嵌顿痔火毒炽盛与湿热下注证型组织病理差异性研究
|
摘要
嵌顿痔是肛肠科的常见的急症之一,其发病时痔核脱出、肛门下坠、局部肿胀疼痛以致活动行走受限、排便排尿困难等,给患者本人带来了极大的痛苦,而治疗不及时或治疗不当,嵌顿时间过长,又容易导致病情加重恶化,痔核粘膜表面糜烂以至痔核坏死、渗血、渗液、感染、纤维化甚至发生菌血症或败血症、脓毒血症等。在嵌顿痔中医辨证分型上尤以火毒炽盛型与湿热下注型最为常见。而目前对于无嵌顿型混合痔的治疗医学界已取得了共识,但对于嵌顿痔的治疗原则仍存在分歧,加之对嵌顿痔病理及其病因机制的研究国内外尚不多见,因而在其治疗原则上广大学者对于是否应该行急诊手术一直都未取得共识。
目的：针对上述,本研究将通过收集不同症型(火毒炽盛型、湿热下注型)嵌顿痔的痔组织的手术切除标本,以光镜为观察手段,比较观察标本组织中的病理变化。通过组织病理与中医证型的研究与对照,观察两者的差异,进而探讨嵌顿痔的发病机理与中医证型的关系。并根据不同治疗方案(急诊手术、亚急诊手术)对入组病例进一步分组并观察比较其标本组织中的病理变化,从而为嵌顿痔发病中是否发生感染及临床嵌顿痔治疗是否可予行急诊手术提供科学的病理学与中医学依据,为临床更好地治疗嵌顿痔提供理论依据及临床参考价值。
方法：参照1992年全国第七届肛肠学术会议制定的嵌顿痔的临床诊断标准及2006年7月中华医学会外科学分会结直肠肛门外科学组、中华中医药学会肛肠病专业委员会、中国中西医结合学会结直肠肛门病专业委员会讨论通过的《痔临床诊治指南(2006版)》,并根据患者就诊时嵌顿情况和全身症状进行中医辨证分型分组。将符合临床诊断标准的嵌顿痔患者24例分为治疗1组(火毒炽盛型)12例与治疗2组(湿热下注型)12例,其治疗根据就诊时患者嵌顿痔情况及中医辨证论治分型后,视其严重程度,分为两种治疗方案：对于嵌顿时间较短,且疼痛等症状虽较严重但未见到痔核坏死及明显感染等手术禁忌症的患者,则予以治疗方案1(急诊手术治疗)；对于部分嵌顿时间较长,且脱出嵌顿的痔核较大,或其他多种原因,如痔核坏死,出现明显感染等不宜即刻施行手术治疗的患者,则予以治疗方案2(先予以保守治疗,待当前症状已缓解,水肿、糜烂等局部炎症已得到控制并好转后,再行手术治疗)。其中病理采取,治疗方案1者采取术后病理组织；治疗方案2者采取术前未予消炎、消肿等处理措施的病理组织,即术前病理组织。病理评定指标：粘膜炎症浸润程度、粘膜炎症程度、炎症细胞浸润种类、血栓形成机化程度及间质水肿程度并统计发现菌落标本数量。
结果：火毒炽盛型与湿热下注型嵌顿痔痔核组织病理各项积分情况通过统计学分析得出两组病例在粘膜炎症浸润程度、粘膜炎症程度、炎症细胞浸润种类方面比较不存在统计学差异(P>0.05),但在血栓形成机化程度、间质水肿程度方面比较存在统计学差异(P<0.01),且差异情况表明湿热下注型血栓形成机化程度、间质水肿程度积分较火毒炽盛型更为严重；而急诊手术组与亚急诊手术组嵌顿痔痔核组织病理各项积分情况通过统计学分析得出两组病例在粘膜炎症浸润程度、粘膜炎症程度、炎症细胞浸润种类、血栓形成机化程度及间质水肿程度诸方面比较不存在显著统计学差异(P>0.05)；且所有病理切片中没有一例见到明显菌落存在。
结论：嵌顿痔湿热下注型与火毒炽盛型在炎症相关方面如炎症细胞种类、浸润程度等,其组织病理学上并不存在明显的统计学差异,而湿热下注型嵌顿痔发病时间明显长于火毒炽盛型,即随着病程的拖延或时间过长而加重了其水肿的程度和血栓机化的情况,进而导致局部疼痛、渗出甚至坏死的进一步加重,可以说湿热下注型嵌顿痔是在火毒炽盛型嵌顿痔的基础上更加进一步加重的表现,两者中医辨证论治后症型的确立应与其全身症状的关系更加密切,在组织病理学上的区别则主要集中于随病程延伸而导致的血栓机化、间质水肿等方面。另外,所有病理组织切片中均未见到明显菌落存在,且急诊手术组术后病理与亚急诊手术组术前病理对比后发现两组在病理组织学诸方面不存在统计学差异。即嵌顿痔患者的发病原因可以认为并非由细菌感染所引起,其急诊手术也不会引起细菌感染扩散等并发症,只有在嵌顿时间过长,病程延期,病情加重恶化后才可能会造成继发性的细菌性感染,故而将感染应作为指导嵌顿痔治疗方案的因素是不恰当的,而急诊手术可以迅速解除患者疼痛、水肿等症状,并可有效防止痔核坏死、感染等情况的发生,这些都明显优于亚急诊手术治疗方法。
The In-carceration of Internal Hemorrhoids is anus bowel division, one of the common emergency when its outbreak hemorrhoids nuclear of emergence, anal straining, local swelling pain that activities limited, defecate walk, such as dysuria patients themselves caused great suffering, and treatment inferior or cure is undeserved, embedded meal time is too long, and easy to cause illness worse, the mucosal surface erosion and nuclear hemorrhoids hemorrhoids nuclear necrosis, ooze blood, drainage, infection, fibrosis even happen bacteremia or sepsis and septic etc. In embedded bolton on TCM syndrome differentiations hemorrhoids, especially with a burning hot ChiCheng type and the most common type bets. And there's no embedded in the treatment of mixed hemorrhoids medical type has achieved consensus, but for the treatment of In-carceration of Internal Hemorrhoids, together with the principle of differences still exist in the In-carceration of Internal Hemorrhoids pathological mechanism of and its causes at home and abroad, and still not saw many scholars in their treatment in principle to whether should go to emergency operation has been not agreed.
Objective:in view of the above, this research will through collecting the different type ChiCheng USES (fire poison, hot and humid betting type) the hemorrhoids hemorrhoid organization embedded meal in the surgical resection specimen, observation methods, compared to light the pathological changes observed specimens organization. Through the organization of pathology and TCM syndrome type of research and comparison, observed differences between them, and then discusses the pathogenesis of hemorrhoids embedded meal with TCM syndrome type relationship. And according to the different treatments (emergency operation, and emergency operation of the group of cases) further group, and observed and compared the pathological changes his specimens organization so as to whether the incidence hemorrhoids embedded bolton's an infection and clinical embedded in treatment of hemorrhoids whether do emergency operation of pathology and provide scientific basis, for traditional Chinese medicine clinical better treatment In-carceration of Internal Hemorrhoids provide the theoretic basis and clinical reference value.
Methods:refers to the 1992 seventh anorectal conference of the In-carceration of Internal Hemorrhoids formulated clinical diagnosis standard and July 2006 zimmet pz colorectal surgery in anus et al, Chinese society of TCM surgery illness professional committee, China samples of itcwm learn colorectal anal disease professional committee of the discussion through treatment guidelines hemorrhoids (2006 edition) ", and according to the patient arrives and systemic symptom embedded bolton TCM syndrome differentiations grouping. Will comply with the clinical diagnosis standard In-carceration of Internal Hemorrhoids patients 24 patients divided into treatment group 1 (fire poison ChiCheng type) in 12 cases and treatment of two groups (hot and humid betting type) in 12 cases, the treatment according to occur in patients and In-carceration of Internal Hemorrhoids syndrome differentiation and treatment parting, depending on the seriousness of the divided into two treatment strategies:for embedded meal time is short, and although more severe symptoms such as pain but not see hemorrhoid nuclear necrosis and obviously infection, then the operation contraindication disease patients to treatment plan 1 (emergency surgery); For some time embedded meal is long, and the embedded's hemorrhoid emergence of larger nucleus, or other reasons, such as hemorrhoids nuclear necrosis, apparent infection is unfavorable immediate treatment with surgery, then be treatments plan 2 (first be conservative treatment, stay current symptoms, edema, debaucjed already ease such local inflammation is under control and improvement, poste operation after treatment). Including pathological take, treatment 1 plan take postoperative pathologic organizations; Treatments 2 plan take preoperative instabilities antiphlogistic, detumescence processing measures, namely the histopathology preoperative pathology organization. Pathologic evaluation index:mucosal inflammation infiltrating degree, mucosal inflammation degree, inflammatory cells infiltrating types, thrombosis machine the degree of and edema degree and statistics found colonies specimens quantity.
Results:ChiCheng type and burning hot betting type In-carceration of Internal Hemorrhoids hemorrhoid histopathological each integral nuclear situation through statistical analysis concluded that both groups cases in mucosal inflammation infiltrating degree, mucosal inflammation degree, inflammatory cells infiltrating kinds aspects quite does not exist significant differences (P> 0.05), but in thrombosis machine, the degree of comparative degree of edema existing statistically significant (P< 0.01), and variance show hot and humid betting type thrombosis machine, edema the degree of integration is a burning ChiCheng degree type more serious; And with the emergency surgical emergency surgical In-carceration of Internal Hemorrhoids hemorrhoid histopathological each integral nuclear situation through statistical analysis concluded that both groups cases in mucosal inflammation infiltrating degree, mucosal inflammation degree, inflammatory cells infiltrating types, thrombosis machine and the degree of the degree of edema compared does not exist statistically significant difference (P> 0.05). And not all pathological a colony there. See obvious
Conclusion:embedded with hot meal hemorrhoid bet ChiCheng type type burning in related to inflammation aspect such as inflammatory cells infiltrating degree types, etc., and its histopathological not obvious statistical differences, and hot and humid betting type In-carceration of Internal Hemorrhoids significantly longer than the disease ChiCheng type, namely, burning with progression delay or time is too long and increased its edema of the extent of the situation and thrombosis machine, and then lead to local pain, oozy and even necrotic accentuate further, can say to hot and humid betting type embedded meal in ChiCheng hemorrhoids burning the hemorrhoids type based on embedded meal more accentuate further performance, both the syndrome differentiation and treatment USES its established after the systemic symptom should be closer, the difference in histopathological is mainly focus on course to extend with the thrombus machine, edema, etc. In addition, all histopathological slices are not seen obvious existence, and emergency surgical colony and the postoperative pathologic emergency surgical pathology found before two groups in contrast histologic aspects does not exist significant differences. Namely the onset of In-carceration of Internal Hemorrhoids patients can not think the reasons caused by bacterial infection, its emergency surgery does not cause complications such as bacteria infection spread, only in embedded meal time is too long, duration extension, illness aggravating deterioration ability may cause secondary bacterial infection, so should be as guidance will affect the In-carceration of Internal Hemorrhoids treatment is not appropriate, factors and emergency surgery can quickly remove symptoms such as pain and swelling patients, and can effectively prevent hemorrhoid nuclear necrosis, infection, etc, these are happening obviously superior to the emergency surgical treatment method.
目的：针对上述,本研究将通过收集不同症型(火毒炽盛型、湿热下注型)嵌顿痔的痔组织的手术切除标本,以光镜为观察手段,比较观察标本组织中的病理变化。通过组织病理与中医证型的研究与对照,观察两者的差异,进而探讨嵌顿痔的发病机理与中医证型的关系。并根据不同治疗方案(急诊手术、亚急诊手术)对入组病例进一步分组并观察比较其标本组织中的病理变化,从而为嵌顿痔发病中是否发生感染及临床嵌顿痔治疗是否可予行急诊手术提供科学的病理学与中医学依据,为临床更好地治疗嵌顿痔提供理论依据及临床参考价值。
方法：参照1992年全国第七届肛肠学术会议制定的嵌顿痔的临床诊断标准及2006年7月中华医学会外科学分会结直肠肛门外科学组、中华中医药学会肛肠病专业委员会、中国中西医结合学会结直肠肛门病专业委员会讨论通过的《痔临床诊治指南(2006版)》,并根据患者就诊时嵌顿情况和全身症状进行中医辨证分型分组。将符合临床诊断标准的嵌顿痔患者24例分为治疗1组(火毒炽盛型)12例与治疗2组(湿热下注型)12例,其治疗根据就诊时患者嵌顿痔情况及中医辨证论治分型后,视其严重程度,分为两种治疗方案：对于嵌顿时间较短,且疼痛等症状虽较严重但未见到痔核坏死及明显感染等手术禁忌症的患者,则予以治疗方案1(急诊手术治疗)；对于部分嵌顿时间较长,且脱出嵌顿的痔核较大,或其他多种原因,如痔核坏死,出现明显感染等不宜即刻施行手术治疗的患者,则予以治疗方案2(先予以保守治疗,待当前症状已缓解,水肿、糜烂等局部炎症已得到控制并好转后,再行手术治疗)。其中病理采取,治疗方案1者采取术后病理组织；治疗方案2者采取术前未予消炎、消肿等处理措施的病理组织,即术前病理组织。病理评定指标：粘膜炎症浸润程度、粘膜炎症程度、炎症细胞浸润种类、血栓形成机化程度及间质水肿程度并统计发现菌落标本数量。
结果：火毒炽盛型与湿热下注型嵌顿痔痔核组织病理各项积分情况通过统计学分析得出两组病例在粘膜炎症浸润程度、粘膜炎症程度、炎症细胞浸润种类方面比较不存在统计学差异(P>0.05),但在血栓形成机化程度、间质水肿程度方面比较存在统计学差异(P<0.01),且差异情况表明湿热下注型血栓形成机化程度、间质水肿程度积分较火毒炽盛型更为严重；而急诊手术组与亚急诊手术组嵌顿痔痔核组织病理各项积分情况通过统计学分析得出两组病例在粘膜炎症浸润程度、粘膜炎症程度、炎症细胞浸润种类、血栓形成机化程度及间质水肿程度诸方面比较不存在显著统计学差异(P>0.05)；且所有病理切片中没有一例见到明显菌落存在。
结论：嵌顿痔湿热下注型与火毒炽盛型在炎症相关方面如炎症细胞种类、浸润程度等,其组织病理学上并不存在明显的统计学差异,而湿热下注型嵌顿痔发病时间明显长于火毒炽盛型,即随着病程的拖延或时间过长而加重了其水肿的程度和血栓机化的情况,进而导致局部疼痛、渗出甚至坏死的进一步加重,可以说湿热下注型嵌顿痔是在火毒炽盛型嵌顿痔的基础上更加进一步加重的表现,两者中医辨证论治后症型的确立应与其全身症状的关系更加密切,在组织病理学上的区别则主要集中于随病程延伸而导致的血栓机化、间质水肿等方面。另外,所有病理组织切片中均未见到明显菌落存在,且急诊手术组术后病理与亚急诊手术组术前病理对比后发现两组在病理组织学诸方面不存在统计学差异。即嵌顿痔患者的发病原因可以认为并非由细菌感染所引起,其急诊手术也不会引起细菌感染扩散等并发症,只有在嵌顿时间过长,病程延期,病情加重恶化后才可能会造成继发性的细菌性感染,故而将感染应作为指导嵌顿痔治疗方案的因素是不恰当的,而急诊手术可以迅速解除患者疼痛、水肿等症状,并可有效防止痔核坏死、感染等情况的发生,这些都明显优于亚急诊手术治疗方法。
The In-carceration of Internal Hemorrhoids is anus bowel division, one of the common emergency when its outbreak hemorrhoids nuclear of emergence, anal straining, local swelling pain that activities limited, defecate walk, such as dysuria patients themselves caused great suffering, and treatment inferior or cure is undeserved, embedded meal time is too long, and easy to cause illness worse, the mucosal surface erosion and nuclear hemorrhoids hemorrhoids nuclear necrosis, ooze blood, drainage, infection, fibrosis even happen bacteremia or sepsis and septic etc. In embedded bolton on TCM syndrome differentiations hemorrhoids, especially with a burning hot ChiCheng type and the most common type bets. And there's no embedded in the treatment of mixed hemorrhoids medical type has achieved consensus, but for the treatment of In-carceration of Internal Hemorrhoids, together with the principle of differences still exist in the In-carceration of Internal Hemorrhoids pathological mechanism of and its causes at home and abroad, and still not saw many scholars in their treatment in principle to whether should go to emergency operation has been not agreed.
Objective:in view of the above, this research will through collecting the different type ChiCheng USES (fire poison, hot and humid betting type) the hemorrhoids hemorrhoid organization embedded meal in the surgical resection specimen, observation methods, compared to light the pathological changes observed specimens organization. Through the organization of pathology and TCM syndrome type of research and comparison, observed differences between them, and then discusses the pathogenesis of hemorrhoids embedded meal with TCM syndrome type relationship. And according to the different treatments (emergency operation, and emergency operation of the group of cases) further group, and observed and compared the pathological changes his specimens organization so as to whether the incidence hemorrhoids embedded bolton's an infection and clinical embedded in treatment of hemorrhoids whether do emergency operation of pathology and provide scientific basis, for traditional Chinese medicine clinical better treatment In-carceration of Internal Hemorrhoids provide the theoretic basis and clinical reference value.
Methods:refers to the 1992 seventh anorectal conference of the In-carceration of Internal Hemorrhoids formulated clinical diagnosis standard and July 2006 zimmet pz colorectal surgery in anus et al, Chinese society of TCM surgery illness professional committee, China samples of itcwm learn colorectal anal disease professional committee of the discussion through treatment guidelines hemorrhoids (2006 edition) ", and according to the patient arrives and systemic symptom embedded bolton TCM syndrome differentiations grouping. Will comply with the clinical diagnosis standard In-carceration of Internal Hemorrhoids patients 24 patients divided into treatment group 1 (fire poison ChiCheng type) in 12 cases and treatment of two groups (hot and humid betting type) in 12 cases, the treatment according to occur in patients and In-carceration of Internal Hemorrhoids syndrome differentiation and treatment parting, depending on the seriousness of the divided into two treatment strategies:for embedded meal time is short, and although more severe symptoms such as pain but not see hemorrhoid nuclear necrosis and obviously infection, then the operation contraindication disease patients to treatment plan 1 (emergency surgery); For some time embedded meal is long, and the embedded's hemorrhoid emergence of larger nucleus, or other reasons, such as hemorrhoids nuclear necrosis, apparent infection is unfavorable immediate treatment with surgery, then be treatments plan 2 (first be conservative treatment, stay current symptoms, edema, debaucjed already ease such local inflammation is under control and improvement, poste operation after treatment). Including pathological take, treatment 1 plan take postoperative pathologic organizations; Treatments 2 plan take preoperative instabilities antiphlogistic, detumescence processing measures, namely the histopathology preoperative pathology organization. Pathologic evaluation index:mucosal inflammation infiltrating degree, mucosal inflammation degree, inflammatory cells infiltrating types, thrombosis machine the degree of and edema degree and statistics found colonies specimens quantity.
Results:ChiCheng type and burning hot betting type In-carceration of Internal Hemorrhoids hemorrhoid histopathological each integral nuclear situation through statistical analysis concluded that both groups cases in mucosal inflammation infiltrating degree, mucosal inflammation degree, inflammatory cells infiltrating kinds aspects quite does not exist significant differences (P> 0.05), but in thrombosis machine, the degree of comparative degree of edema existing statistically significant (P< 0.01), and variance show hot and humid betting type thrombosis machine, edema the degree of integration is a burning ChiCheng degree type more serious; And with the emergency surgical emergency surgical In-carceration of Internal Hemorrhoids hemorrhoid histopathological each integral nuclear situation through statistical analysis concluded that both groups cases in mucosal inflammation infiltrating degree, mucosal inflammation degree, inflammatory cells infiltrating types, thrombosis machine and the degree of the degree of edema compared does not exist statistically significant difference (P> 0.05). And not all pathological a colony there. See obvious
Conclusion:embedded with hot meal hemorrhoid bet ChiCheng type type burning in related to inflammation aspect such as inflammatory cells infiltrating degree types, etc., and its histopathological not obvious statistical differences, and hot and humid betting type In-carceration of Internal Hemorrhoids significantly longer than the disease ChiCheng type, namely, burning with progression delay or time is too long and increased its edema of the extent of the situation and thrombosis machine, and then lead to local pain, oozy and even necrotic accentuate further, can say to hot and humid betting type embedded meal in ChiCheng hemorrhoids burning the hemorrhoids type based on embedded meal more accentuate further performance, both the syndrome differentiation and treatment USES its established after the systemic symptom should be closer, the difference in histopathological is mainly focus on course to extend with the thrombus machine, edema, etc. In addition, all histopathological slices are not seen obvious existence, and emergency surgical colony and the postoperative pathologic emergency surgical pathology found before two groups in contrast histologic aspects does not exist significant differences. Namely the onset of In-carceration of Internal Hemorrhoids patients can not think the reasons caused by bacterial infection, its emergency surgery does not cause complications such as bacteria infection spread, only in embedded meal time is too long, duration extension, illness aggravating deterioration ability may cause secondary bacterial infection, so should be as guidance will affect the In-carceration of Internal Hemorrhoids treatment is not appropriate, factors and emergency surgery can quickly remove symptoms such as pain and swelling patients, and can effectively prevent hemorrhoid nuclear necrosis, infection, etc, these are happening obviously superior to the emergency surgical treatment method.
引文
[1]钱海华,朱乘宜.嵌顿性混合痔的中西医结合治疗[J].中国中西医结合外科杂志,1996,01：51-52.
[2]明·陈实功.外科正宗[M].北京：人民卫生出版社,2007：197.
[3]黄乃健.中国肛肠病学[M],山东科技出版社,1996,第一版：622--623.
[4]李忠海.硝黄洗剂治疗嵌顿痔116例疗效观察.湖南中医药导报,2002,8(12)：766.
[5]林明强,洪振强.150例嵌顿痔治疗及病因探讨[J].福建医药杂志,1997,19(4)：76.
[6]杨关根.嵌顿痔的处理原则探讨[J].浙江中西医结合杂志,1997,7(1)：61.
[7]Winquist RA. Ragmental fracture of the lower extremity and the floatingknee[M]. In:MeyersMH, ed. Themultiply injured patient with complex fractures Isted Philadelpnhia:Lea and Febiget,1984:221-248.
[8]Thomson WH. The nature of haemorrhoids[J]. Br J Surg,1975,62(7):542-552.
[9]Haas PA, Fox TA. Age-related changes and scar formations of perianal connective tissue[J].Dis Colon Rectum,1980,23(3):160-169.
[10]Bernstein WC. What are hemorrhoids and what is their relationship to the portal venous system?[J].Dis Colon Rectum,1983,26(12):829-834.
[11]张东铭.痔与盆底动力学关系[J].大肠肛门病外科杂志,2000,6(4)：49-54.
[12]付贵基,侯圣光,杜萍.早期外剥内扎术治疗嵌顿痔90例[J].中国中西医结合外科杂志,2000,6(2)：129.
[13]于素萍.消痔粉治疗妊娠后期嵌顿痔[J].新中医,2007,3,39(3)：46.
[14]宋红旗,王飞霞.痔科洗方治疗妊娠期嵌顿痔96例[J].浙江中医杂志,2001,36(3)：105.
[15]范小华,任东林,罗湛滨,王建春.中医药治疗老年急性嵌顿痔63例临床观察[J].新中医,2000：36.
[16]张天民.无创性速效疗法治疗老年嵌顿痔78例分析[J].河北医学,2000,6(8)：707.
[17]孙平良,肖振球,尹雪曼.嵌顿痔的临床病理研究[J].广西中医学院学报,2003,06(1)：8-11.
[18]刘峰.手术治疗急性环状嵌顿痔临床分析[J].中外医疗,2009,02：57.
[19]胡伯虎,李宁汉.实用痔瘘学[M].北京：科学技术文献出版社,2000.217-218.
[20]侯广.嵌顿痔急诊手术30例临床分析[J].现代医约卫生,2009.25(15)：2334.
[21]陈方达.嵌顿痔早期手术应注意的几个问题[J].江西中医学院学报,2000,12(3)：102.
[22]喻德洪.肛肠外科疾病问答.上海,上海科学技术出版社,1998：111.
[23]高万续,李巧荣.综合疗法治疗嵌顿痔70例[J].山西中医,1994,10(3)：21.
[24]冯水娟.中西医结合治疗早期嵌顿痔55例[J].浙江中西医结合杂志,1998,8(2)：120.
[25]李博萍,郑琳颖,周艳,等.敷痔散的药效学研究[J].广州医药,1999,30(1)：61.
[26]陈国安,陈道恒.中药熏洗治疗混合痔嵌顿90例[J].河北中医,2007,29(2)：119-120.
[27]牛治,牛明星.大黄牡丹汤加味治疗嵌顿性内痔[J].中国肛肠病杂志,1995,15(5)：7.
[28]黄云春.经方治疗嵌顿痔31例[J].中华实用中西医杂志,2004,17(16)：24-25.
[29]梁瑞文.中医治疗环状混合痔脱出嵌顿50例体会[J].福建中医药,1999,30(2)：30.
[30]范小华,任东林,罗湛滨.中医药治疗老年急性嵌顿痔63例临床观察[J].新中医,2000,32(7)：36.
[31]丰荣胜,鹿建杰,杨翠卿.自拟痔疮Ⅰ号熏洗剂治疗混合痔嵌顿538例疗效分析[J].安徽中医临床杂志,2000,12(3)：200-201.
[32]梁劲军,吴维城,李华山.敷痔散治疗嵌顿痔95例疗效观察[J].新中医,2000,32(5)：15.
[33]佟立成,王玉梅,吴丽华,等.痔疾消熏洗治疗嵌顿痔60例[J].中国中医药科技,1996,3(2)：40.
[34]梁永军.嵌顿痔的诊治概况[J].现代中西医结合杂志,2004,13(18)：2513-2514.
[35]过石胜.手法复位配合中药治疗急性嵌顿痔60例临床分析[J].浙江临床医学,2000,2(9)：7.
[36]马英.非麻醉下手法复位治疗急性嵌顿痔85例体会[J].甘肃中医,2003,16(1)：15-16.
[37]刘传连,张鑫,魏青平,等.综合方法治疗嵌顿环状混合痔100例[J].中国肛肠病杂志,1998,18(11)：42.
[38]许国城.注射法治疗痔嵌顿[J].福建中医药,1999,30(8)：28.
[39]肖振球,孙平良.多区域剥扎注射术治疗环状嵌顿痔的临床对照观察[J].大肠肛门病外科杂志,2004,10(4)：263-266.
[40]逯振喜,安玉玲.异丙嗪封闭疗法治疗嵌顿痔100例疗效观察[J].河北中西医结合杂志,1998,7(5)：692.
[41]彭国家.消痔灵治疗嵌顿痔82例报告[J].中国肛肠病杂志,1995,15(5)：42.
[42]朱德元.注射治疗急性嵌顿痔128例[J].中国肛肠病杂志,1995,15(5)：43.
[43]王敏锋.局部封闭加中药治疗急性嵌顿痔36例[J].中国肛肠病杂志,1998,18(3)：43.
[44]许爱军.综合治疗炎性嵌顿性混合痔[J].河北医学,2002,8(12)：1093.
[45]洪保杰.中医药治疗老年嵌顿痔36例[J].安徽中医学院学报,1998,17(1)：25.
[46]陈小芬,尤祥娇.综合疗法治疗老年人嵌顿痔48例[J].福建中医药,2003,34(6)：17.
[47]李金顺.结扎冷冻治疗嵌顿痔[J].中国肛肠病杂志,1995,15(5)：45.
[48]向德志,陈科,常建国.电子痔疮治疗机治疗嵌顿痔[J].遵义医学院学报,1998,21(3)：64.
[49]梁毅.针刺排液法在内痔及包茎嵌顿复位困难者的应用[J].广东医学,1998,19(7)：499.
[50]逮振喜,安玉玲.异丙嚓封闭疗法治疗嵌顿痔100例疗效观察[J].河北中西医结合杂志,1998,7(5)：692.
[51]高玉元,高冬梅.中约离子导入法治疗嵌顿痔[J],山东医药工业,1997,16(6)：46.
[52]喻德洪.现代肛肠外科学[M].北京,人民军医出版社,1997：199.
[53]王强,王元和.肛肠外科学[M].北京：人民军医出版社,1998：255.
[54]蒋伟冬,浅谈嵌顿痔的治疗近况[J].首届国际中西医结合大肠肛门病学术论坛：524-526.
[55]陈友平.急性嵌顿环状混合痔分段外切内扎术的改良[J].现代诊断与治疗,2001,12(1)：56.
[56]GunnarA, HansK, StaffanH. etal. Open Hemorrhoidec-tomy-Is ThereanyDifference, Dis Colon Rectum,2000,43(1):31-34.
[57]徐伟祥.外剥内扎术早期治疗混合痔嵌顿[J].上海中医药杂志,2006,40(12)：58-59.
[58]王秋玲,刘玉升.嵌顿性环状混合痔早期手术[J].中国肛肠病杂志,1997,17(5)：42.
[59]戴澄安.嵌顿痔的临床手术治疗[J].江西医药,2000,35(6)：349-350.
[60]孙玉伙.中西医结合治疗急性嵌顿痔285例临床疗效观察[J].河北中西医结合杂志,1996,5(2)：96.
[61]尚世多,刘昆生,姜显肃.肛门内括约肌闸门效应对嵌顿痔的作用,中国肛肠病杂志[J].1994,14(1)：39.
[62]陈英忠,陈伟.内括约肌侧位切开术治疗内痔嵌30例体会,中国肛肠病杂志[J].1995,15(5)：9.
[63]全立海,杨晓琳,武雅坤.剥离结扎术治疗嵌顿痔67例分析[J].中国冶金工业医学杂志,2002,9(6)：364.
[64]陆庆革.外剥内扎加肛门内括约肌松解术治疗急性嵌顿痔150例[J].中华实用中西医杂志,2005,18(19)：1151.
[65]钱海华.内括约肌自体延长术在肛裂与混合痔治疗中的应用[J],中国肛肠病杂志,2007,27(10)：45.
[66]丁道峰.内括约肌自体延长术在嵌顿痔手术中的应用体会[J],南京中医药大学学报,2008.24(2)：135-136.
[67]林友彬,杨中权.PPH术治疗急性嵌顿环状混合痔32例.大肠肛门病外科杂志[J].2005,11(2)：131-132.
[68]李春雨,聂敏,张虹玺,蒋松涛,李智勇.PPH治疗急性嵌顿痔(附56例报告).大肠肛门病外科杂 志[J].2003,9(4)：255-256.
[69]黄向阳.吻合器痔上粘膜环切术治疗急性嵌顿痔35例[J].广东医学,2004,25(4)：480.
[70]闫培英,郑淑秀.C02激光治疗嵌顿痔160例观察[J].中国激光医学杂志,2002,11(4)：266.
[71]王作端.手术并YAG激光治疗急性嵌顿痔40例[J].中国中医急症,2003,3：263.
[72]谢坚凤.嵌顿痔的治疗体会[J].江苏中医,1999,20(5)：41.
[73]范学顺,安阿明,王林清,等.外剥内扎法治疗急性嵌顿痔62例[J].中日友好医院学报,1997,11(3)：251.
[74]刘少青,沈秀萍.肛门内括约肌侧位切开术治疗急性痔的疗效观察[J].中国肛肠病杂志,1997,17(5)：26.
[75]国家中医约管理局.中医病证诊断疗效标准[S].南京,南京大学出版社,1994：132.
[76]石辛甫.肠粘膜上皮细胞的免疫功能[J].国外医学$学分册,1999,22(4)：203-206.
[77]吴秉铨.炎症：杨光华,病理学(第五版)[M].北京：人民卫生出版社,2001.57-59.
[78]孙平良,肖振球,尹雪曼.嵌顿痔的临床病理研究[J].广西中医学院学报,2003,06(1)：8-11.
[2]明·陈实功.外科正宗[M].北京：人民卫生出版社,2007：197.
[3]黄乃健.中国肛肠病学[M],山东科技出版社,1996,第一版：622--623.
[4]李忠海.硝黄洗剂治疗嵌顿痔116例疗效观察.湖南中医药导报,2002,8(12)：766.
[5]林明强,洪振强.150例嵌顿痔治疗及病因探讨[J].福建医药杂志,1997,19(4)：76.
[6]杨关根.嵌顿痔的处理原则探讨[J].浙江中西医结合杂志,1997,7(1)：61.
[7]Winquist RA. Ragmental fracture of the lower extremity and the floatingknee[M]. In:MeyersMH, ed. Themultiply injured patient with complex fractures Isted Philadelpnhia:Lea and Febiget,1984:221-248.
[8]Thomson WH. The nature of haemorrhoids[J]. Br J Surg,1975,62(7):542-552.
[9]Haas PA, Fox TA. Age-related changes and scar formations of perianal connective tissue[J].Dis Colon Rectum,1980,23(3):160-169.
[10]Bernstein WC. What are hemorrhoids and what is their relationship to the portal venous system?[J].Dis Colon Rectum,1983,26(12):829-834.
[11]张东铭.痔与盆底动力学关系[J].大肠肛门病外科杂志,2000,6(4)：49-54.
[12]付贵基,侯圣光,杜萍.早期外剥内扎术治疗嵌顿痔90例[J].中国中西医结合外科杂志,2000,6(2)：129.
[13]于素萍.消痔粉治疗妊娠后期嵌顿痔[J].新中医,2007,3,39(3)：46.
[14]宋红旗,王飞霞.痔科洗方治疗妊娠期嵌顿痔96例[J].浙江中医杂志,2001,36(3)：105.
[15]范小华,任东林,罗湛滨,王建春.中医药治疗老年急性嵌顿痔63例临床观察[J].新中医,2000：36.
[16]张天民.无创性速效疗法治疗老年嵌顿痔78例分析[J].河北医学,2000,6(8)：707.
[17]孙平良,肖振球,尹雪曼.嵌顿痔的临床病理研究[J].广西中医学院学报,2003,06(1)：8-11.
[18]刘峰.手术治疗急性环状嵌顿痔临床分析[J].中外医疗,2009,02：57.
[19]胡伯虎,李宁汉.实用痔瘘学[M].北京：科学技术文献出版社,2000.217-218.
[20]侯广.嵌顿痔急诊手术30例临床分析[J].现代医约卫生,2009.25(15)：2334.
[21]陈方达.嵌顿痔早期手术应注意的几个问题[J].江西中医学院学报,2000,12(3)：102.
[22]喻德洪.肛肠外科疾病问答.上海,上海科学技术出版社,1998：111.
[23]高万续,李巧荣.综合疗法治疗嵌顿痔70例[J].山西中医,1994,10(3)：21.
[24]冯水娟.中西医结合治疗早期嵌顿痔55例[J].浙江中西医结合杂志,1998,8(2)：120.
[25]李博萍,郑琳颖,周艳,等.敷痔散的药效学研究[J].广州医药,1999,30(1)：61.
[26]陈国安,陈道恒.中药熏洗治疗混合痔嵌顿90例[J].河北中医,2007,29(2)：119-120.
[27]牛治,牛明星.大黄牡丹汤加味治疗嵌顿性内痔[J].中国肛肠病杂志,1995,15(5)：7.
[28]黄云春.经方治疗嵌顿痔31例[J].中华实用中西医杂志,2004,17(16)：24-25.
[29]梁瑞文.中医治疗环状混合痔脱出嵌顿50例体会[J].福建中医药,1999,30(2)：30.
[30]范小华,任东林,罗湛滨.中医药治疗老年急性嵌顿痔63例临床观察[J].新中医,2000,32(7)：36.
[31]丰荣胜,鹿建杰,杨翠卿.自拟痔疮Ⅰ号熏洗剂治疗混合痔嵌顿538例疗效分析[J].安徽中医临床杂志,2000,12(3)：200-201.
[32]梁劲军,吴维城,李华山.敷痔散治疗嵌顿痔95例疗效观察[J].新中医,2000,32(5)：15.
[33]佟立成,王玉梅,吴丽华,等.痔疾消熏洗治疗嵌顿痔60例[J].中国中医药科技,1996,3(2)：40.
[34]梁永军.嵌顿痔的诊治概况[J].现代中西医结合杂志,2004,13(18)：2513-2514.
[35]过石胜.手法复位配合中药治疗急性嵌顿痔60例临床分析[J].浙江临床医学,2000,2(9)：7.
[36]马英.非麻醉下手法复位治疗急性嵌顿痔85例体会[J].甘肃中医,2003,16(1)：15-16.
[37]刘传连,张鑫,魏青平,等.综合方法治疗嵌顿环状混合痔100例[J].中国肛肠病杂志,1998,18(11)：42.
[38]许国城.注射法治疗痔嵌顿[J].福建中医药,1999,30(8)：28.
[39]肖振球,孙平良.多区域剥扎注射术治疗环状嵌顿痔的临床对照观察[J].大肠肛门病外科杂志,2004,10(4)：263-266.
[40]逯振喜,安玉玲.异丙嗪封闭疗法治疗嵌顿痔100例疗效观察[J].河北中西医结合杂志,1998,7(5)：692.
[41]彭国家.消痔灵治疗嵌顿痔82例报告[J].中国肛肠病杂志,1995,15(5)：42.
[42]朱德元.注射治疗急性嵌顿痔128例[J].中国肛肠病杂志,1995,15(5)：43.
[43]王敏锋.局部封闭加中药治疗急性嵌顿痔36例[J].中国肛肠病杂志,1998,18(3)：43.
[44]许爱军.综合治疗炎性嵌顿性混合痔[J].河北医学,2002,8(12)：1093.
[45]洪保杰.中医药治疗老年嵌顿痔36例[J].安徽中医学院学报,1998,17(1)：25.
[46]陈小芬,尤祥娇.综合疗法治疗老年人嵌顿痔48例[J].福建中医药,2003,34(6)：17.
[47]李金顺.结扎冷冻治疗嵌顿痔[J].中国肛肠病杂志,1995,15(5)：45.
[48]向德志,陈科,常建国.电子痔疮治疗机治疗嵌顿痔[J].遵义医学院学报,1998,21(3)：64.
[49]梁毅.针刺排液法在内痔及包茎嵌顿复位困难者的应用[J].广东医学,1998,19(7)：499.
[50]逮振喜,安玉玲.异丙嚓封闭疗法治疗嵌顿痔100例疗效观察[J].河北中西医结合杂志,1998,7(5)：692.
[51]高玉元,高冬梅.中约离子导入法治疗嵌顿痔[J],山东医药工业,1997,16(6)：46.
[52]喻德洪.现代肛肠外科学[M].北京,人民军医出版社,1997：199.
[53]王强,王元和.肛肠外科学[M].北京：人民军医出版社,1998：255.
[54]蒋伟冬,浅谈嵌顿痔的治疗近况[J].首届国际中西医结合大肠肛门病学术论坛：524-526.
[55]陈友平.急性嵌顿环状混合痔分段外切内扎术的改良[J].现代诊断与治疗,2001,12(1)：56.
[56]GunnarA, HansK, StaffanH. etal. Open Hemorrhoidec-tomy-Is ThereanyDifference, Dis Colon Rectum,2000,43(1):31-34.
[57]徐伟祥.外剥内扎术早期治疗混合痔嵌顿[J].上海中医药杂志,2006,40(12)：58-59.
[58]王秋玲,刘玉升.嵌顿性环状混合痔早期手术[J].中国肛肠病杂志,1997,17(5)：42.
[59]戴澄安.嵌顿痔的临床手术治疗[J].江西医药,2000,35(6)：349-350.
[60]孙玉伙.中西医结合治疗急性嵌顿痔285例临床疗效观察[J].河北中西医结合杂志,1996,5(2)：96.
[61]尚世多,刘昆生,姜显肃.肛门内括约肌闸门效应对嵌顿痔的作用,中国肛肠病杂志[J].1994,14(1)：39.
[62]陈英忠,陈伟.内括约肌侧位切开术治疗内痔嵌30例体会,中国肛肠病杂志[J].1995,15(5)：9.
[63]全立海,杨晓琳,武雅坤.剥离结扎术治疗嵌顿痔67例分析[J].中国冶金工业医学杂志,2002,9(6)：364.
[64]陆庆革.外剥内扎加肛门内括约肌松解术治疗急性嵌顿痔150例[J].中华实用中西医杂志,2005,18(19)：1151.
[65]钱海华.内括约肌自体延长术在肛裂与混合痔治疗中的应用[J],中国肛肠病杂志,2007,27(10)：45.
[66]丁道峰.内括约肌自体延长术在嵌顿痔手术中的应用体会[J],南京中医药大学学报,2008.24(2)：135-136.
[67]林友彬,杨中权.PPH术治疗急性嵌顿环状混合痔32例.大肠肛门病外科杂志[J].2005,11(2)：131-132.
[68]李春雨,聂敏,张虹玺,蒋松涛,李智勇.PPH治疗急性嵌顿痔(附56例报告).大肠肛门病外科杂 志[J].2003,9(4)：255-256.
[69]黄向阳.吻合器痔上粘膜环切术治疗急性嵌顿痔35例[J].广东医学,2004,25(4)：480.
[70]闫培英,郑淑秀.C02激光治疗嵌顿痔160例观察[J].中国激光医学杂志,2002,11(4)：266.
[71]王作端.手术并YAG激光治疗急性嵌顿痔40例[J].中国中医急症,2003,3：263.
[72]谢坚凤.嵌顿痔的治疗体会[J].江苏中医,1999,20(5)：41.
[73]范学顺,安阿明,王林清,等.外剥内扎法治疗急性嵌顿痔62例[J].中日友好医院学报,1997,11(3)：251.
[74]刘少青,沈秀萍.肛门内括约肌侧位切开术治疗急性痔的疗效观察[J].中国肛肠病杂志,1997,17(5)：26.
[75]国家中医约管理局.中医病证诊断疗效标准[S].南京,南京大学出版社,1994：132.
[76]石辛甫.肠粘膜上皮细胞的免疫功能[J].国外医学$学分册,1999,22(4)：203-206.
[77]吴秉铨.炎症：杨光华,病理学(第五版)[M].北京：人民卫生出版社,2001.57-59.
[78]孙平良,肖振球,尹雪曼.嵌顿痔的临床病理研究[J].广西中医学院学报,2003,06(1)：8-11.