2020年10月20日星期二

lidocaine for hemorrhoids,"Minimally invasive" treatment of hemorrhoids

    Shuran is the beautiful mother of two babies. Every morning, she takes up the bathroom for a long time. Her husband always feels puzzled, "I'm making-up? Then my wife's level is really high, her face is white and tender, and there is no trace of makeup."

    In fact, Shuran has ten years of "hemorrhoid age" and spends a lot of work in the morning on the hemorrhoids inside and outside her anus.

    Hemorrhoids are boring, bleeding, swelling and pain, prolapse of the anus after defecation, swelling, itching, mucus secretion, etc. For mild hemorrhoids, adjusting lifestyle habits and using drugs can solve the symptoms. After reaching a certain level, hemorrhoids will remind you of its existence from time to time or always there, and disturb your life.

    Shu Ran, who has been watching the anorectal clinic for nearly ten years, can't bear it this year, and is determined to seek a long-term solution to the problem from doctors for "minimally invasive" methods.

    Minimally invasive means "micro-invasive" or "as little and as little damage as possible". Minimally invasive surgery must be traumatic, and it may also cause serious injuries. Minimally Invasive is technology and concept.

    At present, the concept of minimally invasive treatment of hemorrhoids is not clearly defined. Doctors call the technique "minimally invasive" in order to guide patients, while patients think that "minimally invasive" is a fixed method. When they see the doctor, they will directly say "I want to treat hemorrhoids with minimal invasiveness."

    Any method has indications. For a disease, different methods need to be selected according to individual conditions. The word "minimally invasive" cannot be summarized. The treatment of hemorrhoids is carried out according to the different types and stages of hemorrhoids. The doctor will choose other treatments or operations according to the individual differences of the patients, and formulate a personalized plan.

    The treatment of hemorrhoids is divided into non-surgical treatment and surgical treatment. Non-surgical treatment includes drug treatment, as well as other chemical and physical therapies. These treatments are for internal hemorrhoids.

    Chemical and physical therapy is a non-surgical resection, which is invasive and damaging. It is considered a minimally invasive treatment for hemorrhoids. There are many types, such as sclerosing agent injection therapy, cryotherapy, infrared coagulation therapy, laser coagulation therapy, Ultroid direct current therapy, bipolar diathermy therapy, ultrasound Doppler guided hemorrhoid artery ligation, apron ligation therapy, etc., generally suitable for bleeding Mainly hemorrhoids in 1-2 period. Surgery is either through cell destruction, or through occlusion of blood vessels, or through local thermal effects to damage tissue, form ulcers, and fibrosis. After the damage is gradually repaired, it has a therapeutic effect. These therapies have complications such as pain, edema, bleeding, infection, and sequelae. For hemorrhoids in the 1-2 period that can be improved by drugs, these treatments are often unnecessary. Rubber band ligation therapy can be used for hemorrhoids in the third stage.

    When internal hemorrhoids develop to stage 3-4 with prolapsed symptoms and combined with external hemorrhoids, surgical resection should be considered. Commonly used clinically are stapled hemorrhoidectomy, classic Milligon-Morgan open hemorrhoidectomy, Ferguson closed hemorrhoidectomy, and Parks submucosal hemorrhoidectomy.

    Stapled hemorrhoid fixation includes PPH and TST. It is an operation based on the theory of "anal cushion downward shift theory". It is used to remove the hemorrhoids and the lower rectal mucosa and submucosa at one time through a stapler and nail the incision to block the blood of the hemorrhoid artery. It is called "minimally invasive" surgery to make hemorrhoids ischemic atrophy and anal pad reset to achieve the purpose of treatment. In terms of surgical trauma, the stapler is not a technically minimally invasive surgery. Its damage is far more than that of classic hemorrhoidectomy. There are serious complications that do not occur in classic surgery such as rectal perforation, rectal stenosis, and rectovaginal fistula. Long-term curative effect Also relatively poor. However, the use of instruments to nail the wound with the stapler can reduce postoperative pain, and the wound will recover quickly, with a minimally invasive concept.

    The "minimally invasive surgery" for hemorrhoids treatment should be a manifestation of some techniques and concepts to reduce intraoperative injuries and postoperative pain as much as possible to achieve better results. The procedure is not the basis for distinguishing whether or not minimally invasive surgery.

    Classical hemorrhoidectomy, including Ferguson closed hemorrhoidectomy, Parks submucosal hemorrhoidectomy, Milligon-Morgan open hemorrhoidectomy, the long-term efficacy has undergone long-term clinical practice tests, and doctors can use skills to reduce damage during surgery , The purpose of preserving normal tissues, so that patients suffer less pain and recover quickly. Therefore, the classic hemorrhoidectomy is a combination of minimally invasive technology and concept, which is minimally invasive surgery.

    Although hemorrhoids are simple and common diseases, the appearance, nature, number, and distribution of hemorrhoids of each individual will be different. Therefore, it is absolutely not possible to simply determine or generalize the name of the treatment with "minimally invasive".

    After examining Shuran, the doctor judged that her hemorrhoids were vascular hyperplasia and anal papillary hyperplasia, and she had to push it back to the anus with her hands after going out of the toilet, which could only be surgically removed. After learning about her own situation and the so-called minimally invasive treatment of hemorrhoids, Shuran was relieved to accept the advice, ready to deal with the trouble for many years and return to normal life.

    (In order to protect the privacy of patients, all names used in the text are pseudonyms, and there are links in the blue underlined text)

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