2020年10月28日星期三

are hemorrhoids dangerous,Some points about complications after PPH can be summarized-postoperative bleeding

    Regarding the postoperative complications of PPH, I published a paper on this a few years ago. In order to solve the many questions of the patient, a brief summary is made to facilitate the patient's understanding. This article mainly introduces anastomotic bleeding.

    In the anorectal area, bleeding is the most common and major postoperative complication regardless of the surgery, and PPH surgery is no exception. When the percussion stapler is successfully pulled out, there is often jet bleeding at the anastomotic stoma. According to major domestic and foreign literature reports, the incidence is 36%-60%.

    Bleeding is first divided into primary bleeding within 24 hours after surgery and secondary bleeding within 3 to 10 days after surgery.

    One. Primary bleeding

    1. Instrumental factors: 1) The quality of the anastomotic nail: directly affects the quality of the anastomosis. 2) The quality of the cutter: It is directly related to whether the tissue can be completely removed. If it is completely cut or partially cut continuously, or the cut tissue is not neat, it will easily lead to anastomotic bleeding.

    Solution: In the first few years, there were many such problems, but with the continuous updating of the stapler, starting from Johnson & Johnson 03, the bleeding caused by the quality of the stapler has gradually decreased.

    2. Technical factors: The surgical skills and proficiency of the surgeon directly determine the quality of the anastomosis. 1) The thickness of the tissue cut on the same plane is too different. 2) When the surgeon fired the stapler, the force was not enough or could not complete the anastomosis at one time.

    Solution: Improve proficiency to improve the quality of the anastomosis.

    3. Vascular factors: patients have more local blood vessels or thicker blood vessels.

    Treatment method: After the anastomosis is completed, use the advantageous conditions of the anal dilator to carefully check the anastomosis with the aid of a suture ligator. Not only should the bleeding point be sutured to stop bleeding, but the suspicious bleeding point should be sutured to stop bleeding at the same time. This method is completely different from the treatment of non-pulsatile bleeding points in traditional surgery.

    two. Secondary bleeding

    1. Device factors and technical factors also exist.

    Treatment method: improve the quality of equipment and technical level, thereby improving the quality of the anastomosis.

    2. Infectious factors: Infection can prevent the wound from healing as soon as possible, causing local tissue erosion and bleeding, and even local blood vessel erosion, necrosis and bleeding.

    Treatment method: Effectively prevent postoperative infection through local dressing change, postoperative cleaning and fluid infusion.

    3. Mechanical factors: due to the temporary closure of the blood vessels on both sides of the anastomosis postoperatively, unstable thrombus is formed. When external force is stimulated, such as: the anastomotic nail loosens; the mucous membranes on both sides of the stump atrophy; the stool friction the anastomosis makes the nail feet loose Or mucosal wounds, etc., reopening the broken end of the blood vessel or falling off the blood clot at the broken end can cause bleeding.

    Treatment: Hemorrhoids is a vascular disease or a type of disease mainly related to blood vessels. The surgical treatment of hemorrhoids is like a plumber repairing the faucet without turning off the sluice. Water leakage is inevitable, as is the bleeding of different degrees after hemorrhoids. It is inevitable. A small amount of occasional bleeding does not need to be treated; a small amount of continuous bleeding can be treated symptomatically, such as hemostatic clots, hemostatic drugs, or epinephrine retention enema; heavy bleeding must be locally sutured to stop bleeding. Rectal bleeding Any attempt to stop the bleeding with compression or packing is futile. Comrades who have long been engaged in hemorrhoids and fistulas are well aware of this, and ordinary surgeons must have this experience.

    I hope that the patient friends can understand the situation of the professional doctors in the anorectal department in dealing with the complications after PPH through these descriptions. Don't be afraid of the unknown. I believe the doctor. I believe that the postoperative accident can be solved through the efforts of the doctor. , So you can recover health faster!

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