2020年10月21日星期三

hemorrhoids diagnosis,One of the routine diagnosis and treatment of anorectal surgery in the Yifu Hospital of Nanjing Medical University (hemorrhoids)

    1. Key points of medical history

    1. Bleeding during defecation: the blood is bright red, dripping, not mixed with the stool, and the amount of bleeding is generally not large on the surface of the stool. If the bleeding is too much, it can cause severe anemia. Bleeding is often intermittent and stops spontaneously after the bowel movement. Dry and hard stools, constipation, increased stool frequency, drinking alcohol or eating irritating foods are all causes of hemorrhoid bleeding.

    2. Hemorrhoids prolapse: internal hemorrhoids or mixed hemorrhoids develop to the second and third stages, and the hemorrhoids protrude from the anus and become larger and smaller. From self-reposition to the necessity of retraction.

    3. Pain: There is no pain in simple hemorrhoids. When the superficial mucosa or skin is damaged, infection or thrombosis causes pain. Thrombotic external hemorrhoids, severe local pain, defecation, sitting, walking, and coughing can all be aggravated. When internal hemorrhoids or mixed hemorrhoids are prolapsed, edema, infection, and necrosis appear, the local pain is severe.

    4. Itching: prolapse of hemorrhoids and sphincter relaxation, mucus secretion out of the anus, irritating the surrounding skin, causing itching or eczema. If the stool is bloody dark, mixed with mucus or stool, or has frequent stools or incomplete defecation, the possibility of malignant tumors should be considered.

    2. Inspection and diagnosis

    1. Inspection: Pay attention to the distribution of external hemorrhoids. For thrombotic external hemorrhoids, dark purple oblong tumor masses protruding around the anus can be seen. It is best to observe whether the hemorrhoids prolapse after the stool.

    2. Digital rectal examination: It is an essential examination. Generally, internal hemorrhoids without embolization or fibrosis cannot be felt. It should be noted whether there are tumors and other diseases in the rectal cavity at the same time.

    3. Anoscopy: The mucosa has a semi-circular purple-red bulge below the plane of the anorectal ring, and sometimes active bleeding can be seen. Pay attention to the size, number and location of hemorrhoids.

    4. For suspicious patients, electronic colonoscopy should be performed to rule out the co-existence of malignant tumors.

    Three, treatment

    1. Internal hemorrhoids

    Smaller internal hemorrhoid bleeding can be treated conservatively or injected. Large isolated internal hemorrhoids bleeding is not suitable for injection therapy, and large isolated internal hemorrhoids prolapse is also not suitable for injection therapy. Larger isolated internal hemorrhoids with prolapse or bleeding should undergo internal ligation and external resection. Larger prolapsed circular internal hemorrhoids are best to undergo PPH surgery under general anesthesia.

    a) conservative treatment

    Pay attention to diet, keep the stool unobstructed, wash the anus with warm water, put Jiuhua Hemorrhoid Suppository into the anal canal, and take Maizhiling.

    b) Injection therapy

    Oral laxatives to clear the intestines before surgery.

    Commonly used sclerosing agents are 5% carbolic acid glycerin and Xiaozhiling injection (lidocaine: Xiaozhiling=1:1). No anesthesia is required. Use a flat anoscope to penetrate the hemorrhoids with tonsil needles. No blood is drawn back. , Inject 3~5ml sclerosing agent, no more than 2 hemorrhoids each time. If there are many hemorrhoids, the injection can be divided into 2 injections. If the effect of one injection is not satisfactory, it can be repeated after 1 month.

    From the next day, oral liquid paraffin 30ml, once a day, about 3 to 4 days, so as to avoid dry and hard stool.

    c) Internal hemorrhoids: internal ligation and external resection.

    Take laxatives orally to clear the intestines before surgery.

    Expand the anus with more than four fingers under local anesthesia to expose the hemorrhoids and clamp at the root of the hemorrhoids. Make a reduced incision on the outer side of the clamp. After ligation under the clamp, the hemorrhoids are removed.

    After the operation, the dressing was changed with new rehabilitation yarn.

    On the first day after surgery, 30ml of liquid paraffin was taken orally before going to bed, once a day. Change dressing every day.

    Take laxatives orally to clear the intestines before surgery.

    d) External stripping and internal ligation:

    Extend the four fingers of the anus under local anesthesia to reveal the hemorrhoids. Make an incision about 1 cm wide at the anal opening. Both sides extend toward the inside and outside of the anus to make the entire incision prismatic. The outside incision is about 2-3 cm. , Incision in the anus to the white line. After cutting the skin and mucous membrane, divide the hemorrhoids to the white line, clamp the hemorrhoids at the roots, and remove the hemorrhoids after ligation.

    Chimanding was given orally after surgery, and PP solution was used to take a bath after each bowel movement. , Change the dressing with a small gauze soaked in Kangfuxin liquid, and fix it with dry gauze outside.

    4. Annular hemorrhoids: Prolapse of annular hemorrhoids without obvious connective tissue external hemorrhoids is best to undergo PPH surgery under general anesthesia. Ring hemorrhoids with connective tissue external hemorrhoids are best performed under epidural anesthesia by segmented external stripping and internal ligation.

    Oral laxatives to clear the intestines before surgery.

    External stripping and internal ligation of 3-4 female hemorrhoids should be performed in the direction of the hemorrhoid groove. The operation method should be carried out according to the mixed hemorrhoid surgery. The width of the external stripping and internal ligation at the anal opening should be 1 cm to prevent postoperative incision edema. The skin bridge between external stripping and internal ligation should be kept at least 6 mm. If there is connective tissue external hemorrhoids on the skin bridge, the connective tissue external hemorrhoids should be removed at the anal opening and sutured. If there are swollen veins under the skin bridge, cross the skin bridge at the anal orifice, and then remove the hemorrhoid blood vessels under the skin bridge. If the skin bridge may be lengthy after suture, it should be cut off and sutured horizontally.

    5. Thrombotic external hemorrhoids

    Generally rest on the supine position, local wet and hot compresses, without surgery. If the thrombosis is large and the pain is severe, external hemorrhoidectomy can be performed under local anesthesia.

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