2020年10月23日星期五

hemorrhoids and anal fissures,Clinical treatment of 150 cases of mixed hemorrhoids with anal epithelium preservation and radical hemorrhoidectomy

    Abstract 150 cases of mixed hemorrhoids were treated with preserving anal epithelium and padded hemorrhoids. After the operation, anti-inflammatory, sitz bath, dressing change and microwave physiotherapy were given. All 150 cases were cured with an average treatment course of 13 days. Postoperative anal function was normal, no anal stenosis, no mucosal ectropion, no gland overflow, less anal skin tags and other sequelae. The results show that this operation has the advantages of definite curative effect, fewer complications, and no sequelae.

    Keywords: preservation of anal epithelium and pads mixed hemorrhoids surgery clinical observation

    Preservation of anal epithelium and liner hemorrhoids cure clinical observation of 150 cases of mixed hemorrhoids treatment

    Abstract : The 150 cases of mixed hemorrhoid therapy for anal intraepithelial and liner hemorrhoids resection, postoperative given anti-inflammatory, bathing, dressing and microwave therapy. 150 cases were all cured, the average 13D of course. Postoperative anal function is normal, no anal stenosis, without everting mucosa, eglandular spillover, anal skin tag less sequelae. The results show that, this method has exact curative effect, less complications, no sequelae.

    Keywords:  preservation of anal epithelium and liner mixed hemorrhoid operation clinical observatio

    150 cases of mixed hemorrhoids were treated with preserving anal epithelium and padded hemorrhoid radical surgery, with satisfactory results. The report is as follows.

    1 Materials and methods

    1.1 Clinical data In this group, there were 87 males and 63 females; they were 30-68 years old; the course of disease was 2-30 years. The 150 cases all met the "Interim Standards for Diagnosis and Treatment of Hemorrhoids" established by the Anorectal Surgery Group of the Chinese Medical Association in 2000.

    1.2 Treatment methods: All patients were under simplified sacral anaesthesia, prone folding knife position, routine disinfection drapes. Expand the anus until the anus is loose and expose the anal canal. Carefully diagnose the anus. Clamp the external hemorrhoids with small vascular forceps and then cut the skin with a scalpel. Lift the vascular forceps and make a water-drop incision along the body of the external hemorrhoids. While preserving the subcutaneous Treitz ligament, peel it upwards. If there is external hemorrhoid tissue, remove it. Squeeze or remove it so that it does not remain. For the intermediate hemorrhoids under the skin of the anal canal, the resection range should be narrow, the incision should be retracted, and the hemorrhoid tissue should be removed while preserving the liner. When the internal hemorrhoids are peeled off, the extent of resection is enlarged again, and the extent of resection of internal hemorrhoids becomes narrower as it goes upwards. Finally, the superior rectal arteries and veins and a proper amount of surrounding tissues and mucous membrane remain. Use 2-0 absorbable thread to make this part a triple ligation. Then the remaining hemorrhoid tissue under the epithelium of the anus is completely peeled off, and then the absorbable thread that ligates the root of the internal hemorrhoid is used to lock the hemorrhoids. Starting from the root, lock the hemorrhoids along one edge from the inside to the outside, and turn to the opposite side after the tooth line. To the root, tighten the seam thread and ligate, and then use the seam ligation suture to sew the anal epithelium to the anal margin to close the wound in the anal canal. The wound outside the anus is used for drainage and should not be sutured. Treat other hemorrhoids in the same way. After the operation, the anus was inserted with Taining suppository and Vaseline gauze strip, wrapped with external dressing, and fixed with T-band.

    1.3 Postoperative external management Liquid diet for 2 days, preventive antibiotics for 3 days, oral administration of Fusone (polyethylene glycol 4000) before defecation to moisten the bowel and relax. After going to the toilet, take a bath, change the dressing of Taining suppository, metronidazole gauze and microwave physiotherapy until the wound is healed.

    2 results

    All patients in this group were cured at one time, and the course of treatment was 11-15 days. On the day of the operation, most patients had mild anal burning pain and swelling sensation. Difficulty in urination occurred in 12 cases 24 hours after the operation, which was relieved after applying heat to the bladder area and inducing urination. There were 6 cases of mild edema of the skin bridge at the postoperative wound, which was eliminated after 1 week of comprehensive treatment. One case had a small amount of bleeding after operation, but the degree was relatively mild, and he got better without special treatment. A few skin tags formed in the anus after surgery, and the anus was flat after trimming. After half a year of follow-up, 132 cases (18 cases were lost to follow-up) had no recurrence, and no sequelae such as anal stenosis, mucosal ectropion, and glandular overflow.

    3 Discussion

    We use the anal epithelium and liner hemorrhoid radical resection to treat mixed hemorrhoids. The wound is made into a gourd shape, the external and internal hemorrhoids are fully removed, and the intermediate hemorrhoid tissue remaining under the anal epithelium is carefully peeled and removed. The result is a wound. The hemorrhoids under the anal epithelium on both sides of the margin were completely removed, while the anal epithelium was preserved. Then use the suture that ligates the root of the hemorrhoid to start locking along one side of the mucosal margin, and turn to the opposite side after reaching the tooth line. After the stitching continues to the root of the hemorrhoid, the knot is tightened and ligated to fix the free anal epithelium. And covered the mucosal wound. Then fix the anal canal epithelium with the ligated thread of the front purse string suture. The wound outside the anus is opened to facilitate drainage and prevent the occurrence of skin tags, and restore the normal anatomical structure of the anal canal. Its characteristics are: (1) Due to the peculiarities of the anal canal skin ③, anal canal skin defect, mucosal ectropion and extraglandular overflow will be formed after excessive excision during surgery. This operation can not only cure hemorrhoids, but also preserve the anal epithelium, thus reducing the occurrence of skin defects in the anal canal, mucosal ectropion and glandular extravasation. (2) This operation not only preserves the Treitz ligament support tissue, but also protects the flexibility of the anus. (3) Purse-string suture on the mucosal wound of internal hemorrhoids not only closes the mucosal wound well, reduces postoperative bleeding, and promotes the early healing of the wound, but also plays a very good suspending role, making it protrude outside the anus together with the hemorrhoid tissue The anal epithelium was pulled back to its original anatomical position. (4) The drip-shaped wound outside the anus can fully drain, reduce the occurrence of postoperative anal edema, and greatly shorten the course of treatment.

    The problems that should be paid attention to in this operation: (1) Keep the anal epithelium as much as possible and remove the hemorrhoid tissue as much as possible. (2) For the sub-hemorrhoids between the female hemorrhoids, the larger one is treated as an independent hemorrhoid, but the smaller one is removed from the anal epithelium just under the anal epithelium. (3) When ligating the roots of the hemorrhoids, use absorbable sutures. (4) As far as possible, the inner wound should be sutured and the outer wound should be drained. (5) The operation should be meticulous, no necrotic tissue should be left, and the wound should be smoothed.

    references:

    ①Shi Renjie. Diagnosis and treatment of anorectal diseases. Beijing: Chemical Industry Press, 88.

    ②Yu Dehong, Yang Xinqing, Huang Yanting. Re-understanding and improving the diagnostic level of hemorrhoids. Chinese Journal of Surgery, 2000,38(12):890.

    ③Li Chunyu, Zhang Yousheng. Practical Anal Surgery. Shenyang: Liaoning Science and Technology Press, 2005.11.

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