1. Standard hospitalization process for mixed hemorrhoids clinical pathway
(1) Applicable objects.
The first diagnosis was mixed hemorrhoids (TCD BWG000, ICD-10 I84.901);
External resection and internal ligation of mixed hemorrhoids (No. 49.451) was performed.
(B) Diagnosis basis.
Refer to the diagnosis and treatment plan for hemorrhoids of the "Eleventh Five-Year Plan" State Administration of Traditional Chinese Medicine for the diagnosis and treatment of hemorrhoids.
1. Disease diagnosis
(1) Clinical manifestations:
The clinical manifestation of mixed hemorrhoids is that the symptoms of internal and external hemorrhoids exist simultaneously. Among them, internal hemorrhoids are stage II (degree) or higher. The clinical manifestations are bleeding and prolapse, which may be complicated by thrombosis, incarceration, strangulation, and difficulty in defecation. The clinical manifestations of external hemorrhoids are soft tissue masses in the anus, anal discomfort, damp itching or foreign body sensation, and pain if thrombosis and inflammation occur.
(2) Auxiliary inspection:
Digital anal examination: The hemorrhoid nodules with longitudinal wrinkles and/or bulges can be felt above the tooth line.
Anorectoscope: It can clarify the location, size, number of internal hemorrhoids and whether there is bleeding, edema, erosion, etc. on the surface of internal hemorrhoids.
Colonoscopy: Patients with blood, family history of gastrointestinal tumors or polyps, patients over 50 years of age, positive stool occult blood test, and iron deficiency anemia hemorrhoids are recommended for patients with conditions Census.
2. Syndrome diagnosis (syndrome differentiation)
(1) Wind-injured intestinal collateral syndrome: stool dripping blood, ejection or blood, red blood, dry stool, anal itching, dry mouth and throat. Red tongue, yellow coating, floating pulse.
(2) Hot and humid betting card: The stool is bloody and red, and the amount is large. Anal swelling, swelling, burning pain or hydration. Dry or loose stools, short red urine. The tongue is red, the coating is yellow and greasy, and the pulse is floating.
(3) Qi stagnation and blood stasis syndrome: Tumor prolapses outside the anus, edema, thrombosis or incarceration, dark purple surface, erosion, effusion, severe pain, obvious tenderness, tight anal canal, constipation , Difficulty in urination. The tongue is dark purple or has petechiae, and the pulse is stringy or astringent.
(4) Syndrome of spleen deficiency and qi stagnation: the tumor prolapses outside the anus, it is not easy to reset, the anus is swollen, the stool is weak, and the stool is bloody. Facial complexion, dizziness and fatigue, less food and fatigue, less gas and lazy talk. Pale tongue, thin white fur, thin and weak pulse.
(3) Choice of treatment plan.
Refer to the "Eleventh Five-Year Plan" State Administration of Traditional Chinese Medicine for the diagnosis and treatment of hemorrhoids in the anorectal key specialist collaboration group for treatment.
1. The diagnosis is clear: mixed hemorrhoids
(1) Mixed hemorrhoids with purulent infection;
(2) Patients with mixed hemorrhoids accompanied by dysentery or severe diarrhea;
(3) Patients with severe heart and lung diseases;
(4) Patients with severe liver, kidney disease or blood disease;
(5) Mixed hemorrhoids caused by abdominal cavity tumors or portal hypertension;
(6) Mental patients who cannot cooperate with surgery.
3. When there are contraindications: use conservative treatment to reduce the symptoms of hemorrhoids.
(4) The standard hospital stay is ≤14 days.
(5) Entry path standards.
1. The first diagnosis must comply with ICD: D25 mixed hemorrhoid disease code;
2. There are indications for surgery but no contraindications for surgery;
3. When the patient is diagnosed with other diseases at the same time, but does not require special treatment during the hospitalization period and does not affect the implementation of the first diagnosis clinical pathway process, the pathway can be entered.
4. The patient agrees to undergo surgery.
(6) Preparation for 1-2 days before operation, necessary inspection items.
1. Routine of blood, urine and feces;
2. Liver and kidney function, electrolytes, blood sugar;
3. Examination of infectious diseases of hepatitis B, hepatitis C, syphilis and AIDS;
4. Examination of coagulation function;
5. Full chest X-ray
(7) Selection and timing of preventive antibacterial drugs.
1. Apply preventive antibiotics in accordance with the "Guiding Principles for Clinical Application of Antibacterial Drugs" (Weiyifa  No. 285); one-time use within 2 hours before surgery.
2. Use preventive antibiotics within 72 hours after surgery.
(8) The operation day is the 2-3 days after admission.
1. Before the operation, Kaisailu 2 anus for simple bowel preparation.
2. Anesthesia: local anesthesia or lumbar anesthesia or saddle anesthesia;
3. Operation method: external resection and internal ligation of mixed hemorrhoids.
(9) Postoperative hospital stay ≤14 days.
1. On the second day after the operation, the wound was changed dressing, fumigated and washed with Chinese medicine (see attachment: diagnosis and treatment plan for details);
2. The use of traditional Chinese medicine preparations based on syndrome differentiation (see attachment: diagnosis and treatment plan for details);
3. Preventive medication: use antibacterial drugs within 72 hours after surgery.
(10) Discharge criteria (around general conditions, incision conditions, first diagnosis outcome).
The surgical ligature fell off, the wound was dry, the patient had no fever, and he could defecate normally.
(11) Whether there is variation and its cause analysis.
During the implementation of the clinical pathway, cases that fail to follow the clinical pathway due to any factors, including those who disagree with the patient's cognition and informed consent/signature, are regarded as variants