(1) Internal treatment (see TCM therapy for details)
(2) external therapy
1. External washing method: For local swelling and pain, add or subtract Sophora Flavescentis decoction, and smoke and wash the decoction while it is hot.
2. External application method: Yi Tu Home Hemorrhoids Ointment can be used externally in acute anal fistula.
Treatment of anal fistula with cryotherapy and electrotherapy
Anal fistula is very common, mainly refers to granulomatous catheter around anus, with internal and external openings. The external orifice is located on the perianal skin, and the internal orifice is located in the anal canal or rectum. Most anal fistulas are caused by abscesses around the anorectum. Its main manifestation is that a small amount of purulent, bloody and mucinous secretions often flow out of the fistula. Cryotherapy is not difficult to treat anal fistula, which is beyond the reach of some simple physical therapies.
1, cryotherapy
It is suitable for the treatment of low simple anal fistula. Liquid nitrogen at-196 degrees Celsius is used to coagulate and necrotize the fistula. Then it falls off, forms a new wound and heals itself. Under anesthesia, the fistula was properly scraped from the external orifice with a curette, then the probe was inserted to determine the direction and trend of the fistula, and then the probe was pulled out, and a similar cryoprobe (copper tube with different bending degrees, with a diameter of about 2 mm) was selected for contact freezing and frozen for 3 minutes, so that the whole tube became a white popsicle. After natural rewarming, the probe was pulled out, anti-inflammatory and analgesic ointment was applied externally, and the dressing was changed in hip bath after operation. This method is simple, painless, without bleeding, anal incontinence and other complications.
2, electrotherapy instrument treatment
According to the principle of traditional Chinese medicine thread-drawing therapy [2], the anal fistula is treated by using the high-temperature physical technology of modern anal fistula electrotherapy instrument, and the local tissue is cauterized by high temperature generated by arc discharge, so as to cut the anal fistula and achieve the treatment purpose. Suitable for the treatment of low anal fistula. Under anesthesia, the probe was used to find out the internal and external opening and direction of fistula, and electrotherapy instrument was used to cut the anal fistula wall in turn along the probe to expose the wound surface, and scald ointment was applied externally. This method is simple in operation and short in course of treatment, and can be cured by electrotherapy once.
Traditional Chinese Medicine Treatment of Anal Fistula
Traditional Chinese medicine treatment of anal fistula can also be summarized as three principles: elimination, support and reinforcement. Because of the different causes of the disease, the changes of the condition are also different, so there are many treatment methods in clinical application. Generally speaking, there are principles of clearing away heat and cooling blood, clearing away heat and promoting diuresis, clearing away heat and toxic materials, invigorating qi and benefiting blood, purging heat and dredging fu-organs, nourishing yin and moistening dryness, invigorating middle energizer and invigorating qi, promoting blood circulation and removing blood stasis, nourishing yin and clearing heat, warming yang and strengthening spleen.
1. Clearing heat and cooling blood: suitable for patients with hematochezia caused by blood heat and intestinal dryness, or patients with internal hemorrhoid bleeding and thrombotic external hemorrhoid. The selected prescriptions are often treated with Liangxuehuangtang and Huaijiao Pill.
2, clearing heat and promoting diuresis: suitable for patients with anorectal carbuncle, anal sinusitis and inflammatory external hemorrhoids. The selected prescriptions are often treated with Jiawei Jixian Shishi Decoction and Longdan Xiegan Decoction.
3. Clearing away heat and toxic materials: suitable for patients with anorectal carbuncle syndrome and internal and external hemorrhoid infection. Huanglian Jiedu Decoction and Xianfang Huoming Decoction are commonly used to treat the selected prescriptions.
4, purging heat and clearing intestines: suitable for constipation patients caused by thermal colon dryness. Dachengqi decoction and spleen rupture Maren pill are commonly used to treat the selected prescriptions.
5, nourishing yin and moistening dryness: suitable for constipation patients caused by blood deficiency and insufficient body fluid. The selected prescriptions are often treated with Runchang Decoction, Wuren Decoction or Zengye Decoction.
6, qi and blood: suitable for people with insufficient qi and blood or long-term illness. Prescriptions are often treated with Shiquan Dabu Decoction and Bazhen Decoction.
7. Buzhong Yiqi: It is suitable for children, elderly people with physical weakness or puerpera, and patients with rectal prolapse or internal hemorrhoid prolapse caused by qi deficiency subsidence. Buzhong Yiqi decoction is often used to select prescriptions for treatment.
8, nourishing yin and clearing heat: suitable for patients with internal heat due to yin deficiency such as anal fistula and hemorrhoids. Prescriptions are often treated with Artemisia annua Biejia Decoction.
9, promoting blood circulation and removing blood stasis: suitable for patients with qi stagnation and blood stasis, meridian stasis. Taohong Siwu Decoction is often used to select prescriptions for treatment.
10, Warming Yang and Strengthening Spleen: It is suitable for patients with hematochezia caused by spleen-yang deficiency or spleen-kidney yang deficiency. Jiawei Huang Tu Decoction is often used to treat selected prescriptions.
Self-care of patients with anal fistula is particularly important, which can not only improve the stimulation of local adverse environment, but also provide a good foundation for treatment and rehabilitation. Pay attention to the cleanliness and hygiene of anus in remission period, and often wash anus with warm salt water, or wash it with alum water, or wash the part with potassium permanganate solution at least once a night, which can not only clean local hygiene, but also improve local blood circulation, enhance resistance to diseases and reduce inflammatory reaction. When the secretion of anal fistula increases, the underwear should be washed and changed frequently, and the secretion should not be accumulated in the affected area. During the attack, the external orifice can be surgically enlarged to drain pus, which can not only relieve the swelling pain, but also prevent the pus from spreading to other parts. In a word, taking appropriate health care measures can control the development of diseases and reduce the suffering of patients. The treatment principle of anal fistula should be based on the mechanism of anal fissure and the anatomical structure of anal fistula.
① Internal orifice resection: The key to the treatment of anal fistula is to find the primary internal orifice during operation and remove the infected anal sinus, anal gland and its catheter.
② Treatment of fistula, branch pipe and dead space: clean fistula, branch pipe and dead space to avoid postoperative recurrence.
③ Preservation of anorectal ring: During anal fistula operation, we should make a clear diagnosis, find out the direction of internal orifice and fistula, preserve anorectal ring and maintain normal anal containment function.
In the specific operation, we must carefully look for the internal orifice to prevent cutting off the anorectal ring.
therapeutic regimen
Anal fistula cannot heal itself. Without treatment, perianal abscess will recur and must be treated surgically. The principle of treatment is to cut the fistula to form an open wound and promote healing. There are many surgical methods. The operation method should be selected according to the position of the internal orifice and the relationship between fistula and anal sphincter. The key of operation is to minimize the injury to anal sphincter, prevent anal incontinence and avoid fistula recurrence.
Fistulotomy is a method of cutting all fistulas and healing wounds through granulation tissue growth. Suitable for low anal fistula, because the fistula is below the deep part of external sphincter. After the operation, only the subcutaneous and superficial parts of the external sphincter are damaged, and there will be no postoperative anal incontinence. The operation was performed under sacral anesthesia or local anesthesia. In lateral position or lithotomy position, methylene blue solution was injected into the patient from the external port to determine the position of the internal port, and then a probe was inserted into the gallstone tube from the external port to understand the operation of the fistula and its relationship with the sphincter. Under the guidance of the probe, the surface tissue on the probe is cut until the internal opening. Scrape the granulation tissue and necrotic tissue at the fistula, trim the skin edge to make the wound a V-shaped wound with a small inside and a large outside, and fill the wound with oil gauze to ensure that the wound grows from bottom to top.
Surgical steps of anal fistula incision:
The principle of operation is to completely cut the fistula and remove the scar tissue on both sides of the incision, so that the drainage is smooth and the incision is gradually healed. This method is only suitable for low straight or arc anal fistula. The operation method is as follows.
1 the operation of correctly exploring the internal orifice to find the internal orifice is the same as that of thread-drawing therapy. After probing the inner mouth, pull the probe out of the anus. If the fistula is bent or branched, and the probe can't probe into the inner port, inject a small amount of 1% methylene blue solution from the outer port to determine the position of the inner port, then probe into it from the outer port with a slotted probe, and gradually cut the pipeline until it probes into the inner port. If the internal orifice cannot be found after careful exploration, the anal sinus suspected of being diseased can be treated as the internal orifice.
2. Incise the fistula and completely remove the marginal tissue. Incise all the surface tissues of the fistula, from the external orifice to the internal orifice and the corresponding anal sphincter fibers. After the fistula is cut, check whether there is any branch pipe, and if there is, cut it. After the fistula is completely cut, the rotten granulation tissue will be scraped clean. Generally, it is not necessary to cut the whole fistula to avoid the wound being too large. Finally, trim the edge of the wound to make it V-shaped, with a small opening at the bottom, which is convenient for the deep wound to heal first.
During anal sphincter amputation, the relationship between probe position and anorectal ring should be carefully understood. For example, when the probe enters the lower part of the anorectal ring, although the fistula, most of the external sphincter and the corresponding internal sphincter are cut off, anal incontinence will not be caused because the puborectal muscle is preserved. For example, if the probe enters the rectum above the anorectal ring (such as anal fistula on the sphincter and external anal fistula on the sphincter), fistulotomy should not be done, but thread-drawing therapy or thread-drawing staging surgery should be done. In the first stage, the subcircular fistula is cut or removed, and the supraannular fistula is hung with thick wire and tied tightly. In the second operation, after most of the external wounds healed, the anorectal ring was adhered and fixed, and then the anorectal ring was cut along the silk thread
After fistula incision, the granulation tissue of the wall can be scraped off with a curette, which is generally not needed to be taken out to reduce bleeding and avoid damaging the sphincter of the posterior wall. The resected fistula tissue should be sent for pathological examination.
4 wound treatment The treatment of the wound after operation is often related to the success or failure of the operation. The key is to keep the wound healing gradually from the base to the surface. Change the dressing once a day, preferably after defecation, and the filling dressing in the wound will gradually decrease until the wound in the anal canal heals. A digital rectal examination every few days can dilate the anal canal and prevent bridge adhesion and false healing.
2. Thread-hanging therapy is a method of slowly cutting anal fistula by mechanical compression of rubber band or corrosive medicine thread. It is suitable for simple anal fistula with low or high internal and external openings within 3-5 cm from anus, or as an auxiliary treatment for complicated anal fistula incision and resection. Its greatest advantage is that it will not cause anal incontinence. The ligated muscle tissue appears blood supply disorder, and gradually becomes necrotic and disconnected. However, due to fibrosis caused by inflammatory reaction, the severed muscles adhere to the surrounding tissues. The muscles will not contract too much and gradually heal, thus preventing anal incontinence caused by the retraction of the cut anorectal ring. At the same time, the thread hanging can also drain the fistula and eliminate the exudate in the fistula. Prevent the occurrence of acute infection. This method also has the advantages of simple operation, less bleeding, convenient dressing change and no skin incision adhesion before the rubber band falls off. The operation was performed under sacral anesthesia or local anesthesia, and the probe was inserted from the external orifice. Follow the direction of the fistula and pass through the internal orifice. Tie a sterilized rubber band or thick silk thread on the probe at the inner mouth, guide it through the whole fistula, cut the skin between the inner and outer mouth, and then tie the thread. After operation, take a bath in every mouth and clean the local area after defecation. If there are too many ligatures, ligature will be done after 3-5 days. Generally, the ligated tissue spontaneously breaks after 10- 14 days. 3. Anal fistula resection: pry the fistula, remove all the bone wall of the fistula to healthy tissue, and the wound surface will not be sutured; If the wound is large, it can be partially sutured, partially cut and filled with human oil gauze to make the wound grow outward from the bottom until it heals. Suitable for low simple anal fistula.
SFT technology, that is, a computerized diagnosis and treatment system for anorectal diseases, integrates examination, treatment and patented technology of automatic measurement of bioelectrical impedance (BEIM), and is composed of high-frequency capacitance field therapy function, high-frequency electrotome function, high-frequency capacitance field hemostasis function and high-frequency electrocoagulation function. This technique is mainly used for minimally invasive treatment of anal fistula and perianal abscess. The lesion is displayed on the computer screen, and the image is clear, accurate and solidified. In the course of treatment, according to the requirements of the symptom site, that is, the best treatment site, the treatment range is small and shallow, and the diseased tissue instantly solidifies and hardens without carbonization, thus avoiding the adverse reactions and complications such as anal incontinence caused by traditional surgery and anal pain, dysuria and urinary retention caused by traditional surgery, and creating a model for minimally invasive treatment of anal fistula and perianal abscess.