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 is not easy 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 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 needle, then cut a superficial incision along the tooth line with scissors, and tie a knot around the hemorrhoid base. 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 protrudes 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; Dermatosis 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 hemorrhoid oil is injected, 0.5 ~ 1 ml should be injected into each nucleus, and the total amount should not exceed 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: Take painkillers orally, or use 1% procaine 10 ml to block the middle or lower thalamus, 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.