2020年11月14日星期六

hemorrhoids gel,Ultrasonic hemorrhoidectomy

    Application of ultrasonic knife in hemorrhoidectomy

    Xie Youlong Peng Rui Liu Bin Wang Dong Wu Haixiong Dai Liping Yan Song

    【Abstract】 Objective To evaluate the application value of ultrasonic knife in hemorrhoidectomy. Methods The clinical data of 60 patients with mixed hemorrhoids undergoing hemorrhoidectomy with ultrasonic knife (ultrasonic knife group) were retrospectively analyzed, and compared with the 60 patients with mixed hemorrhoids undergoing Milligan-Morgan operation (control group) during the same period. Results Compared with the operation time (10±1.2min) of the ultrasonic knife group and the control group (20±2.5min), the difference was statistically significant (P<0.05); the intraoperative blood loss (5.0±1.5ml) of the ultrasonic knife group was significantly less In the control group (45±4.3ml) (P<0.001); there was no significant difference between the ultrasonic knife group and the control group in terms of postoperative pain, cure rate, recurrence rate, and postoperative anal function (P>0.05). Conclusion The application of ultrasonic scalpel to hemorrhoidectomy can be delicate, safe and feasible, and can improve the efficiency of operation.

    【Key words】 Hemorrhoids; Ultrasonic knife; Application value

    Chinese Library Classification Number: R657. 1    Document identification code: A

    Application of ultrasonically in hemorrhoidectomy

    XIE you-long, PENG rui, LIU bing, WANG dong, WU hai-xiong, DAI li-ping,YAN song. Department of General Surgery, Shenzhen Hospital. Shenzhen 518020 Chine.

    Corresponding author: XIE you-long,E-mail: youlong_73@tom.com

    Abstract: Objective Evaluation of ultrasonically in hemorrhoidectomy application value. Methods Retrospective analysis of the application of ultrasonically in hemorrhoidectomy performed60 cases of patients with mixed hemorrhoids (ultrasonically group) clinical data, and with the same period in60cases of patients with mixed hemorrhoid underwent Milligan- -Morgan surgery (control group) were compared.Rrsults Ultrasonically group operation time (10±1.2min) and control group (20±2.5min), the difference was statistically significant (P <0.05); ultrasonically bleeding volume in operation (5.0 ± 1.5ml) was less than that of the control group(45±4.3ml) (P <0.001); in postoperative pain, cure rate, recurrence rate, postoperative anal function of ultrasonically group and the control group had no significant difference (P> 0.05). Conclusion Application of ultrasonically in hemorrhoidectomy, can do fine, safe, feasible, can improve operation efficiency.

    【Key words】 Hemorrhoids; ultrasonically; application value

    Author unit: General Surgery, Shenzhen People's Hospital, Guangdong Province, 518020.

    Corresponding author: Xieyou Long (E-mail: youlong_73@tom.com)

    Materials and Methods

    1. Research object

    1. Case selection criteria: Refer to the "Interim criteria for diagnosis and treatment of hemorrhoids" established in 2002 by the Colorectal and Anal Surgery Group of the Chinese Medical Association Surgery Branch [2] and agree to participate in this study.

    2. Case exclusion criteria: (1) Patients with complete anal incontinence, anal stenosis, anal fissure, anal fistula, perianal infection and other anal diseases; (2) Those with history of hemorrhoid surgery and injection therapy; (3) Serious complications (such as severe cardiovascular and cerebrovascular diseases) , Patients with blood diseases); ⑷ those who do not agree to participate in this research.

    Second, the surgical method

    Control group: spinal anesthesia, folding knife position, 30 external hemorrhoid skin tags at the lithotomy position, V-shaped incision of the skin and mucous membrane with a blade, the hemorrhoid tissue was excised from the superficial side of the internal sphincter until the top of the internal hemorrhoids and the suprahemorrhoidal artery 3 -0 micro-Qiao line "8" suture and resection, continuous suture of the mucosal incision above the dentate line, skin incision below the dentate line is not sutured for drainage; trim the wound; treat mixed hemorrhoids in 70 and 110 directions with the same method. The preoperative and postoperative treatment is the same as the ultrasonic knife group.

    Three, statistical methods

    All data are statistically analyzed by SPSS 13.0 software package. The comparison of measurement data uses independent sample t test, and the comparison of count data uses x2 test.

    Result

    There was no statistically significant difference between the two groups of patients in terms of postoperative pain, wound healing time, recurrence rate, and postoperative complications (follow-up for half a year); however, the difference was statistically significant in terms of intraoperative blood loss and operation time. See Table 1.

    Table 1 Comparison of surgical and postoperative data between the two groups

    Item Ultrasonic knife group (80 cases) Control group (80 cases) P value

    Bleeding during operation (ml) 5.0±1.5 45±4.3

    Operation time (min) 10 ±1.2 20 ±2.5

    Postoperative pain (case%) 43 (53.7) 47 (58.7)

    Urinary retention (case%) 16 (20) 19 (23.8)

    Anal edge edema (case%) 18 (22.5) 21 (26.3)

    Postoperative anal bulging (case%) 12 (15) 15 (18.8)

    Healing time (days) 21±4 23 ±4

    Postoperative recurrence (case%) 3 (3.7) 4 (5)

    Postoperative bleeding (case%) 1 (1.3) 2 (2.5)

    Discuss

    The working principle of the ultrasonic knife is to make the metal knife head mechanically oscillate at an ultrasonic frequency of 55.5kHz through the ultrasonic frequency generator, so that the water molecules in the tissue contacting the knife head are vaporized, the protein hydrogen bond is broken, the cell collapses, and the tissue is cut. Or coagulation, blood vessel closure, so as to achieve the purpose of cutting tissue and hemostasis [3]. When the ultrasonic knife separates the tissue, the temperature is low, causing thermal damage to the surrounding tissues <115mm; domestic literature reports that the ultrasonic knife can directly treat blood vessels with a diameter of less than 5mm [4]. Therefore, in hemorrhoidectomy, ultrasonic scalpel can basically achieve no blood in the operation, and hemostasis is reliable, reducing postoperative tissue edema.

    After 6 months of follow-up, there were no serious complications such as fecal incontinence and anal stenosis. There was no significant difference between the ultrasonic knife group and the control group in terms of postoperative pain, cure rate, recurrence rate, and postoperative anal function (P>0.05). It can be seen that ultrasonic scalpel hemorrhoidectomy does not increase the risk of surgery, and can achieve the same surgical effect as Milligan-Morgan surgery. There is a statistically significant difference between the ultrasound knife group and the control group in terms of intraoperative blood loss and operation time, which brings convenience and efficiency to the surgeon.

    Need to pay attention to the situation of ultrasonic scalpel in hemorrhoidectomy: The ultrasonic scalpel is prone to cause scabs to accumulate in the opening of the knife head. It should be cleaned in time to avoid damaging the knife pad during cleaning. Do not close the empty step or clamp the metal. Do not clamp too much tissue [5].When cutting off the hemorrhoidal artery pedicle, in order to coagulate thoroughly and prevent postoperative bleeding, the "breakwater" coagulation technique can be used [3]. That is, the proximal end of the blood vessel to be cut is coagulated with an ultrasonic knife, but not cut, and then the blood vessel is coagulated and cut at the place to be cut. During the coagulation and cutting process, avoid excessive tension on the blood vessels and skin and mucous membrane tissues that need to be cut. If the tension is too high, the patient will easily cause the wound to open and bleed when using the anus to defecate after the operation.

    Compared with the Milligan-Morgan operation, ultrasonic knife hemorrhoidectomy has certain advantages in the treatment of mixed hemorrhoids: (1) The surgical field is clear: the blood supply of the anal hemorrhoid tissue is very rich, some of which are varicose veins. In traditional operations, Intraoperative bleeding has always been a major problem that plagues surgeons, resulting in unclear surgical fields and blurred tissue levels, which hinder the progress of the operation. The ultrasonic knife cuts and hemostasis at the same time, and the hemostasis is firm, so there is basically no blood during the operation, and the operation field is kept clear, the tissue separation is fine, and the hierarchy is clear, and the blind resection of excessive mucosa and internal sphincter tissue is avoided. (2) Short operation time: In traditional operations, the hemorrhoidal artery needs to be firmly sutured, the incision should be sutured carefully, and the bleeding site should be sutured. The ultrasonic knife does not require these operations, and the operation time is significantly shortened. The difference in the experimental data of this group is statistically significant. In addition, the ultrasonic knife does not need to suture the incision, which can reduce the postoperative foreign body sensation and anal bulging sensation. (3) High safety: Ultrasonic scalpel can stop bleeding firmly to avoid intraoperative hemorrhage; the surgical field is clear to avoid tissue damage; the ultrasonic scalpel does not directly conduct electrical energy to the patient, so patients who cannot use an electrosurgery with a pacemaker can also be usable.

    It can be seen that as a new type of surgical instrument, the ultrasonic knife can simplify the operation of hemorrhoidectomy, shorten the operation time, and improve the efficiency of the operation as long as the use of the ultrasonic knife is mastered. Therefore, the ultrasonic scalpel is worth popularizing in hemorrhoidectomy.

    references

    [1] Foreman E, Aspinall S, Bliss RD, et al. The use of the harmonic scalpel in thyroidectomy:‘beyond the learning curve’.Ann R Coll Surg Engl,2009,91(3):214-216

    [2] Anorectal Surgery Group, Chinese Medical Association Surgery Branch. Interim criteria for diagnosis and treatment of hemorrhoids. Chinese Journal of Surgery, 2003, 41:699.

    [3] Zhu Jiangfan, editor in chief. General Surgery Endoscopic Surgery [M]. First edition. Jinan: Shandong Science and Technology Press, 2001.24-26.

    [4] Liu Tianwei, Zhang Genfu, Gong Jianping. The application of ultrasonic knife in gastrointestinal surgery (with a report of 49 cases) [J]. Colorectal Surgery, 2006, 12 (1): 332.

    [5] Jing Huazhong, et al. The application of ultrasonic knife in laparoscopic radical gastric cancer surgery. Progress in modern general surgery in China. 2011, 14 (12): 984-985.

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