直肠脱垂图文课件

Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety脱肛（直肠脱垂）浏阳市中医医院肛肠科周明亮Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety概念•肛管、直肠黏膜、直肠全层、甚至部分乙状结肠脱出肛门外的一种疾病•多见于年老、体弱、小儿和多产之人Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety中医病因病机•小儿气血未旺•老年及久病体弱者气血衰退•多胎产妇气血亏损•中气下陷，固摄失司•《难经》：病之虚实，入者为实，出者为虚Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety现代医学病因学•直肠的支持固定力量减弱•如发育不全、功能衰退、外伤Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety现代医学病因学•直肠受到异常的推压和牵拉•如久泻便秘、慢性咳嗽、排尿困难、直肠息肉脱出Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety临床表现—脱出Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety临床表现脱出肛门坠胀肛门潮湿粘膜充血、水肿糜烂少量出血Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety并发症•嵌顿：脱垂的粘膜水肿，难以回纳，肛门灼热疼痛Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety检查•望诊•指诊•蹲位检查Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety望诊•脱出物的形状：花瓣状、圆锥状、圆柱状Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety指诊•脱出物的厚度、硬度•肛门括约肌松弛Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety指诊•反折沟是否消失：•了解肛管是否脱出Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety蹲位检查Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety分度•一度脱垂•二度脱垂•三度脱垂Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety一度脱垂•直肠黏膜脱出•长3~5cm•环状黏膜皱襞•柔软，无弹性•可自行回纳Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety二度脱垂•直肠全层脱垂•长5~10cm•圆锥状，表面有环状黏膜皱襞•较厚，有弹性•肛门松弛，需手助回纳Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety三度脱垂•直肠及部分乙状结肠脱出•长10cm以上•圆柱状•触之很厚•肛门松弛Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety鉴别诊断•内痔脱出形态：分颗脱出，无环状皱襞颜色：暗红或青紫出血：容易，量多Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗•内治•外治•针灸•注射•手术Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗—内治•脾虚气陷补气升提，收敛固摄代表方：补中益气汤病久及肾，注意补肾•湿热下注多属虚实夹杂之证清热利湿Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗—外治•复位•熏洗法•外敷法Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗—针灸•体针及电针•梅花针Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗—注射•黏膜下注射法适应症：一、二度直肠脱垂•直肠周围注射法适应症：二、三度直肠脱垂Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗—手术•手术方法有100多种，均有一定的并发症和复发率•应选择安全、创伤少的术式•直肠瘢痕支持固定术•肛门紧缩术Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety肛门紧（环）缩术Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗方案（1）•小儿多为直肠黏膜脱垂，有自愈倾向•消除诱因•外治、注射疗法Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗方案（2）•成人直肠黏膜脱垂•以注射疗法为主•配合内治、针灸疗法Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗方案（3）•成人直肠全层脱垂•先选用注射疗法•如无效则选择手术疗法Withtheimprovingqualityoflifeaswe