2020年12月14日星期一

hemorrhoids early pregnancy,Causes and prevention of common complications after anorectal diseases

    With the improvement of people’s quality of life and the increase of people’s mobility, anorectal diseases are becoming more and more common in the population, which seriously affects people’s lives and work, and brings certain suffering to patients. With the improvement of understanding and economic ability, more and more patients choose surgery to treat anorectal diseases (patients with surgical corrections and clear surgery). As long as the operation will bring certain discomfort and pain to the patient, the unsuitable pain after the anorectal disease operation is more serious; the operation will bring many complications to the patient (the so-called pain of the patient), and these complications require the anorectal Doctors can treat them correctly to relieve the patient's pain, so that the patient can recover as soon as possible, so that more and more patients undergoing anorectal surgery no longer fear, fear, escape, and even "talk about hemorrhoids". In order to change people’s understanding of postoperative pain of anorectal diseases, we must first understand the postoperative complications. The anorectal area has a complex anatomical relationship. The blood vessels, lymphatics, and nerves are abundantly distributed, and are related to the urethra, prostate, and bladder. The neck, cervix, uterus and other organs are adjacent; various anorectal operations can cause certain postoperative complications such as stretching, squeezing, and injury to the anorectal muscles and adjacent tissues. The common ones are the following:

    One: pain

    Pain is the most common complication and the most obvious complication after anorectal disease surgery. Almost all anorectal diseases are the first manifestation after surgery and the discomfort and pain described by the patient first are pain. The causes of pain are as follows: 1 .Damage and irritation to local tissues during surgery. 2. After the wound is exposed, the nerve is stimulated by the outside world. 3. Local inflammation, edema and local infection after operation. 4. Packing too many drainage strips in the anus, resulting in spasm of the internal sphincter. 5. Defecation and dry stool cause local stimulation and friction, and dry stool makes the pain more obvious and severe. 6. Postoperative stimulation of local nerves will produce paroxysmal tingling, like acupuncture. 7. Dissatisfaction with local anesthesia. 8. The patient's mental tension and fear have become sensitive to pain. All of the above causes result in local pain. There are the following treatment and preventive measures for pain:

    The treatment of pain has the following points:

    ① Fumigation and washing method This method refers to a treatment method that uses steam fumigation and warm water to soak the anus after the medicine is decocted or soaked in boiled water. It is commonly known as "sit bath". The fumigation and washing method is widely used in the clinical application of anorectal surgery, and the effect is quite significant. In addition to the effect of local cleansing of the wound, it also has the function of dredging the blood, clearing heat and detoxification, reducing swelling and pain, promoting blood circulation, removing wind and dampness, and killing insects. It relieves itching, promotes muscle growth and sores. After years of clinical practice and patient return visits, postoperative fumigation has a significant effect on local pain, and has certain treatment and improvement effects for the above eight causes of pain. Commonly used fumigation formulas include Sophora flavescens soup and Chinese gallnut soup. Commonly used medicines such as Cnidium, Sophora flavescens, Phellodendron chinense, Atractylodes macrocephala, Radix gallbladder, Kochia scoparia, Yinhua, Safflower, Angelica, Purslane, Puxiao, Red peony root, Polygonum cuspidatum root, Borneol, etc. Generally 2 times a day, morning and evening or after bowel movements, each time ranging from 10-15 minutes. Of course, some Chinese patent medicines used in clinical practice have obvious effects and are simple and convenient. ②Drugs can be treated by oral pain relief tablets or oral acetaminophen. Other oral or intramuscular drugs include tramadol and dystein, etc. For severe pain, intramuscular injection of Durhamin can be used. Generally, the pain will be alleviated after fumigation treatment. There is a certain degree of relief and improvement, and there are relatively few patients who have been intramuscularly injected with Dulinding. Anal plug analgesic suppository has obvious analgesic effects. ③Acupuncture at Changqiang, Chengshan, Zusanli and other points. ④ Local long-acting closure, most clinically, methylene blue is mostly used, and there is no exact support and application standard in the literature. ⑤Physiotherapy Physical therapies such as iontophoresis and infrared radiation also have good effects. ⑥For local edema, magnesium sulfate can be applied externally to relieve pain after edema.

    The prevention of pain has the following points:

    ① The operation should be stable, accurate, fast, and delicate to minimize damage to the anal canal area. ②Choose suitable anesthetics and the requirements of anesthesia technology. ③Control the amount of activity after the operation and keep the stool unobstructed. You can take orally moisturizing drugs and stool softening drugs. ④Prevent postoperative anal stenosis. ⑤Publicity, education and psychological counseling of patients before surgery.

    Two: bleeding

    Postoperative bleeding of anorectal diseases is also one of the common complications of anorectal department. There are many causes of bleeding. There are common small amounts of bleeding, such as blood in the stool, dripping, blood in the stool, a small amount of bleeding on the surgical surface, and massive bleeding. Bleeding can be treated without special treatment, and massive bleeding requires proper treatment. We have related discussions about major bleeding. Regardless of the type of bleeding caused by the patient, while stopping the bleeding, we must do a good job of ideological work for the patient, inform the cause of the bleeding, stabilize the patient’s mood, and give drugs to stop the bleeding. Proper fluid replacement. Do everything possible to find the bleeding point and sew it to stop the bleeding. Bleeding after hemorrhoid surgery is divided into primary and secondary. There are many causes of bleeding, but local factors are the main cause. According to the nature of bleeding, it can be divided into primary bleeding and secondary bleeding:

    1. Primary bleeding: (occurred within 24 hours after surgery) mostly caused by improper operation or imperfect hemostasis on the surgical surface during the operation. The reasons are as follows: ① The wound is too large and deep, and injured. And large arteries are not ligated, such as the circular resection of hemorrhoids. ② There are more hemorrhoid tissues on the ligation line. The atrophy of the hemorrhoids will cause the slippage of the surgical line and cause bleeding. ③ When putting oil gauze into the wound during anorectal dressing change, the surgical thread is pushed off when the force is improper or the direction is not smooth, causing bleeding. ④The ligation of the surgical thread is not tight. The ligation method is incorrect or slippery, causing the surgical thread to loosen and cause bleeding. ⑤ Local anesthesia, adrenaline has the effect of contracting blood vessels during operation, and postoperative blood vessel dilation causes bleeding.

    2. Secondary bleeding: (occurring 4-15 days after operation) It usually occurs 4-15 days after operation. It is the period of hemorrhoids shedding and necrosis, forming wound bleeding. The reasons for secondary bleeding are as follows: ① 4-15 days after internal hemorrhoid ligation, band ligation, and injection of necrotic agent, when a fresh wound is formed due to the necrosis and shedding of the hemorrhoid tissue, the arteries and blood vessels are not closed and the thrombus falls off, resulting in active bleeding. ②. After the hemorrhoid ligation thread falls off, the needle penetrates deeply and hurts the large arteries and blood vessels. When the hemorrhoids necrosis and fall off, the arteries and blood vessels of the deep wound are not locked tightly, and massive hemorrhage is formed. ③Wound injury, postoperative hemorrhoid shedding and wound repair, vigorous activity or constipation, due to excessive force during defecation, the wound may tear or the arteries and blood vessels may rupture, causing massive bleeding. ④ Certain systemic diseases, such as thrombocytopenia, prolonged bleeding time, portal hypertension, hypertension, aplastic anemia, hemophilia and other systemic diseases with bleeding tendency, are ignored or untreated before surgery, and postoperative hemorrhage is caused.

    The treatment of bleeding has the following points:

    ① A small amount of bleeding after the operation, pay attention to observation, and may not be treated. At the same time, keep the stool unobstructed and control activities. ②. In case of heavy bleeding, immediately under local anesthesia or sacral anesthesia, clear the blood in the intestinal cavity, and then find the bleeding point under anoscope, use tissue forceps to pull out the wound, and use 4# or 0# intestine The thread runs through the suture to stop bleeding. ③ It is inconvenient to ligate bleeding spots that are more oozing or deep. Gel sponge, oil gauze, and vicerenin gauze can be used to fill the bleeding. Airbag compression can also be used to stop bleeding. ④The enema method. For secondary bleeding, the amount of bleeding is relatively small and the bleeding rate is slow, the use of alum enema has many advantages. It is a non-surgical hemostatic measure, which is simple, convenient, and inexpensive. Method of hemostasis. ⑤After the ligation thread falls off, the bleeding caused by incomplete hemostasis during the operation can be re-ligated under local anesthesia. Sew under anoscope to stop bleeding. If it is caused by hemorrhage caused by infection and necrosis in the injection area, the wound should be carefully debrided before suture ligation, all blood clots in the intestinal cavity should be removed, and then suture ligation. If the bleeding area is large and the ligation is difficult, high-frequency electrosurgical electrosurgery can be used. Coagulation to stop bleeding. While using various hemostasis methods, fluid therapy should be actively cooperated. ⑥ If it is arterial bleeding, ligate and suture under direct vision to stop the bleeding, and do not delay the time, so as to avoid serious consequences.

    The prevention of postoperative bleeding has the following points:

    In order to prevent postoperative hemorrhage, the following points should be emphasized: ①Know the medical history in detail before the operation, and earnestly grasp the patient's physical condition, especially for patients with coagulation dysfunction and hypertension, and prevent them in the postoperative hemorrhoid shedding 5-14 days, if there are signs of bleeding, hemostatic drugs should be used for 3-5 days. ② Careful and standardized operations during the operation. ③Strengthen postoperative care and strictly use medications to allow patients to maintain unobstructed bowel movements, avoid strenuous activities, and perform normal inspections and dressing changes. When performing digital examinations, anoscopy and anus enlargement or when changing dressings, avoid excessive force that may damage normal tissues, and avoid prematurely pulling the ligature to cause tissue tears.

    Three: Anal bulge

    After anorectal diseases, local "tenesmus", "swelling discomfort", "strong sense of bowel movement" and other manifestations caused by mechanical or inflammatory stimuli are called anal swelling. This symptom often occurs in the short term after perianal surgery, which is a normal manifestation. Generally, the symptoms gradually relieve after surgery.

    Reasons: ① mechanical irritation, excessive ligation of tissue during surgery, or postoperative dressing change due to stimulation of foreign objects such as operation or packing of drainage strips, drugs, or postoperative local tissue spasm or fecal congestion. ②Inflammation irritation: Postoperative wounds have local congestion and edema, or poor drainage, or pseudo-healing secondary infections.

    Treatment: ①Medicinal treatment: For patients with obvious swelling, take analgesic drugs for clearing heat, removing dampness, detoxification and reducing swelling. The disease is combined with the fumigation and bathing of the detoxification soup for clearing heat and detoxification, promoting blood circulation and removing blood stasis; hemorrhoid suppositories and hemorrhoids can be used in the anus Ointment, etc. is conducive to the relief of swelling. ②Physiotherapy Physical therapies such as iontophoresis and infrared radiation also have good effects.

    Prevention: ① Intraoperative operations should be gentle, and the ligated tissue should be as little as possible to avoid excessive scars in local tissues after surgery. ②Drainage strips should not be packed too much when changing the dressing, and try not to use more irritating drugs. ③After the operation, keep the stool unobstructed, and take a bath after going to keep the wound clean and reduce the irritation of fecal residues on the wound. ④ Postoperative control activities. ⑤ Don't eat spicy food and send me to avoid diarrhea and constipation.

    Four: Urine retention

    Urinary retention is one of the common complications after anorectal disease surgery, and there are more men than women.

    Reason: ① Anesthesia. ②Surgery stretch, squeeze, and injury cause local edema and severe pain, leading to reflex urethra and bladder neck sphincter spasm. ③ Enlarged prostate, urethral stricture, foreign body irritation (excessive packing of drainage strips and dressings). ④There are urinary system diseases, cystitis, urethritis, etc. ⑤ Too nervous, environmental conditions change, etc. ⑥ Too much fluid was injected after operation.

    Treatment: ① Fumigation bath or hot compress on lower abdomen can relieve spasm of urethra and bladder sphincter. ② Stimulate urination with the sound of running water. ③Acupuncture and moxibustion treatment, take Zhongji, Guanyuan, Qihai, Shuidao, Sanyinjiao and other points. ④Press the 4 transverse fingers below the umbilicus to the midline for 2 minutes, and massage the patient. ⑤ Catheterization treatment when the above treatment is invalid (pay attention to aseptic operation).

    Prevention: ① Do a good job of patient ideological work before surgery to relieve tension. ② Empty the bladder before surgery. ③Limit the amount of liquid. ④ Choose an effective anesthesia. ⑤Surgery operations try to avoid damage to too much tissue. ⑥The postoperative anal canal drainage strip is properly packed.

    Five: Edema

    Edema is caused by local blood and lymphatic circulatory disorders in anorectal diseases, increased permeability of blood vessel walls and excessive retention of water in the interstitial spaces. Increased inflammatory exudation leads to inflammatory edema.

    Reasons: ①The anesthesia effect is not satisfactory, the sphincter muscle cannot relax, and the blood and lymph are refluxed. ②Improper operation. ③Dry stools, poor defecation, difficult, frequent, and prolonged anal venous return after surgery. ④ Local inflammation.

    Treatment: ①Fumigation and sitz bath with Chinese medicine Qudu Decoction or Kushen Decoction, each time ranging from 10-15 minutes, 2 times a day, or perianal hot compress with magnesium sulfate, followed by external application of hemorrhoid cream to promote edema subsidence . ② The larger ones that cannot be resolved can be partially removed.

    Prevention: ①Master the correct surgical methods and surgical techniques. ② Peel off the venous mass as thoroughly as possible. ③ Keep the stool unobstructed after operation. ④Fumigation and bathing and dressing should be changed every day after surgery to prevent infection.

    Six: fever

    The body temperature of patients with anorectal diseases is around 37.0℃--38.5℃ for 2-3 days after surgery, most of which are stimulation of surgical trauma or local tissue absorption of heat, which generally subside on their own without special treatment. If the body temperature exceeds 38.5℃, the cause needs to be found.

    Reasons: ① surgical injury, absorption of necrotic tissue, toxin stimulation and secondary infection. ② Absorb heat. ③Combined with other diseases, such as colds, urinary tract infections, tuberculosis and anemia.

    Treatment: ①If the body temperature is around 37.5℃, it can be left untreated, and it can subside on its own. ② Those with a body temperature of 38.0℃ can be taken orally or physically cooled. ③After the cooling treatment, if the body temperature does not drop, other factors should be considered, such as infection or other diseases, and further antibiotics or related diseases are needed.

    Prevention: ①Strict aseptic operation and skilled surgical operation. ② Reasonable application of antibiotics. ③ Maintain smooth drainage after operation to prevent infection. ④Perform relevant inspections before surgery.

    Seven: fecal congestion

    Patients with anorectal diseases have a weakened bowel movement and need to prevent constipation, otherwise it will cause fecal congestion.

    Reasons: ① Postoperative pain, patients are afraid of defecation and inhibit defecation, stool accumulates for a long time, and moisture is absorbed and dried. ②The elderly are frail, with abnormal bowel function or low colonic transmission function. ③Excessive sweating with antipyretic and analgesic drugs after surgery. ④ Those who have had a barium enema before the operation, but the barium is not completely eliminated. ⑤ Habitual constipation before surgery.

    Treatment: ①Oral intestinal moisturizing and laxative drugs, keeping stool about once a day. ②Inject Kaisailu into the anus. ③Clean the enema. ④ When necessary, crush the fecal mass and discharge it.

    Prevention: ①Patients should take proper activities after surgery and eat more foods such as vegetables and fruits that contain more fiber. ②Enhance intestinal peristalsis. ③Appropriate intestinal laxative drugs can be given before operation.

    Eight: infection

    The body temperature of the anorectal disease has gradually dropped on the 4-5th day after surgery and returned to normal. If the body temperature rises on the 5th-6th day without other obvious reasons, the possibility of postoperative infection should be considered.

    Reasons: ① Susceptibility, frail elderly patients, malnutrition, etc. ②Improper treatment of wound, leaving dead space, hematoma or poor drainage. ③The concept of sterility is not strong, and the disinfection is not strict. ④Long operation time, too long tissue exposure, improper operation or excessive ligation.

    Treatment: ① Local swelling and pain can be treated with fumigation and sitz bath and dissipating masses. ②The pus should be incised and drained. ③ Control inflammation and choose reasonable antibiotics.

    Prevention: ① Strict aseptic operation during surgery to reduce tissue damage. ② Keep local drainage smooth. ③It is necessary to improve the immunity of frail elderly patients and strengthen the resistance to infection factors.

    The above 8 conditions are common complications after anorectal surgery. In addition to the above, some of the wounds heal slowly, syncope and other complications, which are quite rare in clinical practice.

    Through the above discussion on the common complications of anorectal diseases, it is not difficult to see that the occurrence of various complications has a certain relationship with the following aspects: ① Whether the preoperative preparation is perfect. ②Preoperative evaluation of patients. ③ Treatment of patient complications. ④Surgery skills and proficiency. ⑤ Postoperative care and patient comfort. ⑥ The patient's own immunity. Understand the postoperative complications of anorectal disease and its various treatments, improve the discomfort and pain of patients after surgery, and play a certain role and effect in carrying out anorectal surgery.

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