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1、中医治疗直肠脱垂介绍北京长青肛肠医院100195韩宝(河-南安阳学术交流会20()9-3-30)摘要:脱肛病是指肛管、直肠粘膜、直肠全层和部分乙状结肠向下移位,脱出或不脱出肛门外的一种疾病。相当于现代医学之“直肠脱垂”。中医药治疗直肠脱垂具有显著优势,治疗方法主要有辨证论治、注射疗法与手术治疗三种方法。特别是采用中药制剂消痔灵注射固脱治疗直肠脱垂,具有操作简便、经济、安全、痛苦小、疗效好的优点,其缺点是仍存在着一定的复发率。分型分期论治是提高直肠脱垂治疗效果的重要途径,一型直肠粘膜脱垂可采取直肠
2、粘膜下注射法、直肠粘膜结扎法与直肠粘膜环切术。二型I度、II度直肠全层脱垂可采取直肠内外双层注射疗法,疗效都很满意,是中医治疗优势所在。对于二型III度直肠脱垂单纯行消痔灵双层注射法,近期疗效较好,但远期复发率仍有30%左右,如果加做直肠粘膜紧缩术和肛门环缩术可显著降低远期复发率,总之,不管是何种类型的直肠脱垂,消痔灵注射治疗均可以作为本病的首选治疗方法,西医手术是中医治疗的有效补充。作为中医药治疗本病的难点在于消痔灵注射在远期疗效上存在着一定的复发率。要降低复发率,提高中医药疗效,就必须探索直
3、肠脱垂的发病机理,以寻找更佳治疗方法,或优化现有中医治疗方案,开展中西医治疗方法的队列研究,研究新药物、新剂型等等都是当今需要迫切解决的问题。关键字:直肠脱垂;注射;治疗IntroductionofDepletion・RelievingInjectionforTreatmentonRectalProlapseHanbao,BeijingChangqingAnorectalHospitalAbstractTaoGangBing,aterminTraditionalChineseMedicineco
4、rrespondingtotherectalprolapseinterminologyofthemodernmedicine,referstotheinferiortranslocationofproctodaeum,rectalmucosa,thefull-thicknessrectum,andpartialsigmoidcolon,withorwithouttheprolapseoutoftheanus.Withsignificantadvantagesinthetreatmentonrec
5、talprolapse,traditionalChineseMedicineprovidesthreemaintherapiesincludingSymptomDifferentiationandTreatmentAdministration,injection,andsurgery,especiallyXiaoZhiLingasthepreparationofTraditionalChineseMedicineappliedtorectalprolapse,whichischaracteriz
6、edintheadvantagesofsimplifiedadministration,lowcost,safety,lesssufferingsandbettereffects,inspiteofacertainrecurrencerateasitsshortcoming・TheTreatmentAdministrationbasedonstagesandtypesoftherectalprolopseisthekeytoimprovethetherapeuticeffect.Rectalsu
7、bmucosalinjection,rectalmucosaligation,orrectalcircumferentialmucosectomycanbeadoptedfortype1rectalprolapse,whilegradeIorII(thefullthicknessrectalprolapse)intypeIIcanbetreatedwithdoubleinjectionintoboththeexteriorandinteriorlayersoftherectum.Satisfac
8、toryeffectshavebeenobservedinallofthetherapiesasabove,demonstratingtheadvantagesofTraditionalChineseMedicine.Agoodearlytherapeuticresulthasbeenobservedinthesingletreatmentwithdouble-layerinjectionwithXiaoZhiLingfortypeIIgradeIIIrectalprolapse,despite