(1) Indications: Internal hemorrhoids of all stages and mixed hemorrhoids.
(2) Injection method: The patient is placed in the supine or side-lying position, undergoes routine disinfection and anesthesia, and puts Xinjier cotton into the anus and then expands it. This sterilized cotton ball will push up the anoscope and organize it. The dirt flows downwards, so there is no need to remove it. Apply lubricant to a wide-mouth simple bevel anoscope, slowly insert it into the anal canal, pull out the scope core, and observe the number and size of the lower rectal mucosa and hemorrhoids so that you can have an idea when injecting. After inserting the anoscope for the second time, submucosal injection can be performed on the hemorrhoid body. This area is also called high-level or high-level injection, which is injected into the upper boundary of hemorrhoids.
In 1928, Blanchorde believed that injecting the injection solution into this area could reduce the blood supply to the hemorrhoid area and improve the efficacy. Therefore, Gabriel injected 2~3 ml of low-concentration 5-phenol vegetable oil under the rectal mucosa above the internal hemorrhoids. . First, disinfect the mucosa of the injection area. If there is mucus, wipe it clean with gauze. Remove the 10ml syringe of the rare hemorrhoid medicine solution, use a No. 5 needle to penetrate the mucosa 0.3~0.5cm deep, inject the medicine to make it swollen, the general dosage is 1~3ML, switch the anoscope field of view, right back, left middle, right front three After the regional injection is completed, the anoscope is removed and the high plane injection is completed. Followed by hemorrhoidal injection.
This area is also called low or low plane injection, and also called interhemorrhoidal injection. When injecting medicine in this area, first penetrate the mucosa about 0.5cm deep into the center of the hemorrhoids and the tooth line in the middle of the hemorrhoids. After the medicine is injected, the hemorrhoids will be fully swollen. Generally, a larger amount is used. After the injection of medicine, tiny blood vessels can be seen on the mucosa on the thin surface of hemorrhoids. Huang Naijian calls this red streak syndrome. This sign may not be obvious if the fibrous tissue proliferates more severely or the injection is less than full. For example, hemorrhoids show a red streak sign and the hemorrhoid body is swollen and blister-like, which is a sign that the medicine has been fully swollen. If white dots appear on the mucosa, such as skin testicles, it is a sign of penetration into the mucosa and there is a possibility of superficial necrosis. The injection should be stopped and the puncture site should be changed.
If a certain part of the hemorrhoid body is still the original color or slightly changed, it means insufficient injection of medicine. That is, change the punctum and inject medicine there to make it swell and change color. Care should be taken not to miss the injection area on the tooth line. The three major hemorrhoids should be injected in sequence, and all the small hemorrhoids should be injected at the same time. Hemorrhoid injection should be carried out in different zones. After injecting one hemorrhoid, another hemorrhoid needs to be inserted several times. Therefore, the anoscope must be inserted several times. For submucosal injection on hemorrhoids, the anoscope must be inserted sequentially. When injecting drugs in three zones, the anoscope field of view must be changed. That’s it.
After injection, put a Jiuhua ointment cotton ball or inject Jiuhua ointment into the anus and apply a dressing externally. Change the dressing every day or every other day. If the hemorrhoids are not completely gone, another injection can be given after 7 days. When the hemorrhoids are small, there is no need for anesthesia and medicine can be injected directly under the anoscope.
(3) Key points for operation: pay attention to aseptic operation; the puncture should not be too deep, nor should it penetrate into the mucosa; no blood can be withdrawn before injecting; the injection area should be fully swollen and do not The injection area on the dental line is omitted; do not inject the medicine on the same day after injection. The pharmaceutical composition of the hardener used is: alum, glycerin, berberine, procaine, benzyl alcohol, etc. It mainly has astringent, hemostatic, analgesic, antibacterial and other effects. After injection, tissue hardening and atrophy can be achieved, and the loose mucosa and muscle layer can be adhered and fixed.
(1) Indications: This therapy is suitable for hemorrhoids and varicose mixed hemorrhoids in all stages.
(2) Injection method: Inject in two steps.
①. Basal sclerosis injection of female hemorrhoids: mainly inject into three female hemorrhoid areas. The main feature of this therapy is to focus on the submucosal superior rectal artery branch area (hemorrhoidal artery area) above the base of the mother hemorrhoid. The patient lies on the right side. After local anesthesia, an anoscope is inserted to expose the hemorrhoids, or the patient is asked to try to prolapse outside the anus on his own. Use the index finger of his left hand to touch the pulsating point of the hemorrhoidal artery on the internal hemorrhoids. If there is no obvious pulsation, it should be above the hemorrhoids. The corresponding site serves as the injection point.
Insert the needle from the inside of the lower layer of the external sphincter at the left anal verge (3 o'clock lithotomy position), and insert 3~4cm along the anal canal toward the internal hemorrhoid, until it reaches the hemorrhoid artery at the base of the submucosal hemorrhoid in the upper part of the internal hemorrhoid. Inject medicine into the pulsating area or corresponding area in a fan shape after treatment. Use the same method to inject internal hemorrhoids at the 7 o'clock and 11 o'clock lithotomy positions. Inject 1~2ML into each hemorrhoid, and the total amount for two female hemorrhoids is 4~7ml at one time.
② Internal hemorrhoid injection, as an auxiliary to basal injection: after exposing the hemorrhoids, directly inject the medicinal solution into the internal hemorrhoids, first into the small hemorrhoids, and then into the large hemorrhoids. It is appropriate for the internal hemorrhoids to be slightly full, once The total amount is 4~6ml.
(3) Precautions:
① Be sure to inject the medicinal solution into the hemorrhoid artery area above the internal hemorrhoids;
② Do not inject the medicinal solution into the external sphincter. , to avoid pain, edema and necrosis;
③Do not inject the liquid into the urethra behind the male prostate or into the vagina of women;
④When injecting internal hemorrhoids, you should The medicinal solution is injected into the hemorrhoids, not into the muscle layer to avoid necrosis, and should not be injected below the tooth line to avoid causing edema and pain. This therapy was created by Nanjing Traditional Chinese Medicine Hospital and is made of alum, coptis, tannic acid, etc. Hemorrhoid liquid, Nanjing Traditional Chinese Medicine Hospital and Nanjing Armed Police Hospital jointly conducted animal experiments and took specimens for pathological examination, and concluded that the effect of this hemorrhoid liquid belongs to the category of sclerosis.
(1) Indications and relative economics: This method is applicable to all stages of internal hemorrhoids, internal hemorrhoids of mixed hemorrhoids, and internal hemorrhoids combined with mild varicose external hemorrhoids. Various external hemorrhoids, internal hemorrhoids incarcerated, combined with anal verge inflammation and infection, eczema, and serious systemic diseases such as heart failure, hypertension, liver cirrhosis, urinary tract infection, etc. are all contraindications.
(2) Injection method: The patient is placed in the lateral position, local anesthesia is performed, and the hemorrhoids are exposed. Use digital examination and touch the hemorrhoidal artery pulsation area, take a 10ml or 20ml syringe, inhale the medicinal solution, install a No. 5 dental needle, puncture 0.5cm above the dental line, insert the needle into the submucosa, and move above the hemorrhoids to the hemorrhoidal artery pulsation area. Then inject medicine, usually 2~3ml. If there is no pulsating area, it also needs to be injected at the corresponding location.
Retreat the needle tip to the center of the hemorrhoids and inject medicine under the mucosa so that the medicine liquid fills the hemorrhoids. Inject other hemorrhoids in the same way. When there are multiple hemorrhoids, the small hemorrhoids should be injected first, and then the larger ones should be injected; for circular internal hemorrhoids, the injection should be done in the mother hemorrhoid area. The injection dose is at least 1ml for each hemorrhoid, up to 14ml, and the total amount is up to 348ml. After the injection, the hemorrhoids should be completely reset and fixed with a tower-shaped gauze bandage. Injection of hemorrhoids using a sclerosing agent formulated with carbolic acid and vegetable oil is a traditional method. In 1871, Dr. Mitchell from the United States used carbolic acid and olive oil to make injections to treat hemorrhoids. In 1928, Dr. Morley described injecting 1 to 2 ml of 5-phenol vegetable oil into the submucosa above hemorrhoids. The method is to inject once every 5 to 7 days. It is believed that it has the following advantages:
① It can be injected in large doses with 5-concentration carbolic vegetable oil, and there are no adverse reactions when injecting 10~15ml;
② The solution prepared with vegetable oil is not easy to absorb and reacts Small;
③Less scarring after local injection.
(1) Indications:
① Internal hemorrhoids are most suitable in the early stage;
② Internal hemorrhoids in stages II and III can eliminate or reduce prolapse symptoms
③Those who bleed or prolapse again after hemorrhoid surgery
④Those who are elderly and frail, or who have systemic inflammation and are not seriously ill.
(2) Injection method: The traditional 5-phenol glycerin injection method can be injected at the lower part of the hemorrhoid body or high above the hemorrhoid, but it should be injected into the submucosa of the hemorrhoid. The needle should be inserted into the submucosal layer of the hemorrhoids about 0.5cm. If the needle tip can move to the left and right after insertion, it is a clear evidence of submucosal infection. If the needle is inserted too deep into the muscle layer and the needle tip cannot move easily, the needle should be withdrawn a little. If there is no blood return after aspiration, the medicine can be injected. Generally, 2~4ml is injected into each hemorrhoid. The total volume after injection of Shangemu Hemorrhoids is 10~15ml. After injection, the microvessels in the mucosa are clearly visible. If the mucosa is pale, it indicates that the needle tip penetrated too shallowly, and the depth should be adjusted before injecting. No more than three internal hemorrhoids should be injected per injection.
(3) Precautions:
① The first injection dose must be sufficient;
② The injection needle should be a No. 20 lumbar puncture needle, which is too thick It is easy to bleed, and it is difficult to inject if it is too thin;
③ Low injection should be inserted 0.5cm above the dental line. If the medicine is too low, downward infiltration may cause pain;
④Injection 24 You should not defecate within hours to avoid hemorrhoid prolapse and incarceration;
⑤The injection site should not be too deep, too shallow, or too low to avoid local pain, necrosis, bleeding, etc.
This therapy is represented by the injection therapy of "603 Xiaozhi Liquid". This method was jointly developed by Jiangsu Provincial Hospital of Traditional Chinese Medicine and Jiangsu Provincial Institute of Traditional Chinese Medicine. It is a method to improve blood circulation and achieve the purpose of eliminating hemorrhoids. This method is different from injection therapy for sclerosis and hemorrhoid necrosis.
The therapeutic effect of "603 Xiaozhi Liquid" injection on hemorrhoids is mainly due to the fact that this liquid has the functions of dilating blood vessels, increasing blood vessel attention, anticoagulation, and relaxing the smooth muscles of the anal canal. Achieve smooth blood flow, improve local blood circulation and eliminate hemorrhoids.
(1) Indications: Internal hemorrhoids of all stages, internal hemorrhoids of mixed hemorrhoids, varicose external hemorrhoids, etc.
(2) Injection methods: For stage I and II hemorrhoids, high and low submucosa injections are used; for stage III hemorrhoids and mixed hemorrhoids (external hemorrhoids are varicose veins), high and low submucosal injections are used and the "external muscle" method is used. "Four-point injection method" can be used in combination; for simple varicose external hemorrhoids, "four-point injection method of external muscles" can be used.
Before the injection, instruct the patient to empty his or her bowels, use laxatives for those with constipation, and use saline enema if necessary. The perianal skin should be prepared when doing "four-point injection of external muscles". Multiple injections can be given for each disease, generally three times is allowed, and the interval between each injection is 3 to 7 days. The specific operations are as follows:
① High and low injection method in the submucosal layer: at the top of the hemorrhoids, that is, the uppermost edge of the direct injection, or directly above the anal and rectal ring, called high; in the hemorrhoid body, near the tooth line, downward It does not exceed the tooth line and is called the low position from just above it to the middle of the hemorrhoid. Both the upper and lower submucosa are fully infiltrated by the medicinal solution, but the medicinal solution should not be injected into the blood vessels.
a. The patient lies on the right side, inserts the anoscope, exposes the internal hemorrhoids and tooth line, and makes the hemorrhoids to be injected protrude above the anoscope opening without twisting them. Large hemorrhoids still need to be pushed upward. The upper part of the hemorrhoids is completely exposed. Then use 1 chlorhexidine or 0.25 chlorhexidine cotton balls to disinfect and wipe dry.
b. Take a syringe filled with "603 Xiaohemorrhoid Liquid", put it on a No. 6 long closed needle, puncture the top of the internal hemorrhoids such as the submucosa, aspirate if there is no blood return, and then push the medicine. At this time, while slowly pushing the medicine, the frontier anoscope is slowly withdrawn, so that the medicine gradually infiltrates into the hemorrhoid body, making the entire hemorrhoid swell like a pool until the blood vessel texture on the superficial surface of the hemorrhoid mucosa is clearly visible. Generally, small hemorrhoids can be injected with one puncture. For larger hemorrhoids, high puncture and injection are required. If the local area is not fully infiltrated, another puncture and injection above the dental line will be performed until the entire hemorrhoid becomes blister-like and swollen. However, the medicinal solution will not It should go below the tooth line.
c. Injection dosage: Generally, a single internal hemorrhoid can reach 3~5ML, a third-stage internal hemorrhoid can reach about 10ml, and three parent hemorrhoids or annular mixed hemorrhoids can reach 30~40ml, but the maximum does not exceed 60ml. This is to avoid mucous membrane swelling, leakage or bleeding, which may lead to ulcers and other adverse consequences.
d. When injecting, if the mucosa is white and has a ridge-like protrusion, it indicates that the puncture is too shallow and is not within the submucosa. The patient should be pushed forward slightly and then inject. At this time, there should be no resistance when pushing the medicine, and the mucous membrane should be blister-like and evenly bulging. If the puncture is too deep, there should be a tight feeling when pushing the medicine, and no blister-like bulges are seen on the mucosa, indicating that the needle tip has reached the muscular layer of the intestinal wall, and the needle tip should be withdrawn later.
e. When there are multiple hemorrhoids, the small hemorrhoids should be injected first, and then the large hemorrhoids. For ring-shaped mixed hemorrhoids, the third hemorrhoid area is the main injection point, and the other parts are auxiliary. If necessary, inject in stages.
f. Be careful to puncture blood vessels during puncture, otherwise it may easily lead to submucosal hematoma. At this time, it is common for the mucosa to show localized dark red or pinhole bleeding. You can use sterilized cotton balls to compress and stop bleeding. When exiting the anoscope after the injection, use a cotton swab to push the hemorrhoids into the anus through the anus to completely reset them, and fix them with tower-shaped gauze to prevent the hemorrhoids from protruding and becoming incarcerated.
② "External muscle four-point injection method": that is, from four points outside the anus at 2.5.7.10 lithotomy positions, 2~2.5cm away from the anal verge, puncture through the skin, so that the needle tip is between the internal and external sphincter. It is carried out in the interplane and reaches the anal canal and rectal ring. After injection, the liquid should be evenly distributed around the anal canal at the changed site.
Specific operations:
a. The patient lies on the right side, and the perianal skin is routinely disinfected. The surgeon inserts his left index finger into the anus, feels out the anal canal and rectal ring, and uses it as a guide for puncture positioning. Before the injection is completed, the left index finger should always be kept in the anus and should not be withdrawn midway to avoid contaminating the anchor point.
b. Disinfect the skin at the puncture point again. Take 20ml of "603 Hemorrhoid Elimination Liquid" with a ratio of 1:1. Put a No. 5 dental needle in the syringe. You can first puncture the lithotomy site at 5 o'clock, away from the anus. The edge of the anal canal is 2~2.5cm, and the puncture needle is at an angle of approximately 30° with the longitudinal axis of the anal canal. The needle is inserted in the radial direction, and the needle is slowly inserted under the digital guide and advanced for approximately 3.5cm. to reach the injection site. At this time, the needle tip can be palpated slightly below the anorectal ring above the tooth line, and there is a sense of toughness covered by the intestinal wall muscle layer. At this time, the medicine can be pushed. There will be no resistance in front of the needle and the fingertips will feel pushed. If there is resistance, it means that the needle tip is not within the plane of the internal and external sphincter. It should be withdrawn slightly and repositioned under the guidance of digital diagnosis. After the positioning is correct, if there is no blood return during aspiration, the medicine can be injected. The remaining points are injected one by one according to the above method.
c. After the injection, withdraw the index finger, insert the anoscope, and observe the rectal mucosa. There should be no obvious edema, nor blister-like swelling. The skin around the anal canal will be swollen in the afternoon, and the anal sphincter is completely relaxed. That means the injection is successful. When "external muscle four-point injection" is performed, be sure to damage the tissue or inject the medicinal solution into the prostate and urethra tissue. If necessary, the injection point can be changed. When external intramuscular injection is used to treat anal fissure, if anal pain is caused by digital examination, local anesthesia can be applied to the bottom of the anal fissure ulcer before injection, and then the above method can be followed.