Segmented ligation and interval suture for treatment of circular mixed hemorrhoids
150 surgical reports
*Dalian Xinhua Anorectal Hospital
1 Clinical data
1.1 General information: 50 cases of severe circular mixed hemorrhoids, 87 males, 63 females, aged 26 to 76 years, the longest course of disease is 50 years, the shortest is 5 years.
1.2 Surgical methods
Take the cutting position, and spread the sterile sheet for routine disinfection. Lidocaine is locally anesthetized, and the rectal and anal canal is disinfected twice with iodophor to expand the anus so that the hemorrhoids are completely prolapsed. The external hemorrhoids are clamped and lifted with tissue forceps and divided into 6 equal parts at 3, 7, and 11 points. ; Use No. 10 silk thread to suture the base of the hemorrhoids at the 3, 7, and 11 o'clock segments, ligating the external hemorrhoids in an "8" shape, and cut off the hemorrhoid tissue at the 0.3cm distal end of the suture thread. Separate hemorrhoids were lifted up and spread out with horizontal clamps, and then cut and sutured with 000 absorbable thread, stitch distance 0.3cm, margin distance 0.3cm. Treatment of other hemorrhoids in the anal canal: carefully check the position, number, and size of the hemorrhoids, and sew them across the "8" with 000 absorbable threads. Methylene blue lidocaine long-acting anesthetic is injected into the anus margin. Place a rubber tube, pressurize and bandage, the operation is completed.
1.3 Postoperative reaction
The pain can be tolerated and does not affect daily activities. Individual patients may experience orthostatic hypotension (dizziness, nausea, and vomiting) with lidocaine for local anesthesia, which can be relieved after 2 hours in bed without special treatment. Urinary retention may occur in a few cases, and you can urinate on your own after taking a bath in warm water.
(1) Curative effect standard
Healing: No blood in the stool, no prolapse of hemorrhoids, atrophy of hemorrhoids, flat anus, no bulge in stool.
Improved: No blood in the stool, no hemorrhoids prolapsed during the stool, the anoscope looked directly at the hemorrhoids atrophy, and some external hemorrhoids bulged during the stool.
Ineffective: No significant change compared with before treatment.
(2) Results: After 6 months to 1 year follow-up, all recovered, without recurrence.
2.1 The external hemorrhoid ligation method is to ligate the base of the hemorrhoids with silk thread to cause avascular necrosis of the hemorrhoids. The advantage is that the thread replaces the knife to slowly cut the hemorrhoids, which makes it easier to retain the skin bridge and prevent the anal canal skin bridge and mucosa from curling; due to the slow cutting, the skin bridge can embolize the rich small blood vessels in the two wounds, avoiding surgery After bleeding, edema. It has the advantages of protecting the skin of the anal canal, less bleeding, small wound surface, quick wound healing, and less pain for patients. This method has been widely used. However, after ligation of severe circular mixed hemorrhoids, it is necessary to incise the subdental branch 1.5~2.0cm outside the anal margin obliquely, including the lower part of the external sphincter skin and the lower end of the internal sphincter to prevent postoperative anal stenosis. This will inevitably cause the damage of the anal sphincter and the destruction of the anal shape, and will leave large scars on the anal margin, and some patients will also experience sphincter insufficiency. The advantages of this modified operation are: the external hemorrhoids can be completely removed, the skin bridge is sufficient, the sphincter and perianal skin are not cut, the anal margin is not surgically scarred, the anus shape is complete after the operation, and the anal function is ensured. It is a safe and reliable surgical method.
2.2 For the treatment of internal hemorrhoids, there are sclerosing agent injection, band ligation, stitching, freezing, laser and so on. We chose the horizontal "8" stitching method for internal hemorrhoids. While treating internal hemorrhoids, it also serves as an anal cushion. The suspension function prevents the eversion of the anal mucosa.