2020年9月21日星期一

hemorrhoids how to treat,What is minimally invasive surgery for hemorrhoids

    1. What is PPH? How does it cure hemorrhoids?

    When it comes to the treatment of circular hemorrhoids, everyone may be more concerned about a method called "PPH". The full name of PPH is "circumcision and nailing of hemorrhoids", which is to remove a section of rectal mucosa above the hemorrhoids, and nail both ends of the incision with "staples" (titanium nails), so that the rectal mucosa after the incision can be restored. Put it together. By removing the rectal mucosa and shortening the length of the intestinal mucosa, the "prolapsed" hemorrhoids can be lifted and the effect is very good from the appearance. Cutting off the rectum above the hemorrhoids can also cut off the blood supply around the hemorrhoids, allowing the hemorrhoids to shrink, thereby treating the hemorrhoids.

    2. Is PPH circumcision a minimally invasive operation?

    Many people think that this PPH method is minimally invasive and can be treated at the outpatient clinic without affecting work and life. In fact, PPH is not as beautiful as everyone thinks. Everyone hopes that their surgical trauma can be less. For example, laparoscopic surgery through several small holes will not affect the appearance; but the anorectal is a channel inside and outside the body, and the appearance does not have much significance for this part. Moreover, the trauma caused by PPH is still relatively large. It is not completely "minimally invasive" to cut off a section of the intestinal mucosa.

    3. Which patients are suitable for PPH?

    Strictly speaking, the indications of PPH are only "internal hemorrhoids (common internal hemorrhoids, circular internal hemorrhoids)" and "intestinal mucosal relaxation". PPH only cuts a section of the hemorrhoids. The external hemorrhoids only have a lifting effect, and it does not fundamentally treat the external hemorrhoids. Therefore, for external hemorrhoids and mixed hemorrhoids, the effect of PPH is not good, and it will relapse after a long time.

    4. What are the complications of PPH surgery?

    After PPH, some patients often have rectal stenosis. Rectal stenosis caused by PPH is very troublesome to deal with. Unlike ordinary anal stenosis, the position is relatively low, and it is relatively easy to operate. The position of the anastomosis after PPH circumcision is generally 2-75px on the tooth line, which means that there is a distance of 5-150px from the anal opening. It is difficult for the fingers to reach in, and it is difficult to loosen this narrow ring. Some people may think that this kind of narrow ring incision is enough, but it is not so simple to loosen rectal stricture: after the incision wound heals, there will be secondary stenosis or even three stenosis. PPH surgery is also improving. Previously, a circle of intestinal mucosa was cut off, but now a C-shaped incision can be made. Leave a gap to maintain the integrity of the intestinal mucosa to a certain extent, and the problem of rectal stenosis can also be improved.

    Since there are more perianal nerve reflectors, if the PPH anastomosis is too close to the anus, the anus may fall and become narrow; if the position of the anastomosis is moved up, move to the upper rectum, it can avoid the high distribution area of ​​anal nerves, and the symptoms will be Somewhat lessened. But in this way, the lifting effect of PPH surgery will be worse, and once complications such as bleeding and stenosis occur, because the anastomosis is located deep in the rectum, it will be difficult to handle.

    5. How to judge whether there is rectal stenosis?

    There are two methods to determine whether there is rectal stenosis. The first is to touch with your hands. A normal rectum can pass two or three fingers. Some people say that one finger can pass through the rectum. This is also a sign of stenosis. The ampulla of the rectum is very large and elastic, so that there is room for storing feces and contracting and squeezing the feces. There is a vivid analogy, rectal stenosis is like putting a ring on the rectum. The rectum was originally very wide, but a narrow ring formed in the middle, and the stool could not come out if it was slightly thicker. Many patients who come to seek medical treatment can no longer reach their fingers, showing the degree of stenosis of the anastomosis. The second way to judge is whether it is difficult to defecate. The anastomosis is narrow and it is extremely difficult to defecate. Many patients are painful to defecate every day, and they can defecate smoothly after using Kaisailu.

    6. Is it easy to bleed after PPH? Will it hurt?

    In a short period of PPH surgery, the most common complication is bleeding. Two weeks after PPH surgery is the safe period. Do not eat spicy food within two weeks. Pay attention to defecation or exercise to prevent postoperative bleeding. Many people feel that the biggest benefit of PPH surgery is that it is not painful. PPH removes the rectum, avoiding the most sensitive nerve tissue in the anus, and may not have obvious pain. However, after circular incision of the intestinal mucosa, it will also stimulate the visceral nerves and produce a feeling of bulging.

    7. Are the titanium nails in PPH harmful to the human body?

    In PPH surgery, the role of the titanium nail is to temporarily put the two pieces of tissue together. After the tissue is healed, the titanium nail is a foreign body. In principle, it must be taken off. The titanium nail may cause harm to the body if it does not fall off. If the titanium nail is properly fixed on the rectum, it will not be a big problem for the patient; but once one end of the titanium nail falls off or breaks, it will stimulate the intestinal wall; the patient will feel unconsciousness, swelling, and pain If the intestinal wall is pierced, it may even cause heavy bleeding. Therefore, if you have similar symptoms after PPH, you can go to the hospital to check it. Basically, you can feel the protruding titanium nail on the digital examination; if you can’t feel it on the digital examination, you can take an X-ray to clearly see how much titanium there is. Nail residue.

    8. Can the titanium nail be removed? What kind of titanium nails can be taken?

    For patients who want to take nails, it should be analyzed according to different situations. In some patients, the anastomotic stoma and intestinal mucosa can be seen from the titanium nail under anoscope. The titanium nail can be seen and can be removed in the clinic. If most of the titanium nails are buried in the anastomosis, they cannot be taken casually. The anastomosis is farther from the anus, and the rectum is rich in blood vessels. You must first enter the rectum to cut the anastomosis and pull it out when you see the titanium nail. Just like a nail falling into a pile of rubbish, it is very difficult to turn the nail out. This will undoubtedly cause another trauma to the intestinal cavity and cause postoperative bleeding.

    9. How long do I need to stay in hospital for PPH surgery? what is the estimated cost?

    Just do PPH surgery and stay in hospital for 2-3 days. Of course, during this period, you should still be wary of postoperative bleeding. Once you have defecation bleeding, you need to go to the hospital to deal with it in time. Don't wait until the bleeding is too large to come to the hospital. If the bleeding is large, it may be life-threatening. Surgical instruments such as PPH are domestically made and imported, and the cost is different. The domestically produced 2,000 yuan, the imported 4,000-5,000 yuan, plus the operation fee, the PPH surgery is about 10,000 yuan.

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