2020年10月25日星期日

what does a hemorrhoids look like,The true face of PPH and its advantages and disadvantages

    PPH is the abbreviation of Procedure for prolapse and hemorrhoids, literally translated as a method of treating prolapse and hemorrhoids.

    In 1997, Pescatori reported the use of transanal stapling for rectal mucosal resection for the treatment of rectal mucosal prolapse. In 1998, Italian scholar Longo used this technique to treat prolapse of hemorrhoids and described the mechanism of rectal mucosal circular resection for the treatment of prolapsed hemorrhoids. Domestic Yao Liqing carried out this operation in 2000 for the treatment of severe hemorrhoids.

    The principle of PPH treatment of hemorrhoids is to use a circular stapler to circularly remove a section of mucous membrane 4cm above the upper edge of the hemorrhoid, and at the same time nail the cutting edge, so that the hemorrhoid tissue can be lifted up to achieve the purpose of treating hemorrhoids, so this is A method of treating hemorrhoids without cutting the hemorrhoids.

    The theoretical basis for PPH to treat hemorrhoids is the theory that "hemorrhoids are anal cushions down". Hemorrhoids are considered to be a normal anatomical structure common to everyone, that is, anal cushion, located at the lower end of the rectum, composed of blood vessels in the submucosa, smooth muscles and elastic fibers. When the supporting tissues of the anal cushion Parks ligament and Treits muscle undergo degeneration and rupture, the anal cushion moves down and forms hemorrhoid prolapse.

    Longo believes that the PPH circular resection of the 2~3cm mucosa and submucosal tissues of the lower rectum can restore the normal anatomical structure of the lower rectum, that is, the anal cushion. At the same time, the resection of the submucosal tissue blocks the blood supply of the suprahemorrhoidal artery to the hemorrhoid area, and postoperative hemorrhoids atrophy, which is also considered to be the mechanism of PPH treatment of hemorrhoids. Because PPH only removes the mucosa and submucosal tissues at the lower end of the rectum, and does not leave an incision in the anal canal and perianal that are rich in sensory nerves, theoretically reducing postoperative pain. Because the anastomosis is located above the anorectal ring, the chance of sphincter injury is relatively reduced.

    However, the essence of hemorrhoids is not a simple "pad down". In a piece of hemorrhoid tissue, there are a large number of varicose veins and hyperplastic epidermis, and PPH can't do anything about these two parts. Blocking the blood supply of the hemorrhoidal artery to the hemorrhoid area, the postoperative hemorrhoid atrophy is just speculation. In fact, the blood supply at the end of the hemorrhoid is not abundant. After blocking the hemorrhoidal artery, the collateral circulation will be quickly established, the arteries and veins in the hemorrhoid tissue Anastomosis requires a lot of blood.

    Therefore, in recent years, even the Italian doctor Longo has exclaimed that hemorrhoids after PPH recurred too quickly! Therefore, Longo cooperated with the manufacturer to develop an improved PPH to enlarge the mucosal compartment, which can remove longer mucosa and lift the "liner" even more.

    In fact, the key reason for recurrence after PPH is that the other two pathological factors of hemorrhoids have not been resolved, that is, varicose veins and epidermal hyperplasia. If these two problems are not resolved, what's the point of raising them? What's more, if the lift is too tight, it may cause the anastomotic tension to be too great and rupture and hemorrhage. I have seen several cases of doctors in a hospital performing PPH surgery on patients without prolapse and causing hemorrhage.

    Therefore, to make the hemorrhoids as clean and thorough as possible, PPH must be combined with the removal of the venous mass and the removal of the epidermis and external hemorrhoids. In this way, PPH can solve the problem of prolapsed pads and surgically solve the venous mass and external hemorrhoids. The operation is perfect. .

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