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    No need for surgery?

    • Last Update: 2021-10-11
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read and refer to the new method of minimally invasive treatment of internal hemorrhoids, come and learn! "After so long, I can finally sit down
    .

    " A young mother said with emotion after the endoscopic sclerosing treatment of internal hemorrhoids
    .

    The patient has always had a history of hemorrhoids, without special treatment, hemorrhoids aggravated in the third trimester of pregnancy, and he was miserable, even to the level of "restlessness", and she persisted until the child was born for the sake of the child
    .

    Then, the patient underwent endoscopic sclerotherapy
    .

    On the second day after the operation, Ms.
    Zhang's "restlessness" symptoms were relieved
    .

    This is a case in which patients with hemorrhoids resolved their pain after sclerosing treatment of internal hemorrhoids under endoscopy
    .

    What kind of technique is this that can cure internal hemorrhoids without surgery? We specially invited Gao Fengyu, director of the Endoscopy Center of Shandong Maternity and Child Health Hospital to share his experience with us
    .

    Director Gao Fengyu said that in order to understand the treatment technology of endoscopic internal hemorrhoids with sclerosing agent, one must first understand the pathogenesis and classification of internal hemorrhoids
    .

    Internal hemorrhoids and external hemorrhoids, stupid and confused? Hemorrhoids, or hemorrhoids, are soft venous clusters formed by the expansion and flexion of the venous plexus under the mucous membrane of the human rectum and under the skin of the anal canal
    .

    According to different locations, hemorrhoids can be divided into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids
    .

    Internal hemorrhoids: The dentate line is covered with mucosa on the surface
    .

    External hemorrhoids: under the dentate line, covered with skin on the surface; mixed hemorrhoids: a mixture of internal and external hemorrhoids
    .

    The well-recognized theory of the formation mechanism of internal hemorrhoids is the anal cushion sliding/buffering theory, that is, the abnormal sliding of the anal cushion in the anal canal is the main pathophysiological mechanism of internal hemorrhoids.
    The content includes: 1.
    The anal cushion slides down during defecation; 2.
    The connective tissue that supports the anal cushion is destroyed; 3.
    The blood of the internal hemorrhoid vascular plexus increases during defecation, and the return of the superior and middle rectal vein is reduced; 4.
    The blood stagnation in the internal hemorrhoids dilated venous plexus
    .

    With the increase in intra-abdominal pressure and the absence of valves in the rectal veins, the outflow of the veins in the sinus during defecation can be restricted, resulting in abnormal expansion of the arteriole-venule anastomosis of the internal hemorrhoidal venous plexus
    .

    Standing upright position of the human body, pregnancy, obesity, ascites, difficulty defecation, long defecation time, weightlifting and strenuous exercise, drinking alcohol, eating irritating food, etc.
    all increase the risk of hemorrhoids
    .

    What are the types of internal hemorrhoids? At present, the most commonly used method to classify internal hemorrhoids is the Goligher classification
    .

    Table 1: Goligher classification
    .

    The main symptoms of internal hemorrhoids include blood in the stool, prolapsed hemorrhoids, pain, itching, abnormal bowel movements, perianal discharge, perianal discomfort, and anal lumps
    .

    Endoscopic internal hemorrhoid sclerosing treatment 1.
    Principle: Inject the foam sclerosant prepared on site into the internal hemorrhoids and hemorrhoids, without damaging the physiological functions of the mucous membrane and anal pad, directly stimulating the vascular endothelium, promoting the formation of thrombus, and causing inflammatory changes and tissues Fibrosis, fibrotic cords replace pathological blood vessels, leading to permanent occlusion of pathological blood vessels, thereby achieving the purpose of hardening and hemostasis; local connective tissues produce scarring changes, resulting in fixation and suspension, and lifting the loose rectal mucosal prolapse Or lower anal pads to achieve the purpose of treating hemorrhoids and mucosal prolapse
    .

    2.
    Indications: ①I-III degree internal hemorrhoids are accompanied by internal hemorrhoid-related symptoms; ②I-III degree internal hemorrhoids are ineffective in conservative treatments such as diet and drugs; ③Relapse after internal hemorrhoid surgery, and cannot be operated again after repeated anal surgery; ④Old age, high blood pressure, Diabetes and serious systemic diseases cannot tolerate surgery; ⑤Reluctant to accept surgery
    .

    3.
    Contraindications: ① IV degree internal hemorrhoids, mixed hemorrhoids and external hemorrhoids; ② I-III degree internal hemorrhoids are accompanied by complications such as incarceration, thrombosis, ulceration, and infection; ③ Severe heart, brain, lung, liver, and kidney failure cannot be tolerated.
    Endoscopic treatment; ④ Accompanied by perianal infectious diseases, anal fistula and active inflammatory bowel disease, etc.
    ; ⑤ Coagulation dysfunction or are using anticoagulant or antiplatelet drugs; ⑥ Pregnant women
    .

    4.
    Relative contraindications: ① a history of low rectal or anal surgery; ② a history of pelvic radiotherapy; ③ a history of repeated sclerotherapy in the near future; ④ patients with mental disorders; ⑤ women in the puerperium; ⑥ patients with colorectal tumors
    .

    5.
    Preoperative preparation (1) Patient preparation: All colonoscopy is recommended for all patients who have not undergone a colonoscopy within three years or are at high risk of colon disease, and make adequate preparations for bowel cleansing before the examination; no need for a colonoscopy or need Emergency treatment of patients, according to their bowel habits and operation types, can be considered respectively: ① laxative preparation of the intestines; ② preoperative enema; ③ preoperative defecation
    .

    (2) Preoperative examination: preoperative digital anus examination, routine blood tests, and coagulation function
    .

    (3) Preparation of medicines and equipment: sclerosing agent (commonly used is cinnamyl alcohol injection), injection needle for endoscopy (the length of the needle is 4-6mm), and a transparent cap
    .

    6.
    Treatment method: Put on a transparent cap, observe the internal hemorrhoids and rectal mucosa through the front and inverted lenses, insert the injection needle through the clamp channel of the endoscope, and select the hemorrhoid with the most obvious protuberance as the injection point.
    The bevel of the injection needle and the mucosa are 30-45 degrees After the needle is inserted into the hemorrhoids, there is a sense of frustration, and then the cinnamyl alcohol liquid is injected through the injection needle until the hemorrhoid mucosa is fully swollen, the capillaries are exposed, and the color becomes pale.
    Generally speaking, the injection dose of the sclerosing agent stock solution is about 0.
    5-1.
    5 per point.
    ml, the total amount of sclerosing agent in one treatment usually does not exceed 10ml
    .

    For internal hemorrhoids with large hemorrhoids and active bleeding, the dosage of lauric alcohol can be appropriately increased
    .

    After the injection, the needle is slowly recovered, and the needle hole is pressed with a transparent cap for 10-20 seconds to stop bleeding.
    After the wound has no bleeding, the next hemorrhoid can be hardened and injected until all injection points are processed.

    .

    Schematic diagram of endoscopic sclerosing agent treatment (1), Tomiki Yuichi et al.
    Endoscopy, 2014 Schematic diagram of endoscopic sclerosing agent treatment (2) 7.
    Key points of operation (1) For internal hemorrhoids, the injection position is at the base of the target hemorrhoid (2) ) For mucosal prolapse, it is necessary to inject into the submucosa.
    (3) Insert the needle above the dentate line during sclerosing injection.
    Avoiding the dentate line is a technique to reduce pain and discomfort during injection and postoperative anus; (4) Treatment in awake state Attention should be paid to the patient's pain response and tolerance, to prevent over-injection or misplaced injection; (5) Finger massage after injection of sclerosing agent can increase the penetration of sclerosing agent to hemorrhoids in order to improve the curative effect
    .

    8.
    Postoperative treatment (1) Occasionally abdominal distension and slight abdominal pain within 2-8 hours after the operation, and then quickly relieved
    .

    When postoperative pain is obvious, consider using analgesics: non-steroidal anti-inflammatory drugs; (2) Liquid diet on the day after the operation, semi-liquid diet on the next day, low residue diet within 3 days after operation, avoid spicy and stimulating diet, and avoid drinking alcohol (3) Keep the stool unobstructed, avoid forced stool, use laxative drugs to soften the stool, wash locally after defecation, and fumigate with traditional Chinese medicine after cleaning the perianal; (4) healthy people do not need to use antibiotics preventively; elderly, weak and immune Patients with low strength and chronic inflammation around the anus should use antibiotics as appropriate after surgery; (5) Try to reduce the amount of activity one week after surgery, avoid sedentary sitting and cycling; avoid fatigue and strenuous exercise; (6) use anticoagulation and antiplatelet For patients with medication, it is recommended to resume taking it at least 5 days after surgery; (7) Catheterization when urination is difficult, generally not indwelling a urinary catheter; (8) Avoid sex for 2 weeks
    .

    9.
    Advantages ①No pain during the whole process, simple postoperative care; ②Clear vision, fully exposed hemorrhoids, can ensure precise injection of sclerosing agent; ③Less complications during and after surgery, rarely anal orifice pain; ④Fast recovery, 1 After days, you can eat and get out of bed; ⑤It is the least expensive method for various hemorrhoids surgery at present; ⑥Complete colonoscopy at the same time
    .

    Doctor's summary: As the saying goes, "ten people have nine hemorrhoids", "hemorrhoids" is the most common rectal and anal canal benign disease
    .

    Among the resident population of urban and rural residents over 18 years old in China, the prevalence of anorectal diseases is as high as 50%, of which hemorrhoids account for 98%, and internal hemorrhoids are the most common, accounting for 59.
    86% of hemorrhoids, and the majority of internal hemorrhoids Internal hemorrhoids of I-III degree (99.
    47%)
    .

    As a new method for the treatment of internal hemorrhoids, endoscopic sclerotherapy can achieve one-time bowel preparation and complete multiple colonic examinations and treatments.
    It has the advantages of safety, effectiveness, simple operation, and quick postoperative recovery.
    It is currently a variety of treatments.
    The least expensive method for hemorrhoid surgery is worthy of being promoted clinically
    .

    References: [1]Sclerosis Net: Technical Guide|Clinical Practical Guidelines for Endoscopic Internal Hemorrhoids Sclerotherapy [2] Shandong Province Maternal and Child Health Hospital Digestive Endoscopy: Good news for patients with "hemorrhoids"—new endoscopic minimally invasive treatment of hemorrhoids Surgery [3] Chinese digestive endoscopic internal hemorrhoid diagnosis and treatment guidelines and operating consensus [4] Anatomy and life: the anatomical difference between the dentate line and the bottom of the rectum and anal canal
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