.
The route is divided into three steps:
South Korea take pictures.
One by one according to the name of the disease.
A variety of complementary treatment together, according to the minutes of billing.
Contrary to the two principles:
The principle of treating asymptomatic hemorrhoids.
The medical humanity, medical ethics principle of good faith ".
Two, excessive treatment of hemorrhoids
The mechanism of internal hemorrhoids in recent years, the theory of "anal down" has become the consensus of scholars at home and abroad, was written in textbooks. Human rectal mucosa of the upper part of the dentate line organization, very thick, there are a large number of blood vessels, dilated veins, smooth muscle, collagen fibers and elastic fibrous connective tissue, known as the "anal cushion" referred to as "anal cushions, anal cushions in the right front and left right after the three most developed, it seems the cushion metal bottle cap, assist anal anal sphincter closed, maintain function. If the support of tissue degeneration, relaxation and fracture under the mucosa, and forced defecation, diarrhea, abdominal pressure increase and other factors, anal pad pathological hypertrophy most or all down, blood in the stool, prolapse, pain and other symptoms, it is called hemorrhoids. Thus, the pathological change is the anatomic basis of anal hemorrhoids occurred, but the main physiological function of anal cushion and the decision can not remove it. Therefore we preferred conservative treatment for forced internal hemorrhoids, surgical treatment was considered only when conservative treatment is invalid. Commonly used surgical treatment of sclerosing agent injection, will move down the anus pad re adhesion fixed in situ, rectal mucosal suspension, rectal mucosal resection (P / P / H) or partial anal cushion resection.
Over 1, the treatment of internal hemorrhoids therapy belongs to:
The internal hemorrhoids circumcision, such as abandoned Kiose circumcision.
Three or more burns or cryotherapy.
The massive necrosis agent injection or a large amount of feldsparthic Kuzhi Ding insertion.
Simultaneous injection of several injections. According to reports of a hospital for young patients with injection therapy of internal hemorrhoid (blood routine, coagulation time, hardening agent (normal) with refined salt 5g, glycerol 70ml, injection water is added to 100ml) 1ml note in the basement with oil injection hemorrhoids, hemorrhoids (alum 4G, salt 4G, 14ml, 2G, Chuanxinlian injection of procaine plus glycerol 100ml) 1ml was injected into the body of hemorrhoids. The eighth day after operation to fifteenth, four consecutive major bleeding, each at 100 300ml (including liver blood clot), check the injection site there is a large area of a necrotic lesion of 2.5 - 3cm, active bleeding, after she escaped.
In the premise of ensuring the cure hemorrhoids injection, can be used as a drug, not two kinds of medicine, can be used in small doses, not high dose.
2, several problems need to clear the treatment of internal hemorrhoids:
Preferred conservative treatment.
Hemorrhoids can not cure.
The standard of cure for hemorrhoids is the disappearance of symptoms.
Surgical treatment to try to protect the tooth line.
The treatment of hemorrhoids to retain sufficient anal skin and mucosal bridge bridge.
Over three, the treatment of anal fistula
1, to expand the scope of the internal resection of the blind.
Because of anal fistula and perianal abscess or abscess incision since the collapse after a contraction of pus. Most of the primary lesion is located in perianal abscess recess of the anal gland infection, thus many anorectal doctor advocates of resection of anal fistula operation to expand inside the mouth, to resection of the primary lesion, anal gland. I think the anal gland infection has become a part of the pipeline operation of anal fistula, as long as the right inside the mouth, open the pipeline and all branch, keeping the drainage unobstructed, can be cured. Anal gland is only under the microscope to identify subtle anatomical structure, the extent of resection in the mouth of deliberately expand, since that cleared the infection of the anal gland, with a lot of blindness, the wound too deep, easy to bleeding and prolonged healing time.
The famous anorectal disease expert Zhang Qingrong, summed up the 1964----1984 from eight doctors in 3580 cases of anal fistula after surgery and recurrence rate was 1%--6.3%. We have twelve years of treatment of anal fistula in 460 cases, 300 cases were followed up for five years, the recurrence rate was 1.5%. During the operation, there was no enlarged resection, and the recurrence rate was not high.
2, excessive removal of tissue around the pipeline.
The first is some doctors, in open the lumen after resection of the bottom wall and lumen to connective tissue, the wound is deep and wide. This is not the case. As a result, these connective tissue is a vital tissue, with the disappearance of inflammation, circulation improvement, will gradually absorb the softening or normal, does not affect the healing.
Secondly, there are many complex anal fistula of the pipeline, the pipeline between the connective tissue removed at the same time, the wound is too large, not only heal slowly, and the scar is too large, resulting in anal deformation, and similarly, without the necessary pipeline between connective tissue resection.
3, the improper application of hanging line therapy.
The hanging line therapy only suitable for high anal fistula. No need to hang the line treatment of anal fistula. High anal fistula Seton, 7 - 10 days off, over time when off-line, no line drainage, there is no cutting action. This line has been hanging in the sphincter and surrounding tissue adhesion firmly, can not hang up the remnant cut off.
Have seen hanging line in January, do not go to the line is not tight line, a large number of wound edema granulation hyperplasia, full of wounds, wrapped around the line is not trimmed, which is obviously improper disposal.
4, can anal fistula wound suture.
All low anal fistula wound and wound suture can be part of high anal fistula, can be part of a healing, not healing can also reduce wound, shorten the treatment time. Requirements: suture to stop bleeding, complete removal of carrion, no branch, antibiotic liquid wash the wound suture without leaving dead space.
Four, excessive treatment of anal fissure
1, behind the anal fissure incision, incision over the height of tooth line.
2, lateral internal sphincterotomy, as more than two incision.
3, all the internal sphincter cut.
4, Seton therapy in the treatment of anal fissure.
5, suture in the treatment of anal fissure, fissure. But the excision of anal fissure and sentinel hemorrhoid transverse suture is possible.
A preliminary attempt, 6 simple anal finger in the treatment of anal fissure.
Five, perianal condyloma acuminatum treatment
1, coated with ointment or a large area of resection, causing a large area of perianal skin damage.
2, the use of interferon.
Over six treatment and severe rectocele
A large number of traditional Chinese medicine treatment.
As anorectal specialists, be familiar with all kinds of common anorectal diseases measles treatment method, choose the best treatment method according to the patient's condition. The best treatment is to achieve the best curative effect for the purpose of simple, safe, painful small, economical treatment. To consider, do not destroy the shape of the anus, anal function protection, surgical methods or minimally invasive as well.
I put forward fifteen years ago, in order to shape the concept of guiding the surgical treatment of anal disease, Mr. Li Yunong advocated the anus cosmetic surgery, the consensus of the two. Let's explore this goal together.