中医治疗直肠脱垂介绍.doc

PAGE PAGE 11 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2009-3-30） 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 Introduction of Depletion-Relieving Injection for Treatment on Rectal Prolapse Hanbao, Beijing Abstract Tuo Gang Bing, a term in Traditional Chinese Medicine corresponding to the rectal prolapse in terminology of the modern medicine, refers to the inferior translocation of proctodaeum, rectal mucosa, the full-thickness rectum, and partial sigmoid colon, with or without the prolapse out of the anus. With significant advantages in the treatment on rectal prolapse, traditional Chinese Medicine provides three main therapies including Symptom Differentiation and Treatment Administration, injection, and surgery, especially Xiao Zhi Ling as the preparation of Traditional Chinese Medicine applied to rectal prolapse, which is characterized in the advantages of simplified administration, low cost, safety, less sufferings and better effects, in spite of a certain recurrence rate as its shortcoming. The Treatment Administration based on stages and types of the rectal prolopse is the key to improve the therapeutic effect. Rectal submucosal injection, rectal mucosa ligation, or rectal circumferential mucosectomy can be adopted for type 1 rectal prolapse, while grade I or II (the full thickness rectal prolapse) in type II can be treated with double injection into both the exterior and interior layers of the rectum. Satisfactory effects have been observed in all of the therapies as