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Anal papilloma refers to the enlargement and hardening of anal papilla due to the long-term stimulation of feces and chronic inflammation. Anal papilloma is one of the common benign tumors of anus and rectum. The arrangement of cells and stroma in the tumor is the same as that of normal tissue, surrounded by adventitia, with slow growth and infrequent recurrence after resection. With the gradual increase of anal papilla, it sometimes comes out of the anus with defecation. Due to repeated prolapse, it stimulates the anal canal and increases the secretion. Therefore, clinically, in addition to the prolapse of anal papilloma, there are often post defecation bleeding, unclean defecation and anal itching. The disease has a concealed onset and slow progress. It is a benign tumor with good effect after treatment. It is more common in young adults, and women are greater than men.
The etiology of anal papilloma is closely related to anal sinusitis. The two are cause and effect. Due to the gradual increase of long-term chronic inflammatory stimulation, it is easy to be ignored by patients because of mild symptoms and slow progress of the disease. With the gradual increase of the tumor, it is not paid attention until it comes out of the anus.
1、 Diagnostic points of anal papilloma:
1. History: there is a history of anal sinusitis, which is easily ignored due to symptoms.
2. Clinical manifestations:
① Sense of incomplete defecation: there are abundant nerve fibers in the anal canal to form an accessory sensory organ. The inflammatory stimulation of anal papilla in the inflammatory stage. Patients often have a sense of incomplete defecation, or accompanied by the feeling of foreign bodies embedded in the anus and falling feeling. Acute inflammation, accompanied by a sense of urgency. The aggravation of female patients' symptoms during menstruation is caused by pelvic congestion during menstruation.
② Anal pruritus: due to repeated prolapse of papilloma for a long time, inflammatory secretions stimulate perianal skin and cause perianal eczema.
③ Anal swelling and pain: after some papillomas are prolapsed, they cannot be returned, resulting in obstruction of lymphatic reflux and anal swelling and pain.
3. Auxiliary inspection:
Endoscopic examination: under the endoscope, the base of papilloma is red, the tip is gray white, and protrudes into the speculum in coral shape.
2、 Diagnostic criteria for anal papilloma:
1. Pathological diagnosis: histologically confirmed as inflammatory tissue or fibroma.
2. Clinical diagnosis:
① Clinical manifestations: there is something prolapse in the anus after defecation, accompanied by a sense of endless defecation, urgency and heaviness. Anal pruritus, or anal swelling and pain.
② Finger diagnosis: the movable hard joint can be touched at the tooth line.
③ Endoscopic examination: gray white, coral like pedicled tumor can be seen under the microscope.
3、 Differential diagnosis of anal papilloma:
1. Rectal polyps: rectal polyps are located on the rectal wall. The surface is red and round. The surface tissue is mucous membrane, so they are easy to appear. They are mostly seen in children.
2. Papillary fibroma has no obvious early symptoms. A few patients can have a sense of incomplete defecation, which does not affect their normal work and life. It is often ignored or mistaken for hemorrhoids.
3. Digital diagnosis and endoscopy are important means for the diagnosis of papilloma. Most patients are found only through digital diagnosis and endoscopy.
4、 Treatment of anal papilloma:
The treatment of papillary fibroma is mainly surgery, which can achieve the purpose of radical cure. Specific treatment methods include:
1. Non operative treatment: non operative treatment is still the main treatment for some patients with mild symptoms.
① Hip bath method: hot water hip bath, 1-2 times a day, local hot compress, improve blood circulation and promote the absorption of inflammation.
② 10% silver nitrate solution or 1 ~ 3% gentian violet solution can be cured by coating it on the nipple.
③ Hemorrhoids ointment or suppository into anus, 1 ~ 2 times a day, can reduce symptoms.
2. Surgical treatment:
① Excision and ligation of anal papilloma: in the lateral position, clamp the root of the papilloma with curved forceps under anoscope, cut a little skin at the root of the nipple along the base of the vascular forceps. If the papilloma is small, simple ligation can be performed. If the papilloma is large and the base is wide, No. 4 or No. 7 silk thread can be used to penetrate the root of the papilloma, make "8" ligation, and cut off the papilloma on the vascular forceps. After operation, take a hot bath every day, and put Jiuhua ointment and chlorhexidine hemorrhoids into the anus until recovery.
② Electrocautery: under the routine anesthesia of the anus, expose the anal papilloma under the anoscope, press the high-frequency electrocautery probe on the root of the tumor, turn on the power supply, and burn the papilloma completely. This method is suitable for patients with small tumor body. It has the advantages of convenient operation and reliable curative effect. It can treat several papillomas at a time. After operation, hemorrhoids ointment or Hemorrhoids Suppository were put into the anus every day, which could be cured in seven days.
③ Cryotherapy: under the anal endoscope, expose the anal papilloma, aim the cryoprobe at the surface of the tumor and freeze it into a crystal ball. Postoperative local routine medication (such as hemorrhoid suppository and antibiotic ointment) was used to prevent infection. After freezing, the tumor tissue degenerated, liquefied, necrotic and fell off. Finally, the tissue was repaired to achieve the purpose of cure. In the treatment, the scope of freezing should be controlled. If it is too large, the normal anal tissue will be damaged, resulting in edema and pain after operation. If it is too small, the tumor will fall off incompletely and be easy to regenerate.
5、 Tips for the treatment of anal papilloma:
1. Early treatment is the key to prevent anorectal diseases: Although anal papilloma is a benign tumor, its occurrence is closely related to anal sinusitis. According to statistics, 85% of anorectal diseases are caused by anal sinusitis. At present, some people believe that the occurrence of rectal and anal cancer is related to its chronic inflammatory stimulation. Therefore, early active and effective treatment is of great significance to prevent the occurrence of anorectal diseases.
2. Strengthen comprehensive treatment: Although surgical treatment is radical for anal papilloma, the timing of operation should be strictly controlled. According to the development of their condition in different periods, we should adopt corresponding comprehensive treatment methods, adopt some preventive treatment for the early stage, and cooperate with traditional Chinese medicine enema to improve the curative effect for the patients who cannot operate. During the operation, we should pay attention to protect the anal skin, minimize the damage to the anal skin and avoid the occurrence of sequelae.
3. Treatment of intraoperative and postoperative complications: for large papillomas during operation, an "8" suture should be made through the ligation to prevent slippage of the ligation line and massive bleeding. Anal papillomas are located at the tooth line. The part below the tooth line must be cut and ligated to avoid postoperative pain and edema. In case of massive bleeding, pain and edema, local anesthesia should be given in time, ligation and hemostasis under endoscope, and traditional Chinese medicine hip bath should be used to relieve pain and detumescence.