Abstract: Sixty-eight cases of annular mixed hemorrhoids were treated with segmented tooth ligation and multiple incision drainage, all of which were cured in a short time. The anal margin was smooth after operation, without complications and sequelae.
Keywords: Annular mixed hemorrhoids, segmented tooth ligation, multiple incision drainage
In recent years, we have used segmented tooth ligation and multi-incision drainage to treat 68 cases of annular mixed hemorrhoids, which effectively avoided postoperative anal edema and anal hemorrhage and other complications, avoided residual skin tags after healing, and ensured that the anal margin was flat. The sequelae of anal canal stenosis occurred, and the results were satisfactory. The report is as follows.
1 General information
There are 68 cases in this group, including 42 males and 26 females; they are between 28 and 68 years old, with an average age of 45.2 years, of which 41 to 60 years old are more than 52 cases, accounting for 76.5%; the course of disease is 5 In ~30 years, there were 26 cases of external hemorrhoids with varicose veins, 25 cases of internal hemorrhoids incarcerated, 31 cases of hemorrhoids prolapsed after defecation, and 24 cases of anal stenosis.
2 surgical method
After the sacral anesthesia or saddle anesthesia is satisfied, the patient takes the side lying position, routinely disinfects and expands the anus. After the anal sphincter is fully relaxed, the position, number, shape and the pathological relationship of the hemorrhoids inside and outside the anal canal are checked, and then according to the shape of the hemorrhoids, Carefully design the segmented hemorrhoids and the number, location and width of the anal canal skin bridges and mucosal bridges. Generally, 3 to 4 surgical areas are selected to be integrated into a single external resection (external stripping) and internal ligation, and the operation area is mainly selected at 3, 7, and 11 points of the lithotomy position. Make a radial fusiform incision at the distal end of the hemorrhoids to the isotopic dentition outside one of the areas, blunt and sharply separate to about 0.5 cm of the isotopic dentition, clamp the base of the hemorrhoids with curved vascular forceps, and use 10 gauge line The hemorrhoids are ligated through the "8" shape, and the ligated hemorrhoids are injected with 1:1 Xiaozhiling injection. After it is filled, the hemorrhoids are removed and the stump is about 0.5cm. Treat other hemorrhoids in the same way, but the thread knots ligating the roots of the hemorrhoids should not be on the same plane, and the external hemorrhoid peeling incisions should not be on the same plane, so that the wounds are staggered like a tooth, showing a petal-like curve. The tubes are parallel. Make 1 to 2 radial fusiform incisions as decompression incisions between the skin with larger skin tags or severe venous stenosis. The incision length is above 0.5 cm on the dentinal line and about 0.5 cm below the external hemorrhoids. It is appropriate to remove the venous plexus of the lower varicose, and finally repair the skin edge of the wound. In the case of tight anal canal, the internal sphincter head can be cut off at the incision on the posterior side. After the operation, the index finger was inserted into the anus, the hemorrhoid stump and its descending tissue were reset into the anal canal and rectum, and the skin edges of the wounds were aligned, and the huanglian oil gauze was placed in the anus, and gauze and tape were pressured and fixed.
3 treatment result
All 68 cases in this group were cured within 12-19 days, none had postoperative anal edema and hemorrhage, flat anal margins, and no anal skin
Sequelae such as hyperplasia and anal stricture.
4 体 会
The following points need to be mastered during the operation: (1) Reasonably design the ligation section to avoid excessive removal of the anal canal skin. Parks once put forward the argument that changes in anal caliber are closely related to the number of hemorrhoids removed. Generally, the enlarged diameter of the adult anal canal is 3cm, and the circumference of the anal canal is about 9.42cm. When a hemorrhoid is removed, the circumference of the anal canal is reduced by 1cm. Removal of 3 hemorrhoids at a time, the circumference of the anal canal is reduced by about 3cm, and the diameter of the anal canal is reduced from the original 3cm to 2.05cm. If it is smaller than this diameter, anal stenosis may occur. Namely: Generally, the skin bridge of the anal canal should not be more than 3cm. Therefore, we take segmental (3~4 areas) ligation for the annular mixed hemorrhoids, the width of the main incision in each area is 0.5~1.0cm, the incision should be parallel to the anal canal and the incision of the anal margin should be It is radial, and the skin and mucous membrane bridges between the segments should be in natural depressions as much as possible, and the bridges are more evenly distributed. For each area where the skin tag is larger or the varicose veins are more serious, one or two radial fusiform incisions are made, and the incision width should not be greater than 0.5 cm. The varicose veins should be completely stripped. The skin bridge of the anal canal remaining between each incision should not be less than 0.5cm, the mucosal bridge should not be less than 0.2cm, the total excised skin should not be more than 3cm, the depth of each incision should not damage the sphincter, and the length of the incision It is about 0.5 cm from the tooth line and down to the edge of the external hemorrhoid. We use multiple small incisions for drainage of annular mixed hemorrhoids without resecting or damaging the skin bridge and mucosal bridge in a large area at one time, which not only shortens the path of the surrounding skin to the incision hyperplasia, shortens the course of treatment, and prevents the operation Anal edema, pain and scar contracture cause sequelae such as anal stenosis. (2) The ligation should be cautious to prevent postoperative anal bleeding. When ligating internal hemorrhoids, the hemostatic forceps should not be clamped too deep or too high, the needle penetration should not be too deep, the ligation thread should not be too thin (7#, 10# line is appropriate), and the ligation should be tight.The hemorrhoids to be removed should be determined according to the size of the hemorrhoids. After the removal of large hemorrhoids, the remaining part should be more to prevent premature slippage of the ligation line. Injection of 1:1 Xiaozhiling injection to the ligated hemorrhoids effectively prevents the operation Anal bleeding is conducive to the early repair and recovery of the wound. (3) Cut off the internal sphincter head to prevent postoperative complications. On the one hand, according to the "button hole", the cause of hemorrhoids is mainly internal sphincter spasm or abnormal activities that cause obstruction of the hemorrhoidal venous return, and a large amount of blood in the hemorrhoid blood vessels to form hemorrhoids. Cutting or expanding the internal sphincter head is helpful to improve local blood. Circulation, improve the clinical symptoms of hemorrhoids, and prevent postoperative anal stenosis. On the other hand, abnormal activities of the internal sphincter are closely related to postoperative anal edema and pain. Hemorrhoid surgery trauma stimulates nerve endings in local tissues, reflexes cause vascular motor nerve excitement, causes anal sphincter spasm, produces pain, and causes local lymphatic drainage to be blocked and edema. Therefore, cutting off the internal sphincter head can effectively prevent postoperative anal pain, edema, anal stenosis and other complications and sequelae. (4) Reasonably perform tooth separation ligation. The tooth-shaped separation ligation is used so that the ligation line is not on the same level, so that the postoperative scar contracture is not on the same level, which effectively prevents sequelae such as anal stenosis. In addition, the tightness of each hemorrhoid ligation is different, and the hemorrhoids do not fall off at the same time, therefore, the possibility of hemorrhage during the off-line period is reduced.
Published in "Sichuan Traditional Chinese Medicine"