The current treatments for mixed hemorrhoids include:
1. Conservative treatment: It is mainly the use of drugs to relieve symptoms through oral, external application, plugging, fumigation and washing.
1. External application of drugs or anal plug. Usually, drugs that have a protective effect on the hemorrhoid mucosa, reduce local inflammation, and promote wound healing.
2. Oral medication. Usually use drugs that clear heat and cool blood, moisturize the bowel, and relieve inflammation and wound healing.
3. Fumigation and washing. Usually use drugs for clearing away heat, detoxifying, activating blood and removing blood stasis, and astringent and solidifying to wash the anus or prolapsed hemorrhoids to prevent edema, incarceration, and thrombosis of mixed hemorrhoids. It is suitable for the elderly and weak, or combined with other such as heart, liver, Patients with renal insufficiency.
2. Surgical treatment (minimally invasive treatment):
1. PPH surgery: PPH is currently recognized as the "gold standard" for the treatment of mixed hemorrhoids by the World Anorectal Society. During the operation, a tubular stapler is used to circularly remove a certain width of the lower rectal mucosa and submucosal tissue on the top of the prolapsed hemorrhoids under anoscope. At the same time, the upper and lower mucosa of the anastomosis are nailed to suspend the prolapsed hemorrhoids. Hanging and lifting simultaneously cut off the blood supply of the hemorrhoids, achieving the therapeutic effect of hemostasis and preventing the prolapse of the hemorrhoids.
Advantages: (1) Safety: There is no need to remove the anal cushion, the normal function of the anus is preserved to the greatest extent, and complications such as anal stenosis and anal incontinence are avoided. (2) Slight pain: Pull the hemorrhoids prolapsed 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) Less 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) Keep the anal cushion intact: It is more in line with human anatomy and physiology. Since the operation is performed on the top of the hemorrhoid, the anal cushion is completely preserved. (5) Wide range of diagnosis and treatment: general ring hemorrhoids, multivalve hemorrhoids, huge isolated hemorrhoids, internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, ring hemorrhoids, incarcerated hemorrhoids, rectal mucosal prolapse, prolapse, etc. (6) Suitable for a large number of people: due to less damage, it is especially suitable for middle-aged and elderly people, white-collar workers who pay attention to efficiency, and patients who have relapsed in traditional treatment, and patients with mild prolapse and rectal mucosal prolapse.
2. RPH (automatic hemorrhoid ligation) The automatic hemorrhoid ligation (RPH) is developed from the traditional Chinese medicine ligation therapy of the motherland. This method is to use a special automatic hemorrhoid ligation device at the appropriate position 1.5～75px above the tooth line Will be specially made. The apron is placed on the base of the hemorrhoids or the mucosa of the hemorrhoids, through the tightening and strangulation of the aprons, blocking the blood supply of the hemorrhoids or reducing the venous backflow, reducing the hyperemia or blood flow stasis of the hemorrhoids, causing ischemia, atrophy, Necrosis, the bandage tissue gradually falls off, and the wound tissue is repaired and healed.
Advantages: (1) The whole process of banding therapy is automated, which saves time, effort, practicality and simplicity; (2) The operation can be completed by one person, which only takes 5 to 10 minutes. (3) No need for anesthesia, no hospitalization, and low price. (4) The pain is mild and complications are rare. (5) No scars are left after the operation, and the normal structure and appearance of the rectum and anal canal are not damaged, which brings great convenience to subsequent treatment. Disadvantages: It cannot be used for the treatment of simple external hemorrhoids, external hemorrhoids of mixed hemorrhoids, anal papilla hypertrophy, and rectal polyps suspected of being malignant.
Indications: Hemorrhoids in all phases (stages I to III have the best effect); mixed internal hemorrhoids; for hemorrhoids or anal cushion insufficiency after PPH or other treatments, RPH can be used as a supplementary treatment; others: rectal focal Diseases, such as rectal polyps, rectal hemangioma or vascular malformations.
3. Polycinnamyl alcohol injection treatment: this method has small damage, quick onset, few adverse reactions, simple operation, light pain, quick recovery, no hospitalization, and almost all hemorrhoids healed after one injection. Suitable for hemorrhoids, varicose mixed hemorrhoids and circular mixed hemorrhoids in various periods. Contraindications: (1) Acute episode of hemorrhoid thrombosis and the following 3 to 4 weeks. Injection therapy can still be used when the thrombus subsides. (2) Accompanied by other anal canal diseases that are not suitable for injection therapy, such as anal fissure, anal fistula (anorectal fistula), tumor, etc. (3) For external hemorrhoids or mixed hemorrhoids dominated by external hemorrhoids, it is easy to inject the medicine into the skin by injection therapy, which causes severe pain for the patient. Therefore, external hemorrhoids and huge internal hemorrhoids covering the skin should not be treated by injection. (4) Patients who have received injection therapy many times. In 1986, foreign experts in Belgium provided Chinese doctors with several patients who they thought were very serious. These patients recovered well under the treatment of injection therapy by Chinese doctors. This technology It also won the Eureka Invention Award that year.
4. Doppler hemorrhoid artery ligation: Hemorrhoid artery ultrasound Doppler examination system is a collection of Doppler ultrasound exploration and hemorrhoid artery ligation surgery, which is efficient, simple, safe, minimally painful, minimally invasive, and length of stay. Short organic system with other characteristics. The system accurately locates the hemorrhoidal artery according to the ultrasound transmitted and received by the probe, displays the depth of the stage, and performs arterial ligation treatment on the dentate line through the real window in front of the probe. It has the characteristics of precise positioning, rapid ligation, and minimal invasiveness.
5. TST technology: also known as selective hemorrhoidal mucosal anastomosis, is a new type of technology developed on the basis of PPH operation. TST minimally invasive surgery uses a special anorectoscope to form different open-loop windows, uses an anastomosis probe to lock the hemorrhoids, adjusts the resection range of the hemorrhoid mucosa according to the size and number of the hemorrhoids, and maximizes the protection of the normal function of the anus. It is mainly suitable for patients with stage III and IV hemorrhoids with non-circular prolapse. Precise positioning: the use of a special anoscope can accurately locate the prolapsed mucosa, and successfully and safely selectively remove the prolapsed hemorrhoid mucosa, which conforms to the theory of lowering the cushion and reduces surgical trauma. Advantages: slight pain, high safety, and short recovery time. The operation time of ST operation is relatively short, there is less bleeding during the operation, the postoperative recovery time is shorter, and the incidence of postoperative anal pain and edema is lower.