2020年8月29日星期六

hemorrhoids lidocaine,Surgical treatment of hemorrhoids

    The so-called severe hemorrhoids refers to a type of hemorrhoids that are too large, excessive in number, or prolapsed or incarcerated, such as circular mixed hemorrhoids, acute incarcerated hemorrhoids, internal hemorrhoids or mixed hemorrhoids with degree III or higher. Such hemorrhoids cause severe pain and should be treated as soon as possible.

    Picture of a typical severe hemorrhoid:

    Figure 1   Annular mixed hemorrhoids

    Figure 2   Annular incarcerated hemorrhoids

    Figure 3   Annular incarcerated hemorrhoids

    Figure 4   Annular incarcerated hemorrhoids

    Treat it early but don't treat it indiscriminately. There is only one earth, and we must be kind. There is only one anus for an individual, so be kind. A professor of surgery said with emotion: "Don't underestimate anal surgery. Once a problem occurs, it is difficult to remedy, and the pain will be lifelong." The fact is indeed the case, thinking that hemorrhoids is a minor disease, so they don't pay attention to it, so they just go to the doctor. As a result, the incurable disease is a minor disease and the cure becomes a "serious disease." So reasonable treatment is a big deal.

    Picture of sequelae of wrong way to treat ring hemorrhoids:

    Figure 5   Anal canal skin defect after hemorrhoid surgery

    Figure 6   Anal canal skin defect after hemorrhoid surgery

    Figure 7   Anal canal skin defect after hemorrhoid surgery

    Figure 8   Rectal stenosis after hemorrhoid surgery

    Figure 9   Anal stenosis after hemorrhoid surgery

    Figure 10   Anal stenosis after hemorrhoid surgery

    What is "li"? Many people take "newness" as a rationale and pursue what is new. In fact, this is a misunderstanding. The rationale will not always change, the rationale is better. "New" mainly refers to the law. Here I do not deny the progressive significance and clinical value of the new method, but if the new method is not combined with the old theory, it may lose its progressive value or even become a scourge. Therefore, reasonable treatment is not blindly chasing new ones.

    To give a simple example, anal stenosis after hemorrhoid surgery is often encountered in clinical practice. The reason is simple, too much anal canal and anal skin were damaged during the operation. You said that I used the most advanced electrosurgical knife, I used laser, I used HCPT... Wait for the new "weapon", why does this problem still occur? Because you don’t understand the importance of protecting the skin of the anal canal, don’t understand how to protect the skin of the anal canal, and don’t understand that these electrosurgical devices are not suitable for ring hemorrhoids because they are damaged. Many such examples can be cited.

    So how to treat severe hemorrhoids? In 1939, Mr. Calman formulated three surgical treatment principles for us: (1) restore the anus, anal canal and rectum to the closest normal state; (2) simple operation, small wound and short time Complete; (2) Postoperative pain is light, bleeding is small and does not cause stenosis. As long as these three items can be met, it is a reasonable and good method.

    But it’s not easy to do these three things. Let’s take a look at the difficulty of severe hemorrhoid surgery. The main difficulty lies in the proper grasp of "go" and "stay". If external hemorrhoids are removed (removed) too much, anal skin defects will cause anal stenosis; if internal hemorrhoids are removed (ligated) too much, mucous membrane will be damaged, which will cause rectal stenosis; but if these factors are taken into consideration, the hand will be merciful and stay too much and treat Not thorough.

    Can we take care of both, except for the disease, but also for the local and unscathed disability, yes, but it requires reasonable methods and rich clinical experience.

    In fact, no matter what kind of hemorrhoids, the most basic surgical methods are nothing more than resection and ligation. These two methods have not been eliminated after hundreds of years of clinical use because of their rationality. Basic surgical methods solve basic problems, and clinical experience is used to solve various complex changes of hemorrhoids. For single internal hemorrhoids, external hemorrhoids, or mixed hemorrhoids, as long as you can excise and ligate, you must have clinical experience for severe hemorrhoids.

    Often patients come up and ask me what method to use? What is the best way to ask me? Generally, I rarely answer such questions, because it is not easy to answer, and I am not sure about your illness. How do I know what is good? Different methods for internal hemorrhoids and external hemorrhoids, mild to severe, and onset and non-onset periods are different

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