血栓性外痔是外痔中最常见的一种。常因排便时用力过猛， 剧烈活动或用力咳嗽使肛门缘静脉破裂，血液外渗到结缔 组织内，成为血块，在肛门部皮下生成圆形或椭圆形肿块， 大小不等，位于肛管内或肛缘外。肿块初起时较软，几天 后变硬。如未发炎，肿块可在3--4周内完全吸收消散，不 留痕迹；如反复发炎，肿块内结缔组织增生，可变成结缔 组织外痔；如发生感染，可生成脓肿。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
预防便秘和血压升高。 5.讲解便血形成的原因，消除其恐惧心理
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
• 呈进行性增多，时呈喷射状，来我院就诊门诊拟混合痔 病程中无 畏寒、发热，无胸闷、气促、无呕血、黑边，无腹痛、腹泻、精神、 饮食、睡眠均可，小便正常。
• 既往史：否认“肝炎、结核、伤寒”等传染病史，否认输血史，无药 物、食物过敏史，预防接种史随社会进行。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
炎性外痔病因病理：常因肛门受损后感染，或因肛裂引起 肛门皱襞发炎和水肿所致。痔疮患者自己觉得肛门部灼痛、 湿痒，便后或活动过多后症状加重。检查时，可见肛门皱 襞充血、肿胀，并有少量分泌物。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
• 临床表现 • 1.主要表现为便血，便血的性质可为无痛、间歇性、便后鲜血，便时
滴血或手纸上带血，便秘、饮酒或进食刺激性食物后加重。 • 2.单纯性内痔无疼痛仅坠胀感，可出血，发展至脱垂，合并血栓形成、
嵌顿、感染时才出现疼痛。 • 3.内痔分为4度。①Ⅰ度 排便时出血，便后出血可自行停止，痔不脱
出肛门；②Ⅱ度 常有便血；排便时脱出肛门，排便后自动还纳；③Ⅲ 度 痔脱出后需手辅助还纳；④Ⅳ度 痔长期在肛门外，不能还纳；其 中，Ⅱ度以上的内痔多形成混合痔，表现为内痔和外痔的症状同时存 在，可出现疼痛不适、瘙痒，其中瘙痒常由于痔脱出时有粘性分泌物 流出。后三度多成混合痔。 • 4.外痔平时无特殊症状，发生血栓及炎症时可有肿胀、疼痛。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
• 肛管 • 指齿状线至肛缘的部分，成人平均长2.5cm。 外科学肛管指肛缘到肛管直肠环平面的
部分，成人平均长4cm，外科学肛管有4个界限； • （1）肛门缘，平常也叫肛门口，是消化道最低的界限；（2）括约肌间沟，即白线，
在肛门缘与齿线之间，距肛缘约1cm，正对内、外括约肌连接处。如将食指伸入肛管， 摸到肛门内括约肌和肛门外括约肌皮下部之间有一个凹陷的沟，即括约肌间沟； • （3）齿线，在白线上方皮肤黏膜交界处，距肛缘约2.5cm有一环锯齿状的线叫齿线； • （4）齿线和白线之间表面光滑，光泽发亮，叫肛门梳。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
• 内痔： • 1.Ⅰ期：痔核较小，如黄豆或蚕豆大，色鲜红，质柔软，不脱出肛外，
大便带血或滴血。 • 2.Ⅱ期：痔核较大，形似红枣，色暗红，大便时脱出肛外，便后能自
行还纳，大便滴血较多或射血一线如箭。 • 3.Ⅲ期：痔核更大，如鸡蛋或更大，色灰白，大便时或行走时脱出肛
外，不能自行还纳，一般不出血，一旦出血则呈喷射状，痔核脱出后 如不源自快还纳，则易嵌顿而绞窄肿胀、糜烂坏死。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
混合痔
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
护理措施 1.耐心细致的讲解疾病发生的原因、治疗经过及预后，掌握基本的预防措施。 2. 告知病人养成定时排便习惯的重要性， • 知道凡使腹内压增加的因 • 素均可诱发、 • 加重直肠肛管疾病， • 如职业性的长久站立、 • 习惯性便秘、 • 慢性咳嗽等。 3.介绍保护肛周卫生的知识： （1）使用柔软、白色、无香味的卫 • 生纸，以免刺激肛门，引起瘙痒、出血。 （2）避免使用肥皂用力擦 • 洗肛周，以免损伤肛周皮肤而引起感染、出血。 （3）便后及时清洁肛门，勤换内裤。 4.提供正确的饮食指导：进食低盐饮食，多食粗纤维，摄入足够水分，保持大便软化畅，
• 护理诊断 • 知识缺乏 • 焦虑 • 疼痛 • 睡眠形态紊乱 • 潜在并发症：出血
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
病例介绍
• 患者史义亚 男53岁因肛门肿物突出伴出血两年 诊断为混合痔于201510-05 11时入院测量生命体征T36.6℃,P72次/分Bp120/80mmHg于 10-08在硬膜外麻醉下行吻合器痔上粘膜环切术，术后于抗炎补液治 疗，保留导尿管一根，于10-10拔除尿管后自解小便。
• 现病史：患者两年前无明显诱因发现每次大便肛门口脱出黄豆稍大肿 物，无疼痛感，此后复发肛门肿物突出，随复发次数增多肿物增大，
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
外痔： 结缔组织外痔因其形态而命名，又称赘皮痔，皮肤下垂物和赘皮性外痔。这种外痔是肛
门缘皮肤皱襞增厚肥大，有结缔组织增生，痔内无曲张静脉，血管甚少，底宽尖长，呈 黄褐色或褐黑色，突出易见，大小形状不等。有时只有一个，在肛门后部或前部正中， 有时数个围绕肛门一周。 静脉曲张性外痔是齿线以下痔外静脉丛曲张，在肛门缘形成圆形、椭圆形或棱形柔软肿 块。如有水肿，则形状变大。在祖国医学中，它属于气痔范畴。如《疮疡经验全书·痔 漏图说》中说：“气痔，感气即下。”本病一般不疼痛，不出血，仅觉肛门坠胀或有异 物感。多与三期内痔和混合痔并发。