1.Innovation and development
For centuries, surgical therapy has been the best method for treating anal fistulas. However, the use of surgical therapy in pediatric patients must be performed under appropriate anesthesia because of their age and physiologic function. When choosing clinical indications, it is generally preferable to postpone surgery for safety in children under 3 years of age and to use general conservative therapy. For this reason, it is envisaged to use a drug applied to the internal orifice of the fistula to close it and heal it, thus replacing surgical treatment. This method is an original study, the first of its kind at home and abroad, and has been successful in clinical treatment, and laboratory studies are continuing.
Professor Huang Naijian found in his long-term clinical practice that there are occasional cases of self-healing fistulas in children. Based on this situation, a compound Chinese medicine with the effect of dispelling wind and dampness and invigorating blood is used and injected into the anal canal in the form of a cream, so that the medicine is applied to the internal orifice of the fistula.
Through more than 15 years of clinical research, more than 400 cases have been cured and good results have been achieved. Especially in the last 3 years of systematic observation, the cure rate reached 100%. The method is a major innovation in the treatment of anal fistula, which is a breakthrough in the non-surgical treatment of pediatric anal fistula with medication and breaks the assertion that anal fistula cannot be cured without surgery. This method fully meets the requirements of not damaging any tissue and protecting the function of the anus intact in the treatment of anal fistula, and eliminates the fear of surgery among the patient’s family, which is of great significance in the treatment of anorectal diseases.
2.Application methods and points to note
(1) application method: take a small amount of the above medicine into a smaller container, with an appropriate amount of cool white water drops into the container to mix the powder into a paste (like toothpaste), and then use a cotton swab to take the paste into the empty needle (syringe), with the syringe core to push the paste to the front of the syringe, such as a 5ml syringe, the front section of the needle nozzle length of about 1.5cm, and the child’s anal fistula from the anal edge depth.
Before the injection of the child to take the appropriate position, generally the left anal fistula to take the left side of the lying position, the right anal fistula to take the right side of the lying position, the cream from the empty needle pushed out a little, so that the front part of the empty needle mouth has a little cream, this can play a lubricating effect, the empty needle mouth from the central anal canal slowly inserted into the child’s anal canal gently and slowly inject drugs, after the injection of the empty needle.
(2) Points for attention.
①Ointment concentration. It should be thick enough, the thicker the better, but can be pushed out from the empty syringe. Ointment should not be dilute, not empty syringe from the drug container will be pumped to the empty syringe.
② Depth of drug injection. The inner mouth of the pediatric anal fistula is about 1.5 cm from the anal verge. 5 ml of empty syringe front of the empty nozzle is 1.5 cm long, and the inner mouth of the anal fistula is at the same depth from the anal verge. The empty needle mouth completely inserted into the anal canal can be injected, injection of medicine, such as no cream from the empty needle mouth around the overflow out of the anus, the injection depth is appropriate, such as cream from the anal overflow, the injection depth is still shallow, the entire empty needle that is all empty needle body gently push forward, so that you can advance 1 ~ 3mm, that is, the injection depth can be deepened a few millimeters; at this time injection such as no cream overflow, injection depth has been appropriate, you can continue to inject medicine.
③If the ointment overflows from the anus after injection, wipe the ointment thoroughly with toilet paper immediately.
④The ointment should not be injected into the anal fistula tube.
⑤ This method does not require aseptic operation, so there is no need for local cleaning and disinfection and intestinal preparation before drug injection.
(6) Pay attention to the change in thickness of the anal fistula canal during treatment, as the change from thick to thin is a clear sign that the fistula is gradually healing.
(7) The medicine should not be used when the child has a cold, fever, or diarrhea, and should not be used if there are local cracks or ulcers in the anus. Vaccination should not be performed during the treatment period.
(8) Consult your physician for any dietary contraindications.
(3) Dosage and frequency of administration: 1.5ml per dose for children under 1 year old, 2 times a day. In order to inject the ointment into the anal canal smoothly, the medicine should be injected at bedtime, once at night when sleeping and once during the day when sleeping after defecating. For adults, 2ml of the medicine should be injected twice a day, once at night before going to bed, and at other times at your own discretion.
3.Cure standard and course of treatment
According to the modern medical viewpoint, the internal opening of anal fistula is a hard scar tissue and it is impossible to make it heal with medicine. The scar formed after fistula surgery is also connective tissue, but the scar can be softened over time after surgery, but it cannot disappear. The amazing thing about this treatment is that not only did the inner opening of the pediatric anal fistula gradually heal after the medication, but the canal changed from thick to thin, and from the original hardness to harder, and finally the canal disappeared completely.
The mechanism is not yet clear, but it is also a mystery of human function. If a fistula has an external opening, it is an obvious sign of progress if the external opening does not reopen 3 months after closing. The course of treatment: children within 1 year of age can generally heal in about 1 month, and most children heal in 2 to 3 months.
4.Related issues
(1) about the site of administration: according to the requirements, the ointment should be applied directly to the internal orifice of the anal fistula under direct vision, so that the site of administration is accurate, the drug is easy to act locally, and the effect is ideal. In clinical practice, however, it was found that children are prone to crying and difficult to cooperate with treatment, so this method of drug injection is used, and this method of administration does not emphasize the exact application of drugs to the internal orifice.
This method of drug administration does not emphasize the exact application of the drug to the internal orifice area because there is indeed blindness in the way the drug is applied to the internal orifice area, i.e., the drug application site is not accurate. However, clinical practice has confirmed that the drug injection method in this study can completely cure pediatric anal fistula with little local irritation and is easily accepted by children.
(2) Advantages and disadvantages of this treatment: this method is easy to operate, painless, without side effects, with definite efficacy, and easily accepted by children and their families. Due to the inadequacy of the drug delivery method, the course of treatment for children is longer and needs to be further improved.