The technique of external peeling and internal ligation of mixed hemorrhoids must be meticulous. Lift the mixed hemorrhoids with tissue forceps near the tooth line, take the reverse "V" incision, cut the skin from the top of the external hemorrhoids to the outer edge of the external hemorrhoids, and peel off the external hemorrhoid tissue , Including external hemorrhoids vascular loops and fibrous hyperplasia tissue, retaining part of the external hemorrhoid skin, namely the triangular flap, completely peeling the external hemorrhoid part to about 0.3cm on the tooth line, double ligating the base of the internal hemorrhoid, and removing part of the hemorrhoid.
Trim the triangular skin flap and suture the top of it and the mucosa under the ligation line at the base of the ligated hemorrhoids so that the triangular skin flap smoothly covers the wound. If the hemorrhoids are large, they can be divided into two and ligated in stages. The top of the triangular flap is sutured on the mucosa between the two hemorrhoids. Circular mixed hemorrhoids are designed according to the shape of the hemorrhoids. Generally, 4 to 6 surgical areas are selected. According to the above operations, the external and internal ligation are performed. If the skin and mucosal bridges cannot be retained between the hemorrhoids, the triangular skin flaps are sutured On the mucosa between two adjacent hemorrhoids. The vascular loops under the skin bridge and the mucosal bridge should be removed under the skin to prevent postoperative edema and the formation of new hemorrhoids.
Severe mixed hemorrhoids refer to stage III-IV semicircular or circular mixed hemorrhoids. It is a common, multiple and difficult disease in anorectal diseases. This type of disease generally has a long course. Because the hemorrhoids are severely prolapsed outside the anus or combined with infection, the connective tissue around the blood vessels is dense and large, and the hemorrhoids are large and deep, which brings certain difficulties to the operation. If not handled properly, complications such as wound edge edema, wound pain, urinary retention, and difficulty in defecation may be easily caused. In recent years, the hospital has used mixed hemorrhoids external stripping and internal ligation and perianal flap plastic surgery to achieve satisfactory results.
Use simple mixed hemorrhoids external stripping and internal ligation. The patient is placed in a lateral position, routinely disinfected and spreading towels. After the local anesthesia is effective, use tissue forceps to lift the external hemorrhoid skin flap to make a diamond-shaped incision into the anus, blunt and sharply peel off the hemorrhoid tissue to 0.5 cm from the tooth line, use curved forceps Clamp the base of the internal hemorrhoids, use a round needle with a 7-gauge silk thread to sew the "8" under the forceps, and cut off the stump.
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