Clinical Research On The Therapy Of Xiaozhiling Injection For Complete Rectal Prolapse

This thesis includes literature summary and clinical study.The literature summary is divided three, aimed at the research development of rectal prolapse of traditional Chinese medicine (TCM), western medical study as well as injection therapy. The content has involved the understanding of the disease, etiology, pathology, classification, diagnostic criteria and treatment.Rectal prolapse, which is called rectocele in traditional Chinese medicine (TCM), is defined as a protrusion of the rectum, the anal canal and the sigmoid colon beyond the anus. The pathogenesis is mainly Qi and blood deficiency, collapse of middle-warmer energy, lingering diarrhea and so on. The treatment should be based on the patient's symptoms, synthesis of the four diagnostic methods, including internal medicine, washing, external applies, ironing, acupuncture treatment, and so on. The treatment above can only make a good effect in first degree prolapse, especially in children, however, for the second and third degree prolapse, it is hard to receive good result, and other surgical therapies are needed.Modern medicine for rectal prolapse tends to sliding hernia theory and intussusception theory. In their treatment, a large number of surgical procedures have been described to correct this disorder. Generally speaking, they are classified as abdominal or perineal approach according to the route of access. In addition laparoscopic surgery shows the latest progress, PPH also reported a lot. Diversity of the operations properly demonstrates that a single surgical operation is not appropriate for all patients with rectal prolapse. A large number of randomized controlled trials are needed to improve the evidence with which the optimal surgical treatment of rectal prolapse can be defined.Injection therapy is applied widely in domestic hospitals. There are various types of sclerotherapy, such as various concentrations of alcohol, saline, glucose, alum agents. The sclerotherapy was applied to the treatment of rectal prolapse. The injection can stimulate the tissue to produce aseptic inflammation and fibrosis in outer layer of rectum (perirectal spaces) and inner layer (rectal submucosa) to reinforcement the rectum and makes good results. It is worth noting that the most widely used sclerotherapy is xiaozhiling injection.Clinical research:Objective: To observe curative effect about the therapy of xiaozhiling injection for complete rectal prolapse and try to study the pathogenesis of the disease, as well as the treatment mechanism of Xiaozhiling injection for complete rectal prolapse.Methods: From September 2006 to March 2009, 35 cases with rectal prolapse were referred to the department of Proctology in Guang'anmen Hospital. They were subjected to prospective clinical study. 27 cases of the total were taken double-layer four-step injection therapy, and the other 8 cases were taken simple injection of rectal around. The use of double-layer four-step injection is as follows: that is, the left and the right side of rectal pelvic space with Xiaozhiling injection 20ml respectively, and 15ml to the space behind rectum, then rectal submucosa with injection of 1:1 dilution 40-60ml. Simple injection around the rectum is : the left and the right side of rectal pelvic space with Xiaozhiling injection 30ml respectively, 20ml to the space behind rectum, and the anterior wall of the rectum with injection of 1:1 dilution 20ml, without submucosal injection. Observation of the efficacy index is the improvement of symptoms, such as the length of rectal prolapse, pain, blood in the stool, secretion, pruritus, constipation, tenesmus, rectal mucosa, and the overall statistical points. The safety indicators are mainly blood tests and liver and kidney function tests. In addition, with the introduction of the entire digestive tract imaging, combined with defecography, the doctors can evaluate whether it is accompanied with prolapse of small intestine. Moreover, anorectal manometry makes people understand the change of anorectal pressure before and after the treatment.Results: During a follow-up period of 1～30 months, all the 35 patients werestudied. The outcome after injection treatment was classified in three categories: Cured: n = 30 (85.71%); Improved: n = 2 (5.71%); Failure (fully recurrent): n = 3 (8.57%). The total effective rate was 91.43%. Throughout the treatment, the symptom of prolapse and blood improved completely. For perianal secretion, pruritus, constipation and rectal mucosa, a marked improvement can be seen before and after treatment. Rectal abscess and necrosis didn't appear after large doses injection. Blood tests and liver and kidney function tests didn't show obvious difference. Among the 9 cases with entire digestive tract imaging, there are 5 cases with small intestine prolapse.Conclusion: Xiaozhiling injection can produce aseptic inflammation and fibrosis in perirectal spaces and rectal submucosa to reinforcement the rectum.①The therapy of xiaozhiling injection for complete rectal prolapse is painless, low-cost and safe. No abnormal changes were seen in the liver and kidney functions with high-dose injection. Besides it is easy to operate, suitable for hospitals at all levels to accept and apply. Therefore, the therapy of Xiaozhiling injection should be used as the first choice of all treatment, even in recurrent cases. Sugical operation should be reserved for those patients in whom twice standard injection treatment had failed.②Similar effect was gained between double-layer four-step injection and simple injection of rectal around. Simple injection of rectal around without submucosal injection reduces the chance of infection; it increases the injection volume around the rectum and is conducive to the fixing of rectum and surrounding tissue; besides anterior injection improves efficacy. Moreover, patients with small intestine prolapse can also be cured by the injection, so we believe that submucosal injection is not needed for the vast majority of cases , and only a very few patients need adjuvant therapy.③The introduction of the entire digestive tract imaging makes a certain significance for exploring the pathogenesis of prolapse. We believe that those associated with prolapse of small intestine, take the conventional injection treatment. In other words, patients with prolapse of small intestine can be considered to give the appropriate adjuvant therapy, such as anterior rectal wall injection to reinforcement effect.④Individual patients after injection showed anterior wall prolapse. The initiating factors must be dealed with, such as with internal hemorrhoids, polyps, so as not to affect the treatment effect; In order to achieve the best therapeutic effect, in the clinical process, several surgical approach aimed at anal sphincter relaxation, mucous relaxation can be considered, such as Thierch operation, tightening operation, as well as ligation mucosa, rectal scar fixation, which needed further study.