铜离子电化学疗法配合外痔切除术治疗混合痔的临床研究
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摘要
痔是一古老的、人类所特有的疾病,发生在直肠下端和肛门部位,是最常见的影响人类健康的疾病之一,其成年人发病率约为59%。男、女皆可发病,患者常表现为便血、肛门异物感、肛门有物脱出、伴或不伴肛门坠胀、瘙痒、潮湿或肿痛不适等症状,日久可导致严重贫血,脱出物嵌顿坏死,则严重影响到人们的日常工作、学习和生活。痔分为内痔、外痔和混合痔,其中以混合痔最为常见,约占痔患者的百分之六十六。对痔的本质的认识一直处于不断探索、更新、深入当中,相应地,痔的治疗原则及治疗手段也发生了根本的变化。
对于痔的本质,肛垫下移学说是目前较为普遍接受的学说之一,即肛垫是直肠、肛门正常解剖的一部分,痔是肛垫病理性肥大、移位及肛周皮下血管丛血流淤滞形成的局部团块,因此不主张见痔就治的做法,而只有当有出血、脱垂、疼痛、嵌顿等症状时,才需要治疗,同时对痔的治疗目的也做出了规定：即痔治疗目的是为了减轻或消除其主要症状。从而使痔的治疗有了全新的概念,学术界普遍接受的是无症状的痔无需治疗,有症状痔才需要治疗,同时需要明确的是：痔治疗的目的重在消除、减轻痔的主要症状,而非根治,解除痔的症状较改变痔体的大小更有意义,应视为治疗效果的标准。痔的微痛、微创治疗是肛肠科治疗的大趋势,因此研究、探索集安全、快速、有效、痛苦小于一身的痔疗法是肛肠界同仁一致追求的目标。混合痔外剥内扎术(Milligan-Morgan术)曾经是临床应用最广的手术方式,该手术操作方法简单、疗效确切,但该术式术后疼痛剧烈、创面愈合慢、住院时间长,可能产生肛门狭窄等并发症,及可能影响肛门的精细控便、排便能力,且对患者耐受力要求较高,年老、体弱、合并重症患者无法耐受。近几十年来,很多肛肠同仁对该术式加以改良,如有保留齿线法、有闭合或开放式、有加注射法等等。尽管这些术式较单纯外剥内扎有了很多改进,但仍不能从根本上解决上述之不足。受中医枯痔钉和铜针留置疗法思想的共同启发,李东冰教授首先于1998年采用铜离子电化学疗法(Copper ion electric chemical therapy,以下简称CIECT)治疗内痔取得成功。经过不断探索,研制了专用的电极针和相关的治疗参数。此后,常宝志等教授经过大量临床病例观察,验证了CIECT)治疗内痔方面疗效显著,无治疗禁忌症,治疗后无明显并发症,随后许多专家也开始对该疗法进行了研究及应用,一致认为：CIECT)在治疗内痔方面,具有疗效佳、痛苦小、并发症少的特点,符合痔的最新治疗观念。此后随着CIECT应用中发现的问题,李东冰教授又不间断地对铜离子电化学治理仪做了进一步改进,使得治疗时间大幅度缩短。
自2003年起,我们将铜离子电化学疗法逐步广泛应用于治疗发病率更高的混合痔患者,方法是首先将混合痔肛门缘以外外痔部分手术切除,但保留混合痔肛门缘以上部分的全部或大部分皮肤,内痔部分采用铜离子电化学疗法治疗,经过大量的临床观察,验证了铜离子电化学疗法配合外痔切除手术(以下简称CIECT加外切术)治疗混合痔可以取得预期的良好效果。同时发现：由于在治疗的同时保护了肛管,从而避免了肛门狭窄等严重后果,并逐步形成了“内痔内治,外痔外治,轻视肛缘、重视肛管”的治疗混合痔的新理论。为了更加系统、更加客观地评价这种治疗混合痔的疗法,我们将CIECT加外切术与传统外剥内扎手术治疗混合痔采用队列研究,通过统计学分析,判断CIECT加外切术在临床疗效、术后疼痛及术后并发症发生率等方面与传统外剥内扎手术的优劣差异,同时为上述理论提供更为详实的临床依据。
目的：
痔的传统手术方法——外剥内扎术的缺点是：术后疼痛剧烈、创面愈合慢、住院时间长及可能产生肛门狭窄等并发症,且对患者耐受力要求很高,年老、体弱、合并重症患者通常无法耐受。患者或术者也因惧怕手术风险而在治疗时却步。CIECT适宜治疗Ⅰ、Ⅱ度内痔,对Ⅲ、Ⅳ度内痔也有一定的疗效。该疗法具有痛苦小、预后佳、并发症少、无禁忌症等优点。本研究拟比较CIECT加外切术与外剥内扎术治疗内痔部分为Ⅱ度的混合痔的临床疗效及术后并发症发生情况,以客观评价CIECT疗效及其与外痔切除配合治疗混合痔的特点及注意事项,以及可行性。尝试为痔患者找到更为简便、安全、有效的治疗方法。
方法:
将就诊于西苑医院及二龙路医院并愿意接受住院治疗的混合痔患者,选取内痔部分为Ⅱ度的混合痔患者采用队列研究的方法分成治疗组和对照组。治疗组101例,采用CIECT加外切术,对照组101例,采用外剥内扎术,前者内痔部分采用CIECT,外痔部分予以切除,后者采用外剥内扎术。通过观察治疗后疗效、术中出血量、手术所用时间、术后24小时和第一次排便时的疼痛指数、术后疼痛持续时间情况,并观察术后伤口出血、术后伤口水肿、术后尿潴留、术后肛门狭窄、术后肛门控便能力等并发症发生情况以及观察患者住院时间和总的治疗费用等指标,并且随访1年,以观察1年期的中期疗效,从而比较两种治疗方法的优劣。
结果：
CIECT加外切术组与外剥内扎术组的疗效相当(P>0.05),两组在术后复发率方面也无明显差异(P>0.05)。
在术后24h疼痛指数、术后第一次排便疼痛指数、术后疼痛持续时间方面,CIECT加外切术组明显优于外剥内扎术组(P<0.05)；在术后出血、术后伤口水肿、术后肛门狭窄等方面,CIECT加外切术组少于外剥内扎组；在住院时间、影响工作方面及治疗费用方面,铜离子加外切术组也优于外剥内扎组。而在手术时间、术后尿潴留发生率方面两组无显著性差别(P>0.05)。
在术后控便力方面：术后4个月内CIECT加外切术组优于外剥内扎组(P<0.05),1年后外剥内扎组部分患者控便力有所恢复,但仍有部分患者有不同程度粪便外溢,尚无统计学差别(P>0.05)。
结论：
采用CIECT加外切术治疗内痔部分为Ⅱ度的混合痔患者,在保证疗效前提下,与传统外剥内扎术相比,具有安全、痛苦小、住院时间短、恢复快、无禁忌症等优点。适于大量推广应用。
Hemorrhoid is one of the common diseases affecting human health for a long time, which happens in anal canal-lower rectum. Everyone, young or old, may suffer from it. The patients of hemorrhoid often have the symptom of hemorrhage, hernia, swelling and discomfort. Some people are slightly indisposed with sitting and sleeping while some experienced anemia and the prolapsed, which, indeed, affected the daily life of people. Hemorrhoid can be divided by internal hemorrhoid, external hemorrhoid and mixed hemorrhoid. Among which the mixed hemorrhoid is the commonest, about 66%. The therapeutic method is changing with the update of knowledge.
The new concept of hemorrhoid treatment is introduced then. First of all, some hemorrhoid with no obvious symptom can be treated without doctors. Strictly speaking, hemorrhoid can not be cured. The aim of the hemorrhoid treatment is to relieve pain and eliminate the main discomfort. Therefore, the relief of pain and the elimination of discomfort have been brought into the evaluation of therapeutic methods. The hemorrhage and prolapsed are two main symptoms of hemorrhoid. The best therapy would be the safe, rapid, effective, and painless ones on the condition of relief of pain and elimination of hernia. Among all the therapies of hemorrhoid, Milligan-Morgan therapy is in common use. In spite of the simpleness and effectiveness of the operation, this method has huge pain and needs a relatively long time to recover and is more likely to lead complications. Since the year of 1998, Doc Dongbing Li initiated the copper ion electrochemistry (CIECT) in treatment of bleeding and prolapsed due to hemorrhoid; many other specialists researched on this field and considered it to be a painless operation with a very positive result. What we are now doing is a comparison of Milligan-Morgan and copper ion electrochemistry (CIECT) in treatment of hemorrhoid in the aspects of curative effect and the value of further application.
Intention:
The common operation of hemorrhoid is Milligan-Morgan, which is a simple and effective way but remain a huge pain for a long time. The CIECT treatment is a relatively painless and quicker way. This paper is an observation of clinical curative difference between Milligan-Morgan and CIECT treatment in order to evaluate the practicability of CIECT treatment.
Methodology:
202 patients of hemorrhoid were randomly divided, with 101 into CIECT treatment group and 101 into Milligan-Morgan group. Then obverse the curative effect, the pain index 24 hours after the operation, the hemorrhage, the swell of the injury, the urine, the prolapsed, the control of stool, the in-patient time and the expense at the hospital.
Result:
There were no significant difference between the two groups in comparison of Milligan-Morgan and the CIECT treatment in the efficiency of treating mixed hemorrhoids (p＜0.05), but other comparison index shows that the CIECT treatment is better than Milligan-Morgan treatment。
Conclusion:
Two methods of treating mixed hemorrhoids have satisfacting curicy rate, but the CIECT treatment is more safe and less pain, the length of time is shorter, quicker recovery, less expense and no contraindications, etc. Suitable for further application.
对于痔的本质,肛垫下移学说是目前较为普遍接受的学说之一,即肛垫是直肠、肛门正常解剖的一部分,痔是肛垫病理性肥大、移位及肛周皮下血管丛血流淤滞形成的局部团块,因此不主张见痔就治的做法,而只有当有出血、脱垂、疼痛、嵌顿等症状时,才需要治疗,同时对痔的治疗目的也做出了规定：即痔治疗目的是为了减轻或消除其主要症状。从而使痔的治疗有了全新的概念,学术界普遍接受的是无症状的痔无需治疗,有症状痔才需要治疗,同时需要明确的是：痔治疗的目的重在消除、减轻痔的主要症状,而非根治,解除痔的症状较改变痔体的大小更有意义,应视为治疗效果的标准。痔的微痛、微创治疗是肛肠科治疗的大趋势,因此研究、探索集安全、快速、有效、痛苦小于一身的痔疗法是肛肠界同仁一致追求的目标。混合痔外剥内扎术(Milligan-Morgan术)曾经是临床应用最广的手术方式,该手术操作方法简单、疗效确切,但该术式术后疼痛剧烈、创面愈合慢、住院时间长,可能产生肛门狭窄等并发症,及可能影响肛门的精细控便、排便能力,且对患者耐受力要求较高,年老、体弱、合并重症患者无法耐受。近几十年来,很多肛肠同仁对该术式加以改良,如有保留齿线法、有闭合或开放式、有加注射法等等。尽管这些术式较单纯外剥内扎有了很多改进,但仍不能从根本上解决上述之不足。受中医枯痔钉和铜针留置疗法思想的共同启发,李东冰教授首先于1998年采用铜离子电化学疗法(Copper ion electric chemical therapy,以下简称CIECT)治疗内痔取得成功。经过不断探索,研制了专用的电极针和相关的治疗参数。此后,常宝志等教授经过大量临床病例观察,验证了CIECT)治疗内痔方面疗效显著,无治疗禁忌症,治疗后无明显并发症,随后许多专家也开始对该疗法进行了研究及应用,一致认为：CIECT)在治疗内痔方面,具有疗效佳、痛苦小、并发症少的特点,符合痔的最新治疗观念。此后随着CIECT应用中发现的问题,李东冰教授又不间断地对铜离子电化学治理仪做了进一步改进,使得治疗时间大幅度缩短。
自2003年起,我们将铜离子电化学疗法逐步广泛应用于治疗发病率更高的混合痔患者,方法是首先将混合痔肛门缘以外外痔部分手术切除,但保留混合痔肛门缘以上部分的全部或大部分皮肤,内痔部分采用铜离子电化学疗法治疗,经过大量的临床观察,验证了铜离子电化学疗法配合外痔切除手术(以下简称CIECT加外切术)治疗混合痔可以取得预期的良好效果。同时发现：由于在治疗的同时保护了肛管,从而避免了肛门狭窄等严重后果,并逐步形成了“内痔内治,外痔外治,轻视肛缘、重视肛管”的治疗混合痔的新理论。为了更加系统、更加客观地评价这种治疗混合痔的疗法,我们将CIECT加外切术与传统外剥内扎手术治疗混合痔采用队列研究,通过统计学分析,判断CIECT加外切术在临床疗效、术后疼痛及术后并发症发生率等方面与传统外剥内扎手术的优劣差异,同时为上述理论提供更为详实的临床依据。
目的：
痔的传统手术方法——外剥内扎术的缺点是：术后疼痛剧烈、创面愈合慢、住院时间长及可能产生肛门狭窄等并发症,且对患者耐受力要求很高,年老、体弱、合并重症患者通常无法耐受。患者或术者也因惧怕手术风险而在治疗时却步。CIECT适宜治疗Ⅰ、Ⅱ度内痔,对Ⅲ、Ⅳ度内痔也有一定的疗效。该疗法具有痛苦小、预后佳、并发症少、无禁忌症等优点。本研究拟比较CIECT加外切术与外剥内扎术治疗内痔部分为Ⅱ度的混合痔的临床疗效及术后并发症发生情况,以客观评价CIECT疗效及其与外痔切除配合治疗混合痔的特点及注意事项,以及可行性。尝试为痔患者找到更为简便、安全、有效的治疗方法。
方法:
将就诊于西苑医院及二龙路医院并愿意接受住院治疗的混合痔患者,选取内痔部分为Ⅱ度的混合痔患者采用队列研究的方法分成治疗组和对照组。治疗组101例,采用CIECT加外切术,对照组101例,采用外剥内扎术,前者内痔部分采用CIECT,外痔部分予以切除,后者采用外剥内扎术。通过观察治疗后疗效、术中出血量、手术所用时间、术后24小时和第一次排便时的疼痛指数、术后疼痛持续时间情况,并观察术后伤口出血、术后伤口水肿、术后尿潴留、术后肛门狭窄、术后肛门控便能力等并发症发生情况以及观察患者住院时间和总的治疗费用等指标,并且随访1年,以观察1年期的中期疗效,从而比较两种治疗方法的优劣。
结果：
CIECT加外切术组与外剥内扎术组的疗效相当(P>0.05),两组在术后复发率方面也无明显差异(P>0.05)。
在术后24h疼痛指数、术后第一次排便疼痛指数、术后疼痛持续时间方面,CIECT加外切术组明显优于外剥内扎术组(P<0.05)；在术后出血、术后伤口水肿、术后肛门狭窄等方面,CIECT加外切术组少于外剥内扎组；在住院时间、影响工作方面及治疗费用方面,铜离子加外切术组也优于外剥内扎组。而在手术时间、术后尿潴留发生率方面两组无显著性差别(P>0.05)。
在术后控便力方面：术后4个月内CIECT加外切术组优于外剥内扎组(P<0.05),1年后外剥内扎组部分患者控便力有所恢复,但仍有部分患者有不同程度粪便外溢,尚无统计学差别(P>0.05)。
结论：
采用CIECT加外切术治疗内痔部分为Ⅱ度的混合痔患者,在保证疗效前提下,与传统外剥内扎术相比,具有安全、痛苦小、住院时间短、恢复快、无禁忌症等优点。适于大量推广应用。
Hemorrhoid is one of the common diseases affecting human health for a long time, which happens in anal canal-lower rectum. Everyone, young or old, may suffer from it. The patients of hemorrhoid often have the symptom of hemorrhage, hernia, swelling and discomfort. Some people are slightly indisposed with sitting and sleeping while some experienced anemia and the prolapsed, which, indeed, affected the daily life of people. Hemorrhoid can be divided by internal hemorrhoid, external hemorrhoid and mixed hemorrhoid. Among which the mixed hemorrhoid is the commonest, about 66%. The therapeutic method is changing with the update of knowledge.
The new concept of hemorrhoid treatment is introduced then. First of all, some hemorrhoid with no obvious symptom can be treated without doctors. Strictly speaking, hemorrhoid can not be cured. The aim of the hemorrhoid treatment is to relieve pain and eliminate the main discomfort. Therefore, the relief of pain and the elimination of discomfort have been brought into the evaluation of therapeutic methods. The hemorrhage and prolapsed are two main symptoms of hemorrhoid. The best therapy would be the safe, rapid, effective, and painless ones on the condition of relief of pain and elimination of hernia. Among all the therapies of hemorrhoid, Milligan-Morgan therapy is in common use. In spite of the simpleness and effectiveness of the operation, this method has huge pain and needs a relatively long time to recover and is more likely to lead complications. Since the year of 1998, Doc Dongbing Li initiated the copper ion electrochemistry (CIECT) in treatment of bleeding and prolapsed due to hemorrhoid; many other specialists researched on this field and considered it to be a painless operation with a very positive result. What we are now doing is a comparison of Milligan-Morgan and copper ion electrochemistry (CIECT) in treatment of hemorrhoid in the aspects of curative effect and the value of further application.
Intention:
The common operation of hemorrhoid is Milligan-Morgan, which is a simple and effective way but remain a huge pain for a long time. The CIECT treatment is a relatively painless and quicker way. This paper is an observation of clinical curative difference between Milligan-Morgan and CIECT treatment in order to evaluate the practicability of CIECT treatment.
Methodology:
202 patients of hemorrhoid were randomly divided, with 101 into CIECT treatment group and 101 into Milligan-Morgan group. Then obverse the curative effect, the pain index 24 hours after the operation, the hemorrhage, the swell of the injury, the urine, the prolapsed, the control of stool, the in-patient time and the expense at the hospital.
Result:
There were no significant difference between the two groups in comparison of Milligan-Morgan and the CIECT treatment in the efficiency of treating mixed hemorrhoids (p＜0.05), but other comparison index shows that the CIECT treatment is better than Milligan-Morgan treatment。
Conclusion:
Two methods of treating mixed hemorrhoids have satisfacting curicy rate, but the CIECT treatment is more safe and less pain, the length of time is shorter, quicker recovery, less expense and no contraindications, etc. Suitable for further application.
引文
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8. HaasPA, FoxTA Jr, HaasGP. The pathogenesis ofhemorrhoids[J].Dis Colon Rectum,1984,27(7):442-450.
9. Parnaud E, GuntzM, Bernard A, et a.1 Normalmacroscopic and micro-scopic anatomy of the hemorrhoidal vascular system [J]. Arch FrMal App Dig,1976,65(7):501-514.
10.张东铭.肛垫微循环及循环障碍[J].中国肛肠病杂志,2004,24(6)：31-33.
11. RoeAM, BartoloDC, VellacottKD, et a.1 Submucosal versus ligation ex-cision haemorrhoidectomy:a comparison ofanal sensation, anal sphincter manometry and postoperative pain and function[J]. Br J Surg,1987,74 (10):948-951.
12. MillerR, Bartolo DC, Roe A, et a.1 Anal sensation and the continence mechanism[J]. DisColon Rectum,1988,31(6):433-438.
13.Felt-BersmaRJ, PoenAC,CuestaMA, eta.1 Anal sensitivity test:what does it measure and do we need it? Cause orderivative of anorectal com-plaints [J]. DisColon Rectum,1997,40(7):811-816.
14. MadoffRD, Fleshman JW, Clinical Practice Committee, American Gas-troenterological Association. American Gastroenterological Association technical review on the diagnosis and treatmentofhemorrhoids[J]. Gas-troenterology,2004,127(3):1017-1018
15. AlperD, Ram E, Stein GY, et a.1 Resting anal pressure following hemor-rhoidectomy and lateral sphincterotomy[J]. DisColonRectum,2005, 48(11):2080-2084.
16. Chanhan A, Thomas S, Bishnoi PK, et a.1 Randomized controlled trial toassess the role of raised analpressures in the pathogenesis of symptomat-ic early hemorrhoids [J]. Dig Surg,2007,24(1):28-32.
17. Read NW, Sun WM. Hemorrhoids constipation and hypertensive anacushions[J]. Lancet,1989,1(8636):610.
18. Jahanson JF, SonnenbergA.The prevalence of hemorrhoids and chroni constipation. An epidemiologic study[J]. Gastroenterology,1990,98 (2):380-386.
19. MaeLeedJH. Amethod of proctology · NewYork. Medieal Department HarperRow,19804
20. Marino · AW Jr · Anorectal surgery — hemorrhoids · DisColonRectum, 1980· 23:211—222 ·
21. Alexander—WilliamsJ. ThenatureofPiles. BrMedJ,1982,285(6349):1137.
22.牛治君,牛明星.大黄牡丹汤加味治疗嵌顿性内痔.中国肛肠病杂志,1995,950：7～8
23.赵连生,董玉琛,杨秀华.自拟活血化瘀加味治疗痔疮80例.内蒙古中医药,2001,9(20)：39
24.宋爱利.血府逐瘀胶囊治疗肿痛痔疗效观察.北京中医杂志,200221(2)：40
25.李思芳.自拟连仙消痔汤治疗内痔19例小结.贵阳中医学院学报2000,22(3)：26.
26.贺向东,石耀武,郑鑫.痔炎灵浓缩液治疗混合痔感染出血738例临床观察.陕 西中医学院学报,2002,25(4)：36～37
27.杨巍,陈勇.痔血宁合剂治疗痔急性发作的临床观察.辽宁中医杂志,2002,29(7)：404
28.冯文新.清痔冲剂治疗痔疮的临床观察.四川中医,1995,9(10)：47
29.冷伟.止痛如神汤治疗急症痔.安徽中医临床杂志,1997,9(1)：54
30.吴冰,戴继杭.泻心汤治疗内痔出血74例疗效观察.中国肛肠病杂志,1998,18(3)：35
31.荀洪仙.补中益气汤化裁治疗内痔脱垂56例.湖南中医杂志1997,13(3)：48
32.谢国良.自拟参赭升降消痔汤治疗内痔60例.陕西中医,2001,2(9)：538
33.赵翠峰,刘道勉,张成群.中药熏洗治疗血栓痔160例.现代中西医结合杂志,2001,10(12)：1159
34.刘成伟,潘素滢.痔宁熏洗冲剂治疗炎性痔106例临床观察.新中医,2003,33(4)：25～26
35.郭正东,段延筑,马聪.痔安散熏洗疗法在痔科疾病中的应用.中国肛肠病杂志,2004,24(3)：12～13
36.陈晓君,宗丙华.消痔膏外敷治疗痔疮43例.中医外治杂志,2003, ：17
37.梁劲军,吴维城,李华山,等.敷痔散治疗嵌顿痔95例疗效观察.新中医,2000,32(5)：15～17
38.黄友土.消痔膏治疗嵌顿性内痔及炎性外痔.中医外治杂志2001,10(3)：42
39.倪宝成,王宽奎.消痔检治疗肛肠痔病临床体会.中国肛肠病杂志,1998,18(3)：39
41.韩丽君,任建国,郜英,等.复方痔康栓治疗混合痔80例临床观察.中医药研究,2002,18(1)：20
42.李补常.针刺天窗治疗痔疮56例.针灸临床杂志,1999;15(4)：48
43.叶红.针灸结合中药熏洗治疗产后痔疮52例.中医外治杂志,2002;2,11(1) ：9
44.李华中.壮医药线点灸治疗痔疮50例.四川中医,2000;18(11)：47
45.刘光忠.艾灸“痔点”治疗痔疮50例疗效体会.针灸临床杂志,2001(3) ：34
YU B M, LIN J J,WU W Q. A multicentral self controlled clinical study on the effect of Alvenor on acute attack ofhemorrhoids[J]. Chin J Gen Surg,2004,19(12):722-724.
47. DIMITROULOPOULOS D,TSAMAKIDIS K, XINOPOULOSD, et al. Prospective, randomized, controlled, observer-blindedtrial of com-bined infrared photocoagulation and micronizedpurified flavonoid fraction versus each alone for the treatmentof hemorrhoidal disease [J]. Clin Ther,2005,27(6): 746-754.
48. ZHANG L N, SHI H Q, LU G Q. Compound Ginkgo bilobaextract capsules [J]. Chin J New Drugs 2004,13(5):471-472.
49. YANG X Q, CHEN C W. Clinical trial of compound Ginkgobiloba extract capsule on cases with operation of hemorrhoids[J]. J Coloproctol Surg, 2004,10 (1):44-47.
50. FAN H X, ZHU X Q, HU A, et al. Study of compound flavoneof Ginkgo biloba leaves on the treatment of haemorrhoid [J].Chin J Mod Appl Pharm,2004, 21 (3):170-172.
51. XU C M, ZHU L T, HAN R. Melilotus extract tablets [J]. Chin J New Drugs, 2007,16 (4):332-333.
52. LIU Z R, CHENG Q Y, ZHU Y F. Experimental and clinicalstudies of melilotus extract in treatment of hemorrhoid [J]. JColoproctol Surg,2004, 10(3):189-191.
53. FU C G, YANG W, SUN J H, et al. Clinical research ofmelilotus extract in the treatment of hemorrhoids [J]. Chin JGastrointest Surg,2004,7(4): 270-272.
54. WANG C S, DING C, TIAN S Z. A new Anti-inflammatorydrug:Aescuven forte [J]. Chin J New Drugs,1998,7(5):389-390.
55. SHAO X J, ZHAN H L. Clinical observation of Aescuven forte to treat hemorrhoids [J]. J Colorect Anal Surg,2007,13 (2):110-111.
56. ZHANG M, SHU J, ZHOU J Z, et al.1360 cases of hemorrhoidstreatment by Aescuven forte [J]. Shanxi J Tradit Chin Med,2003,24(4):332-334.
57. FENG J J, XIANG F. Clinical observation of Aescuven forte totreat hydrops after mixed hemorrhoids operation [J]. Practical JClin Med,2007, 4(2):69.
58. Nagy A. Willnerp, Jankoieh Met al Eight_year experi-ence in treatment of hemorrhoidal disease. Acta Chi Hung,1998.37:71.
59.吕孝东,田志刚.电子痔疮仪与注射消痔灵治疗内痔疗效比较[J].应用激光,1998,18(8)：848.
60.公重康.WHSD-Ⅲ型电脑痔疮治疗仪临床应用体会[J].中国疗养医学,2000.45(7)：5-6.
61.宫毅.脉冲电中药离子导入治疗痔的临床与实验研究[J].云南中医学院学报,2000,23(4)：7-11.
62.徐梅.氦氖激光及旋磁治疗痔疾疗效观察[J].中国疗养医学,2002,11(4) ：9-10.
63.李宏学,顾志强.C02激光治疗痔疮5000例体会[J].应用激光,1996,16(5)：240.
64.彭旭东.射频痔疮治疗机配合中药治疗肛门病154例[J].四川中医,2004,22(8)：85-86.
65.任江涛.红外线光固化治疗内痔320例疗效观察[J].山西医科大学学报,2005,10(8)：23-24.
66.李东冰等.铜离子电化学疗法治疗痔出血及痔脱出的实验研究及临床观察.中华医学杂志,2003：83(11)：958-961.
67.唐磊,张泽平.外剥内扎治疗混合痔157例[J].航空航天医药,2005,18(3) ：177.
68.高原,马富明.混合痔手术方式的探讨[J].内蒙古中医药,2008,27(4) ：57 - 58.
69.王琛.环状痔手术治疗进展[J].上海中医药大学学报,2005,19(4)：5759.
70.张金良.分段齿形外剥内扎术治疗环状混合痔200例[J].中国中西医结合外科杂志,2007,13(3)：287-288.
71.徐道昆,钱伟,陈莉莉.改良分段剥扎加内括约肌部分离断术治疗环状混合痔196例临床观察[J].浙江临床医学,2007,9(9)：1223.
72.史仁杰,谷云飞,许广涛,等.保护肛垫悬吊缝合治疗环状混合痔30例临床研究[J].江苏中医药,2004,25(11)：16-18.
73.王海兵.保留齿线术式治疗混合痔60例临床观察[J].宁夏医学杂志,2008,30(5)：443-444.
74.邵学芹.改良外剥内扎术治疗环状混合痔100例疗效观察[J].实用中西医结合临床,2008,8(1)：26-27.
75.王达方.消痔灵注射保留齿线术式治疗混合痔200例[J].中外健康文摘,2007,4(5)：167-168.
76.秦澎湃,李英茹,卢卫星.多普勒引导下结扎痔动脉治疗内痔31例[J].中国普通外科杂志,2007,16(9)：932-933.
2.张东铭,孟庆有,钱雨根,等.肛门部血管分布[J].中国肛肠病杂志,1986,6(2)： 3.
3.钱立元,蔡立峰,朱晒红,等.痔与门脉高压症的研究[J].中国肛肠病杂志,2001,21(3)：19-20.
4. WaddellWG, Bouchard AG, Wellington JL, et a.1 Functional relations ofthe proximal components of the portal system, A preliminary report [J]. J SurgRes,1972,12(4):281-289.
5. ThomsonWH. The nature ofhaemorrhoids[J]. Br J Surg,1975,62(7): 542-552.
6.夏祖宝,张东铭.痔区黏膜的组织学观察[J].中国肛肠病杂志,1985,5(2)：3.
7. HaasPA, FoxTA Jr.Age-related changes and scar formations of peri-anal connective tissue[J].DisColon Rectum,1980,23(3):160-169.
8. HaasPA, FoxTA Jr, HaasGP. The pathogenesis ofhemorrhoids[J].Dis Colon Rectum,1984,27(7):442-450.
9. Parnaud E, GuntzM, Bernard A, et a.1 Normalmacroscopic and micro-scopic anatomy of the hemorrhoidal vascular system [J]. Arch FrMal App Dig,1976,65(7):501-514.
10.张东铭.肛垫微循环及循环障碍[J].中国肛肠病杂志,2004,24(6)：31-33.
11. RoeAM, BartoloDC, VellacottKD, et a.1 Submucosal versus ligation ex-cision haemorrhoidectomy:a comparison ofanal sensation, anal sphincter manometry and postoperative pain and function[J]. Br J Surg,1987,74 (10):948-951.
12. MillerR, Bartolo DC, Roe A, et a.1 Anal sensation and the continence mechanism[J]. DisColon Rectum,1988,31(6):433-438.
13.Felt-BersmaRJ, PoenAC,CuestaMA, eta.1 Anal sensitivity test:what does it measure and do we need it? Cause orderivative of anorectal com-plaints [J]. DisColon Rectum,1997,40(7):811-816.
14. MadoffRD, Fleshman JW, Clinical Practice Committee, American Gas-troenterological Association. American Gastroenterological Association technical review on the diagnosis and treatmentofhemorrhoids[J]. Gas-troenterology,2004,127(3):1017-1018
15. AlperD, Ram E, Stein GY, et a.1 Resting anal pressure following hemor-rhoidectomy and lateral sphincterotomy[J]. DisColonRectum,2005, 48(11):2080-2084.
16. Chanhan A, Thomas S, Bishnoi PK, et a.1 Randomized controlled trial toassess the role of raised analpressures in the pathogenesis of symptomat-ic early hemorrhoids [J]. Dig Surg,2007,24(1):28-32.
17. Read NW, Sun WM. Hemorrhoids constipation and hypertensive anacushions[J]. Lancet,1989,1(8636):610.
18. Jahanson JF, SonnenbergA.The prevalence of hemorrhoids and chroni constipation. An epidemiologic study[J]. Gastroenterology,1990,98 (2):380-386.
19. MaeLeedJH. Amethod of proctology · NewYork. Medieal Department HarperRow,19804
20. Marino · AW Jr · Anorectal surgery — hemorrhoids · DisColonRectum, 1980· 23:211—222 ·
21. Alexander—WilliamsJ. ThenatureofPiles. BrMedJ,1982,285(6349):1137.
22.牛治君,牛明星.大黄牡丹汤加味治疗嵌顿性内痔.中国肛肠病杂志,1995,950：7～8
23.赵连生,董玉琛,杨秀华.自拟活血化瘀加味治疗痔疮80例.内蒙古中医药,2001,9(20)：39
24.宋爱利.血府逐瘀胶囊治疗肿痛痔疗效观察.北京中医杂志,200221(2)：40
25.李思芳.自拟连仙消痔汤治疗内痔19例小结.贵阳中医学院学报2000,22(3)：26.
26.贺向东,石耀武,郑鑫.痔炎灵浓缩液治疗混合痔感染出血738例临床观察.陕 西中医学院学报,2002,25(4)：36～37
27.杨巍,陈勇.痔血宁合剂治疗痔急性发作的临床观察.辽宁中医杂志,2002,29(7)：404
28.冯文新.清痔冲剂治疗痔疮的临床观察.四川中医,1995,9(10)：47
29.冷伟.止痛如神汤治疗急症痔.安徽中医临床杂志,1997,9(1)：54
30.吴冰,戴继杭.泻心汤治疗内痔出血74例疗效观察.中国肛肠病杂志,1998,18(3)：35
31.荀洪仙.补中益气汤化裁治疗内痔脱垂56例.湖南中医杂志1997,13(3)：48
32.谢国良.自拟参赭升降消痔汤治疗内痔60例.陕西中医,2001,2(9)：538
33.赵翠峰,刘道勉,张成群.中药熏洗治疗血栓痔160例.现代中西医结合杂志,2001,10(12)：1159
34.刘成伟,潘素滢.痔宁熏洗冲剂治疗炎性痔106例临床观察.新中医,2003,33(4)：25～26
35.郭正东,段延筑,马聪.痔安散熏洗疗法在痔科疾病中的应用.中国肛肠病杂志,2004,24(3)：12～13
36.陈晓君,宗丙华.消痔膏外敷治疗痔疮43例.中医外治杂志,2003, ：17
37.梁劲军,吴维城,李华山,等.敷痔散治疗嵌顿痔95例疗效观察.新中医,2000,32(5)：15～17
38.黄友土.消痔膏治疗嵌顿性内痔及炎性外痔.中医外治杂志2001,10(3)：42
39.倪宝成,王宽奎.消痔检治疗肛肠痔病临床体会.中国肛肠病杂志,1998,18(3)：39
41.韩丽君,任建国,郜英,等.复方痔康栓治疗混合痔80例临床观察.中医药研究,2002,18(1)：20
42.李补常.针刺天窗治疗痔疮56例.针灸临床杂志,1999;15(4)：48
43.叶红.针灸结合中药熏洗治疗产后痔疮52例.中医外治杂志,2002;2,11(1) ：9
44.李华中.壮医药线点灸治疗痔疮50例.四川中医,2000;18(11)：47
45.刘光忠.艾灸“痔点”治疗痔疮50例疗效体会.针灸临床杂志,2001(3) ：34
YU B M, LIN J J,WU W Q. A multicentral self controlled clinical study on the effect of Alvenor on acute attack ofhemorrhoids[J]. Chin J Gen Surg,2004,19(12):722-724.
47. DIMITROULOPOULOS D,TSAMAKIDIS K, XINOPOULOSD, et al. Prospective, randomized, controlled, observer-blindedtrial of com-bined infrared photocoagulation and micronizedpurified flavonoid fraction versus each alone for the treatmentof hemorrhoidal disease [J]. Clin Ther,2005,27(6): 746-754.
48. ZHANG L N, SHI H Q, LU G Q. Compound Ginkgo bilobaextract capsules [J]. Chin J New Drugs 2004,13(5):471-472.
49. YANG X Q, CHEN C W. Clinical trial of compound Ginkgobiloba extract capsule on cases with operation of hemorrhoids[J]. J Coloproctol Surg, 2004,10 (1):44-47.
50. FAN H X, ZHU X Q, HU A, et al. Study of compound flavoneof Ginkgo biloba leaves on the treatment of haemorrhoid [J].Chin J Mod Appl Pharm,2004, 21 (3):170-172.
51. XU C M, ZHU L T, HAN R. Melilotus extract tablets [J]. Chin J New Drugs, 2007,16 (4):332-333.
52. LIU Z R, CHENG Q Y, ZHU Y F. Experimental and clinicalstudies of melilotus extract in treatment of hemorrhoid [J]. JColoproctol Surg,2004, 10(3):189-191.
53. FU C G, YANG W, SUN J H, et al. Clinical research ofmelilotus extract in the treatment of hemorrhoids [J]. Chin JGastrointest Surg,2004,7(4): 270-272.
54. WANG C S, DING C, TIAN S Z. A new Anti-inflammatorydrug:Aescuven forte [J]. Chin J New Drugs,1998,7(5):389-390.
55. SHAO X J, ZHAN H L. Clinical observation of Aescuven forte to treat hemorrhoids [J]. J Colorect Anal Surg,2007,13 (2):110-111.
56. ZHANG M, SHU J, ZHOU J Z, et al.1360 cases of hemorrhoidstreatment by Aescuven forte [J]. Shanxi J Tradit Chin Med,2003,24(4):332-334.
57. FENG J J, XIANG F. Clinical observation of Aescuven forte totreat hydrops after mixed hemorrhoids operation [J]. Practical JClin Med,2007, 4(2):69.
58. Nagy A. Willnerp, Jankoieh Met al Eight_year experi-ence in treatment of hemorrhoidal disease. Acta Chi Hung,1998.37:71.
59.吕孝东,田志刚.电子痔疮仪与注射消痔灵治疗内痔疗效比较[J].应用激光,1998,18(8)：848.
60.公重康.WHSD-Ⅲ型电脑痔疮治疗仪临床应用体会[J].中国疗养医学,2000.45(7)：5-6.
61.宫毅.脉冲电中药离子导入治疗痔的临床与实验研究[J].云南中医学院学报,2000,23(4)：7-11.
62.徐梅.氦氖激光及旋磁治疗痔疾疗效观察[J].中国疗养医学,2002,11(4) ：9-10.
63.李宏学,顾志强.C02激光治疗痔疮5000例体会[J].应用激光,1996,16(5)：240.
64.彭旭东.射频痔疮治疗机配合中药治疗肛门病154例[J].四川中医,2004,22(8)：85-86.
65.任江涛.红外线光固化治疗内痔320例疗效观察[J].山西医科大学学报,2005,10(8)：23-24.
66.李东冰等.铜离子电化学疗法治疗痔出血及痔脱出的实验研究及临床观察.中华医学杂志,2003：83(11)：958-961.
67.唐磊,张泽平.外剥内扎治疗混合痔157例[J].航空航天医药,2005,18(3) ：177.
68.高原,马富明.混合痔手术方式的探讨[J].内蒙古中医药,2008,27(4) ：57 - 58.
69.王琛.环状痔手术治疗进展[J].上海中医药大学学报,2005,19(4)：5759.
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