There are many drugs used in injection therapy, but basically the two main categories are sclerosing agents and necrotizing agents. Because of the many complications caused by necrotizing agents, sclerosing agents are currently advocated, but complications can also occur if too much sclerosing agent is injected.
The purpose of injection therapy is to inject sclerosing agents into the hemorrhoids around the block, producing a sterile reaction to achieve small vessel occlusion and atrophy, the prolapsed anal cushion and muscle adhesions fixed no longer prolapse. Commonly used sclerosing agents are 5% petrocarbonate vegetable oil, 5% sodium cod liver oil acid, 5% quinine hydrochloride urea aqueous solution, 4% alum aqueous solution and anti-hemorrhoid injection, etc.
It has been suggested that sclerosing agents can cause occlusion of the hemorrhoidal artery after injection, and therefore atrophy of the hemorrhoidal mass. It is to be confirmed pathologically.
Indications and contraindications of injection therapy for internal hemorrhoids.
1.Indications
All internal hemorrhoids without complications can be treated with injection therapy. The most suitable for injection therapy is stage I internal hemorrhoids, complaining of blood in the stool and no prolapse, which can stop the bleeding with one injection, with obvious effect and high two-year cure rate; stage II and III internal hemorrhoids can prevent or reduce prolapse after injection, and can still be injected after re-bleeding and prolapse after surgery. Patients who are old and frail, have severe hypertension, heart, liver and kidney diseases can be treated by injection.
2. Contraindications Any external hemorrhoids and internal hemorrhoids with complications (such as embolism, infection or ulceration) are not suitable for injection therapy.
3.Injection therapy can be used as a supplement to other treatment methods, such as mixed hemorrhoid surgery while dealing with internal hemorrhoids, and some PPH surgery while doing sclerotherapy injection.
The operation method of injection therapy for internal hemorrhoids.
The patient should empty the stool before the injection, take the lateral or knee-chest position, disinfect the injection site by the oblique head or round-headed anoscope and then stab the needle tip into the submucosa above the root of the hemorrhoid block on the tooth line about 0.5cm, the needle can move to the left and right after stabbing, that proves to be in the submucosa; if the stabbing is too deep into the mucosal muscle layer or sphincter, the needle tip is not easy to move to the left and right, the needle should be pulled out a little and no blood is returned by suction, then it can be injected. The needle should not be pierced into the central venous plexus of the hemorrhoid block to prevent the sclerosing agent from entering the circulation and causing acute hemorrhoid vein embolism.
The amount of drug injected generally depends on the degree of mucosal relaxation and the size of the hemorrhoid block, the general amount of 5% petrocarbonate vegetable oil is 2m1~4ml, if the mucosa is very relaxed it can also be injected 6ml. inject 3 female hemorrhoids total 10m1~15ml, inject the drug into the submucosa within the submucosa, so that the injected part becomes a light red slightly with white bulge, in the surface of the bulge sometimes visible microvascular, this phenomenon is called This phenomenon is called “streak sign”.
If the injection is too shallow, the mucosa at the injection can be seen immediately to become a white bulge, and later necrosis and detachment will leave a superficial ulcer; if the injection is too deep and pierces the muscle layer of the intestinal wall, it can immediately cause severe pain, so the depth of the injection is related to the success or failure of this therapy. It is not advisable to inject at the front center because it is easy to damage the prostate, urethra or vagina.
After the injection is completed and the needle is removed, the puncture site should be observed for bleeding. If bleeding occurs, sterile cotton balls can be used to stop the bleeding for a few moments. Usually when the anoscope is removed, the sphincter muscle contracts to prevent bleeding from the needle hole or the sclerosing agent from flowing out of the needle hole. Injections should be given every 5 to 7 days, with no more than 3 internal hemorrhoids per injection. 1 to 3 times is a course of treatment. The site of the second injection should be lower than the first, and if 10% petrocarbonate vegetable oil or 5% sodium cod liver oil acid is used, the amount of each injection should not exceed 1ml, and it is best to use a tuberculin syringe to inject.
Notes on injection therapy.
1, the first injection is the most important, such as the injection of sufficient amount of good efficacy, to a smaller number of multiple injections is better, the injection needle should be used 9; long puncture needle; if too fine, the drug is not easy to push into, too thick easy to cause bleeding.
2, the injection and after the injection, there should be no pain. If you feel pain, often the injection is too close to the tooth line, so the tip of the needle into the place, must not be below the tooth line.
3, 24 hours after the injection should not defecate to prevent prolapse of the hemorrhoid; if there is prolapse, the patient should be told to immediately retract, so as to avoid venous embolism.
4.Before the second injection, do rectal examination, if the hemorrhoid block has hardened. It indicates that the mucosa has been fixed, then no further injection should be made. Or try by anoscopy first with a blunt needle, if the surface mucosa of the hemorrhoid nucleus is relaxed, then proceed with the injection.
5. If the injection site is too deep, it can lead to local necrosis, pain or abscess formation.
6. After injection, you should rest in bed for a moment to prevent deficiency and other reactions.
Complications:
The treatment of internal hemorrhoids with 5% petrocarbonate vegetable oil injection is very safe and complications rarely occur. Complications are mostly due to incorrect depth of injection
1. Infection or abscess formation at the injection site. It is mainly related to incomplete disinfection.
2.The ulceration and bleeding of rectal mucosa can occur, mainly because the injection site is too shallow and should be injected between the anal cushion and muscle layer, not in the hemorrhoid mass.
3.If you are a male, when injecting the right anterior internal hemorrhoid, if it is too close to the anterior median, it can damage the prostate and urethra and cause hematuria. Therefore, we should pay attention to the injection technique.