2020年12月8日星期二

hemorrhoids and anal fissures,Application of minimally invasive and painless techniques in colorectal and anal surgery

    When people enter the hospital after being ill, during the whole process of completing the medical treatment, whether it is the diagnosis or treatment of the disease, they will definitely suffer physical and mental injury, trauma or injury, but the degree may be Different. "As little or as little trauma as possible", so that patients can achieve and maintain the best local and systemic state stability, is the goal that doctors continue to pursue; "To achieve the same good results with the smallest possible price for the patient, this is the history of medicine Eternal theme".

    With the continuous development of medical technology, generations of medical staff are pursuing a technology that can achieve the greatest possible "use the smallest possible medical behaviors to maximize the benefits of patients, so that patients can obtain the greatest physical and psychological benefits." The goal of “limited rehabilitation”.

    Minimally invasive technology

    The concept of "Minimally Invasive" is to put people first, proceed from the patient's interests, and pursue the maximization of the patient's interests with the smallest possible medical behavior, so that the patient can obtain the maximum recovery in physical and psychological. The birth of minimally invasive technology has largely filled this gap. Therefore, it has been affirmed by the majority of medical workers and patients, has become a milestone in the development of medicine today, and will become the mainstream of medical technology in the future.

    In fact, everyone is familiar with minimally invasive surgery, such as our common laparoscopic surgery and cosmetic surgery. However, many people have a "misunderstanding" about minimally invasive surgery, thinking that minimally invasive surgery is only a small incision and no bleeding. In fact, "Minimally Invasive" is not a technique or tool, let alone a "small incision", but a treatment principle. It covers the entire medical and health field, including internal medicine, surgery, pediatrics, obstetrics and gynecology, stomatology, ENT Department of Ophthalmology and other medical and nursing activities.

    In the clinic, there is no medical care behavior that does not require "minimally invasive", such as taking medicine and injections. Those who can be treated with medicine should not be treated by injection; those who can be treated with non-surgical treatment should be treated with non-surgical treatment as much as possible to reduce the risk. Mechanical injuries of patients, etc. are all obvious medical principles.

    In addition to the principle of “minimal invasiveness” in daily medical activities, “minimal invasiveness” should be pursued in surgical operations: from incision, exposure, hemostasis, suture, knotting, dissection, excision, repair and reconstruction, etc. Every link should be "minimally invasive". Minimally invasive, applicable to all patients, this is the principle.

    Now, with the development and progress of electronics, optics, and biological materials technology, we have ushered in the rapid development and progress of medical careers, such as endoscopy, endoscopy, radiological intervention, radiological diagnosis and treatment, nuclear magnetic resonance, ultrasonic diagnosis and A wide variety of new medical science and technology such as treatment, gamma knife, plasma knife, cell knife, laser, radio frequency, vapor freezing, hyperthermia, medical robots, organ transplantation and cell transplantation, cloning technology and biological therapy have been widely successful application. The birth of minimally invasive technology is of course also inseparable from the development of basic disciplines such as electronics, biology, and optics.

    In terms of colorectal and anal surgery, the most prominent ones are laparoscopic radical resection of colorectal and rectal cancer and PPH (stapled prolapse and hemorrhoidectomy) technology for the treatment of severe prolapsed mixed hemorrhoids.

    The so-called laparoscopic colorectal cancer surgery is to make several small incisions with a diameter of 5-12 mm in different parts of the abdomen, and insert the camera lens and various special surgical instruments through these small incisions, and insert the abdominal cavity taken by the camera in the abdominal cavity. The images of various internal organs are transmitted to the TV screen. The surgeon observes the images and uses various surgical instruments to perform operations outside the body to complete the operation.

    Compared with traditional surgery, laparoscopic surgery has the following advantages:

    1. Laparoscopic surgery has little disturbance to the abdominal internal organs, and avoids the stimulation and pollution of the abdominal cavity by the air and dust bacteria in the air. During the operation, the main operation is electrocutting and coagulation. The blood vessels are first coagulated and then broken, hemostasis is thorough, and there is very little bleeding. Rinse thoroughly before the end of the operation to keep the abdominal cavity clean.

    As a result, the postoperative bowel function recovers quickly, and food can be taken earlier, which greatly reduces the factors of postoperative bowel adhesion.

    2. Laparoscopic surgery is the representative of true minimally invasive surgery, the trauma is greatly reduced, the operation process and postoperative recovery are easy, and the pain is less.

    3. You can get out of bed early after the operation, and the sleeping posture is relatively casual, which greatly reduces the intensity of accompanying family care.

    4. The poke holes in the abdominal wall are small (ranging from 3-10mm), scattered and hidden, and will not affect the appearance after healing.

    5. General anesthesia is generally used, with complete monitoring and greatly increased safety.

    6. Poking hole infection is far less than traditional incision infection or fat liquefaction.

    7. The abdominal wall poke hole replaces the abdominal wall incision, avoiding the damage of abdominal wall muscles, blood vessels and corresponding nerves. After the operation, there will be no abdominal wall weakness and abdominal wall incisional hernia, and the abdominal wall muscle scarring will not affect the motor function, and it will not be caused by the abdominal wall nerves. The cut causes the corresponding skin numbness.

    8. Few abdominal adhesions. Surgery has little interference to the abdominal cavity, no air, gauze, and hand-to-tissue contact, few or no sutures, and no surgical incision. Therefore, abdominal adhesions in patients after laparoscopic surgery are far less than open surgery, thereby reducing bowel The occurrence of adhesions.

    The PPH technique is also called "circumcision of the hemorrhoids", which is a new technique based on the new understanding of the pathogenesis of hemorrhoids caused by anal pad disease. PPH surgery uses a special instrument called a "PPH stapler" to make a circular resection of the prolapsed rectal mucosa above the hemorrhoids. During the operation, first open the anus and suture the rectal mucosa about 4 cm above the dentate line (the junction between the rectum and anal canal). Then insert the PPH stapler into the anus. The stapler can tape the prolapsed mucosa It only takes about half an hour to remove it. Since the rectal mucosa above the dentate line is innervated by splanchnic nerves, the patient has almost no pain after the operation; and because the operation not only removes the rectal mucosal prolapse zone, but also blocks the terminal anastomotic branches of the arteries and veins of the rectum, eliminating The root cause of hemorrhoids has a very ideal therapeutic effect on internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, ring hemorrhoids, severe hemorrhoid prolapse, prolapse and so on.

    Technical advantages

    Summary of advantages

    1. Safety: There is no need to remove the anal pad, and the normal function of the anus is preserved to the greatest extent to avoid complications such as anal stenosis and anal incontinence.

    2. Painless: Pull the hemorrhoids protruding from the anus back to the original position, and cut off the blood vessels that provide blood to the hemorrhoids, without damaging the perianal skin, so there is almost no pain after the operation.

    3. Small trauma and quick recovery: the circular stapling of the mucosa is a non-open wound, with less bleeding, eliminating the trouble of dressing change after surgery, and returning to normal life quickly.

    4. Scope of diagnosis and treatment: ring hemorrhoids, multivalve hemorrhoids, huge isolated hemorrhoids, internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, ring hemorrhoids, incarcerated hemorrhoids, rectal mucosal prolapse, prolapse, etc.

    5. Suitable for: Because of less damage, it is especially suitable for middle-aged and elderly people, white-collar workers who pay attention to efficiency, and those who have relapsed in traditional treatment, and patients with mild prolapse and rectal mucosal prolapse.

    Summary of advantages 2

    1. Speed ​​up the recovery cycle: return to normal life soon.

    2. Short operation time: the whole procedure only takes about half an hour

    3. Safe and secure: avoid complications such as anal stenosis and anal incontinence.

    4. Alleviate pain: minimize the pain caused by surgery.

    5. Wide range of diagnosis and treatment: suitable for the treatment of various hemorrhoids

    6, suitable for many objects: unless there are special cases of patients are suitable for this surgical method.

    Painless technology

    Pain is the subjective feeling of the patient, and medical staff cannot make arbitrary judgments about the pain intensity of the patient based on their own clinical experience. For patients, pain is on the one hand a signal that the body is facing a stimulus or disease, on the other hand it is one of the important factors affecting the quality of life. For physicians, pain is not only the body's response mechanism to trauma or disease, but also a symptom of disease. Acute pain is often accompanied by metabolic, endocrine and even immune changes, while chronic pain is often accompanied by changes in physiological, psychological and social functions, and requires early treatment.

    Relieving pain is an important task in the clinical diagnosis and treatment process, and it is also an urgent requirement of patients. Only by correctly understanding the pain can we correctly evaluate and treat it.

    Surgery for anal diseases, general anesthesia can use local anesthesia, half-body anesthesia (sacral block anesthesia, continuous epidural anesthesia or spinal anesthesia), general anesthesia (tracheal intubation and intravenous combined anesthesia). However, because the anus is one of the most sensitive parts of the human body, the pain is severe during local anesthesia, and the falling feeling is obvious during the operation, which is difficult for many patients to bear. Half-body anesthesia is relatively less painful than local anesthesia, and most of them can complete the operation, but generally require indwelling a urinary catheter, which is one of the patients' pains; patients must lie supine for more than 6 hours without a pillow after surgery, and it may occur Complications such as headache, lumbar discomfort, intraspinal hemorrhage, infection, nerve injury, etc. At the same time, the anesthesia process has a certain impact on the body's circulatory system. General anesthesia requires tracheal intubation and indwelling urinary catheter, which leads to postoperative discomfort and high cost. Postoperative wound stimulation and internal sphincter spasm can cause severe pain.

    Painless technology is a comprehensive analgesic technology that is used in the whole process of surgical treatment of anal diseases, including preoperative, intraoperative, and postoperative analgesia, so that patients can avoid the fear of pain and the impact of pain on the body, and achieve physical and mental Superb treatment. The basic process is to give a general anesthetic drug through intravenous infusion just like doing a painless gastroscope before the operation. This drug has a fast onset of action, and the patient can sleep in a few seconds. At the same time, the drug is metabolized quickly in the body. That is to say, the drug fails quickly, and it can be used repeatedly or with an infusion pump to control a small amount of continuous use until the end of the operation. After stopping the drug, the patient wakes up quickly, and the quality of wakefulness is good. He can walk on his own without side effects such as dizziness and nausea. The state of consciousness is basically the same as before the operation. Because this drug has no muscle relaxation effect, the patient needs to be given local anesthesia to relax the anal muscles after entering the sleep state. It should be noted that the patient has no pain or discomfort during local anesthesia and surgery. Give local long-acting analgesia before the end of the operation. In this way, the patient received surgical treatment unconsciously and recovered completely without pain, completing all treatments for the disease.

没有评论:

发表评论

hemorrhoids and ibs,Efficacy and Indications of Mubiezi

    【Name】Wood turtle     [Source] "Kaibao Materia Medica"     【Pinyin Name】Mù Biē Zǐ     [Alias] Wood Crab ("Kaibao Materia...