| Research background:Hemorrhoid was a common and frequently-occurring disease,which was the anal cushion took place pathological hypertrophy, shift, and cluster formation of perianal subcutaneous vascular plexus blood stasis, and emerged clinical symptoms such as bulge, pain,bleeding or incarcerated, it was called hemorrhoids. The incidence of hemorrhoids were high at home and abroad, The 57292 persons in 155 units were investigated if suffer from hemorrhoids from 1975 to 1977 in our country.the number who diagnosed hemorrhoids were 26503 persons, accounting for 46.3%, while the number was 36.4% accounting for in UK survey and 13.3% in USAHemorrhoids treatment was divided into the conservation and operation people could not think that hemorrhoids was trifling ailment and the neglect of treatment, At began it was generally applied more conservative treatment, include increasing diet cellulose such as eating more vegetables, fruits and sweet potato, water intake, maintaining defecate unobstructed. Local medicine:such as Mayinglong hemorrhoids ointment was squeezeed in anus.These measure could be used in patients such as ligation, infrared coagulation and hardening agent injection therapy if conservative treatments failed. Despite the conservative treatment of hemorrhoids had made great progress in recent years, the hemorrhoids resection rate decline and the rise of anal cushion preserved operation,these were not mean that traditional hemorrhoidectomy operation was not important, especially for hemorrhoids which had developed to the third or fourth degree, no matter the pathological anatomy, or physiological function had no longer recovered normality, or the effect of treatment in acute hemorrhoids wer not improved with other methods, The operation was very important. Hemorrhoids resection was considered the most important standard in hemorrhoids operation, the Milligan-Morgan operation was the most widely uapplied in the world,But this operation had different degree destroyed normal anal cushion structure,which caused more anal pain, anal edema, hemorrhage, urinary retention and other complications after operation. The pain of the patients was severe and took a lot of recovery time for the patients.To relieve postoperative pain, Italy scholar Longo initiated the procedure for prolapse and hemorrhoids (PPH) in 1998 according to the theory of anal cushion down.because this type of operation had not skin incision in the perianal and preserved anal cushion, the postoperative pain was more lighter, in hospitalization time was shorter, and ability of controlled drainage was not affected, no fecal incontinence complications occured, it was widely applied at home and abroad.The domestic scholar created selective hemorrhoid mucosal resection (TST) on the basis of PPH(the procedure for prolapse and hemorrhoids),it was a new operative method, the operation changed from circumcision to selective resection, anal stricture complications.was effectively avoid.The above two kinds of operation mode had applied in clinical for more than ten years, although short-term postoperative effect was good, the long-term effect was not obvious, there were still residual skin tag, prolapse recurrence problem after operation, and the recurrence rate was significantly higher than that of Milligan-Morgan operation, also sometimes created many serious complications:such as perforation of rectum, rectal fistula of vagina, pelvic sepsis, pelvic hemorrhage, Phu Lenies gangrene, these complications did not occurred in traditional operation and the complications were all required laparotomy or bypass operation.Anorectal fistula is a kind of abnormal pipeline which anal or rectal because of pathological element communicated with the formation of the skin around the anus, it was shortly called for anal fistula. Fistula formation around the anus was called anal fistula.The vast majority of it was sequelae of perianal abscess incision and drainage or natural rupture, it was the clinical common disease, the incidence rate of close to perianal abscess, the minority of it was specific infections:such as tuberculosis, Crohn’s disease, ulcerative colitis, anal rectal trauma and tumor rupture secondary infection Kui also could cause anal fistula, but was extremely rare. The inner opening was in anal sinus and its nearby, outside the hole was located in the skin around the anus.Inside or outside the mouth could be single or many, majority of patients were young people aging from 20 to 40 years old, and men were more than women.Patients usually did not have any obvious symptoms. Some local symptom was very light, sometimes anal itching,discharging water, anal wet itching, Sometimes got good or bad.The treatment of anal fistula was divided into the conservation and operation, conservative treatment was limited to outside the mouth closed, rigid cable existed, without any obvious symptoms for many years, it may be natural healing and need not treat. Most patiets need operation treatment. Operation treatment was the fundamental. Many of the current mode of operation in anal fistula were applied in clinic, but the anal fistulotomy still was one of the reliable methods of clinical conventional. This operation was most commonly applied in clinic and was the most basic operation of anal fistula, suitable for low simple or complex anal fistula, straight and curved fistula.There some minimally invasive operation appeared in ten years, such as:.CO2 laser treatment,freezing treatment,electrotherapy treatment.the methods had the advantages of simple operation, little pain, no bleeding, no anal incontinence.but their indications were narrow,only applied to simple and straight fistula.Another method was medical ZT adhesive blocking,applying to low and simple fistula.The specific method was as follow:at first probed the hole from outside to inside with a bougie after anesthesia, determining the fistula contorts, scraped and removed necrotic tissue in the tube and secretion with a small curette. Then rubber plastic pipe filled with ZT was inserted into the inner mouth of fistula, the left index finger of performer inserted into the anus to touch the plastic pipe head, right hand fixed plastic pipe and quickly injected in inner hole of fistula with ZT glue, for 1-2 ml each fistula. Although this method of minimally invasive did not hurt the muscles around the anus, it must first find the inside the mouth,the second the price of ZT glue was expensive, limiting its use in clinical practice, the most important thing that recurrence rate.is high through clinical practice.Although Milligan-Morgan technique had more than 60 years of history, repeatly improving during the period, it was still traditional and effective method in the treatment of mixed hemorrhoids. The rate of postoperative complications was high:such as urinary retention,anal pain, anal edema, hemorrhage, The pain of the patient was severe, recovery time was long. The complication of anal fistula incision had pain and bleeding, especially wound healing was slow and postoperative dressing time was long, even false healing, it was a kind of pain and suffering for the patient and was an urgent problem to be solved for anorectal doctorHow to find a drug to reduce or mitigate postoperative complications of Milligan-Morgan surgery and anal fistula incision, it had become a thorny problem for the anorectal doctor.Chitosan was a natural polymer, which belongs to the amino polysaccharide, scientific name was [(1.4)-2-acetyl amino-2-deoxy-D-glucose] beta. It was rare a high molecular compound positive charge and was the only cationically charged alkaline so far in the polysaccharide, chitosan existed widely in the cell of lower organisms, fungi, algae and the shell.of shrimp, crab, tardigvada insects.Gel could retain large amounts of water in the structure, three-dimensional polymer network expansion which was not easy to decompose, this structure meaned that the drug was capable of absorbing exudate, and could keep the water of the wound surface, and had high permeability to water vapor and oxygen, and had the advantages of similar physiological mechanical properties of soft tissue, chitosan gel (type III) was mainly made of chitosan, It was a kind of biodegradable high molecular polysaccharide biological material, it was aromatic and translucent gel,insoluble in water and soluble in sour, dynamic viscosity was not less than 1000mPa/s, the value of PH was 4.0-7.0, it was good biocompatibility, low toxicity, biodegradability.Chitosan inhibited the growth of many bacteria,it was a natural antimicrobial substances of very broad spectrum antimicrobial, significantly inhibitory effect for Gram-positive bacteria and gram-negative bacteria and fungi and it quickly step bleeding and promoted wound healing effect, besides the chitosan had a strong adhesion tissue,it was more effective than fibrin glue in preventing the sealing air leakage of the small free intestine,artery, trachea tissue, It could protect the mucosa wound from bacteria invading, and could form bio-adhesive film on the wound after the second day of treatment, effectively isolating hostile environment with the rectum, protecting the wound, at the same time relieving the pain of the wound.Chitosan also promotly absorbed local edema, reduced inflammation invasion and conduced to discharge of stool, so that a variety early symptoms of patients could been significantly improved.In recent years, more and more people pay attention to care the applied in field of food, medicine, health care, biological medicine.Foreign Chervinets VM reported clinical effect of chitosan in the treatment of bacterial vaginitis in the 2011 and pointed out that chitosan was a promising drug in the treatment of bacterial vaginosis. LandeckL, Ssbath Sin did a randomized, double blind controlled trial in 2010, Sprayed each containing chitosan and chitosan-free volunteers sprayed on legs. the results was that bacteria count was significantly reduced on the lap of chitosan(P <0.001), finally pointed out chitosan could be used as a topical antibacterial agent in the future. Yang Yang, Chen Xue reported the repair of different concentrations of bone marrow stromal cells in combination with chitosan conduit grafts in adult rat spinal cord injury model in 2011,and pointed out that artificial tissue grafts made of bone marrow stromal cells in combination with chitosan conduits could bridge defects caused by spinal cord injury, and restored some electrophysiological properties, promoted axonal regeneration. Zhang Jingrui, Lirong Jiang applied medical chitosan gel membrane in hemorrhoid surgery wound healing in 2010, and clinical efficacy, noted medical chitosan wound healing gel was effective, simple, effectively reduce the incidence of postoperative complications of hemorrhoids, worthy of promotion.The increasing number of about clinical applications of chitosan had demonstrated its superiority at home and abroad, in the current,but the report of clinical results of application in hemorrhoid surgery was very few at abroad.At present, experiment of rectal injury rats had not been reported in domestic. In the field of application in anal fistula was rarely. Chitosan was only used in the operation, quantity was little, the number of cases was very limited, it could not fully explain the effect and still needed more cases and the basic experiment further to analysis and assess. This research was based on the above problems, produced the model of rectal injury, objectively observed the effect of chitosan gel (type III), and further through clinical verification, so that provide a theoretical basis and clinical guidance for future treatment of anal fistula and hemorrhoids The research was divided into three parts:(1) Effect of chitosan gel(type #) treating the rectum injury induced by acetic acid. (2)Effects of chitosan gel (Ⅲ type) in postoperative wound of hemorrhoidectomy.(3) Effects of chitosan gel (Ⅲ type) in postoperative wound of anal fistula incisionEffect of Chitosan Gel Treating the Rectum Injury Induced by Acetic AcidObjective To detect the affection of chitosan gel on rectal injury induced by acid.Methods After the rats were anesthetized,4% acetic acid swab was put into the rectum of rats.it had been in for lmin and depth was 3cm.36 rats model of rectal injury were divided into model control group,positive control group and drug group with 12 rats each.Chitosan gel 1575mg.kg-1 was given in drug group through anal,while hemorrhoid cream 1575mg.kg-1 in the positive control group and continuous 6 days.At 30 min,1,4,6d after administration,3 rats in each group were sacrificed by exsanguination anesthesia and dissected,then visually observed rectal injury and the differences of rectal pathology morphology between the groups at the various time points of administration.Results At 30min,1,4,6d in medicine group after administrating chitosan gel, score of rectum mucosa damage in experimental group was lower than in model,positive group and athological phenomena(such as epithelial tissue necrosis,interstitial hyperemia,hemorrhage,edema,glanddamage,inflammatory cells infiltration) was significantly lighter than model,positive group and restored fast compared with model,positive group,and there was no obvious scar.Conclusion Chitosan gel could obviously alleviate the rectal damage caused by 4% acetic acid and had some therapeutic effect.Effects of chitosan gel (III type) in postoperative wound of hemorrhoidectomyObjective AIM To explore the clinical effects of chitosan gel in postoperative wound of hemorrhoidectomy.Method Choose the patients over 18 years old, Sclinically diagnosed as mixed hemorrhoids and Milligan-Morgan undergoing surgery, male or female. Excluded patients with diabetes, severe heart, liver, kidney dysfunction and coagulation disorders.a total of 122 patients who received Milligan-Morgan were divided into experimental group (n=63) and control group (n=59). The Experimental group was treated with chitosan gel in postoprerative wound for 7 days, while the control group used Mayinglong hemorrhoids ointment. Score of symptoms (such as pain, bleeding, edema, anus belly) were respectively recorded on the first day, the third day, the fifth day, the seventh day after hemorrhoidectomy, and then the total score was calculated. The clinical curative effect was evaluated through review after one year.Results Symptom scores of two groups had no significant difference (P>0.05) in first day after surgery. Symptom scores of the experimental group were lower than those in the control group on the third day, the fifth day, the seventh day after surgery, and the difference was significant (P<0.05). The effective rate was 95%(60/63) in the experimental group, while it was 92%(54/59) in control group. There was no significant difference in clinical curative effect between two groups (P>0.05). No serious complications (such as serious postoperative severe bleeding, infection, and bowel incontinencet) occurred in two groups.Conclusion Chitosan gel is better than Mayinglong hemorrhoids ointmento in alleviation early postoperative discomfort, while the long-term curative effect is similar to the latter.Effects of chitosan gel (Ⅲ type) in postoperative wound of anal fistula incisionObjective AIM To explore the clinical effects of chitosan gel in postoperative wound of anal fistula incision.Method Choose the patients over 18 years old, Sclinically diagnosed as anal fistula and undergoing incision surgery, male or female. Excluded patients with diabetes, severe heart, liver, kidney dysfunction and coagulation disorders.October 2011 to August 2014,a total of 136 patients who received anal fistula incision were divided into experimental group (n=74) and control group (n=62). The Experimental group was treated conventional dressing with chitosan gel in postoprerative wound, while the control group conventional dressing. Observated granulation tissue growth and Calculated healing time. Result The granulation tissue growth in test group was bettert han the control group in the first 7,10,14days after surgery, and the difference was significant (P<0.05). The healing time(16.3±2.2)d in test group was shorter than it (21.6±3.3)d in control group.there was significantly difference between two groups (P>0.05). No serious complications (such as serious postoperative bleeding, anal canal stenosis, defecate incontinent) occurred in two groups.Conclusion Chitosan gel (Ⅲ type) can promote the growth of granulation tissue, accelerate anal fistula surgery incision wound healing in clinicalThe top flash place in this article1.The model of rectum mucosa injury on rats in this experiment was prepared successfully.2.It start from the basic test in this paper,it was directly observed the change of the rectal damage and repair with the naked eye and microscope.and it had not been reported at home and abroad at present.3.It was closed related with clinical trying further verification,and it was little reported in the current clinical4.The effect of drugs of postoperative wound recovery in the clinical was tested by two common clinical trials,it was more persuasive and high credibility. |
PDF Full Text Request