Hemorrhoids are a common and frequently occurring disease. There are many treatment methods, each with its indications and contraindications. If the treatment is not appropriate, serious complications and sequelae will occur. The treatment of hemorrhoids should be based on the patient's specific condition, according to the different types and symptoms of hemorrhoids, combined with the doctor's clinical experience and medical conditions, etc., to choose a corresponding and reasonable non-surgical or surgical treatment. It needs to be pointed out that according to the pathogenesis of hemorrhoids, the modern treatment view of hemorrhoids is: ① Asymptomatic hemorrhoids do not require treatment. The purpose of all treatments is to eliminate, relieve, and relieve symptoms as the standard of treatment effect, which is better than changing the hemorrhoid body. The size and eradication of hemorrhoids is more meaningful in itself. It is necessary to preserve the anal cushion to the utmost extent. Through fibrosis of the tissues around the hemorrhoids, to achieve the purpose of fixing the anal cushion to the rectal muscle wall and prevent the occurrence of symptoms; ②Strictly grasp the indications for surgery , First give conservative treatment. When conservative treatment fails or the internal hemorrhoids of degree II, III, and IV are no longer reversible, surgical resection is necessary; at the same time, when the patient has symptoms that affect daily life and conservative treatment is ineffective, Need surgery.
(1) Conservative treatment
1. General treatment
Soften stools and maintain smooth defecation to reduce the damage of dry stool and forced defecation to the anal cushion. Adjust the eating habits, ensure adequate drinking water every day, increase the intake of sufficient dietary fiber, and apply laxative drugs as appropriate.
Local care. Sit in a bath after going to bed or before going to bed, and gently reset the hemorrhoid tissue after prolapse; take a bath frequently to keep the perineum clean and dry.
Drug therapy is an important method for hemorrhoid treatment. Patients with internal hemorrhoids of degree I and II should be the first choice for drug treatment.
3. Sclerotherapy injection
Submucosal sclerosing agent injection is mainly suitable for the treatment of Ⅰ and Ⅱ degree (stage) internal hemorrhoids. It also has a certain effect on Ⅲ degree (stage) hemorrhoids, and the short-term effect is significant. With the development of medical technology, only a few medical institutions use sclerosing agent injection treatment.
4. Rubber band ligation treatment
The principle of apron ligation treatment is to insert the apron into the base of the hemorrhoid through a special device to block the blood supply of the hemorrhoid tissue, causing ulcers and necrosis to fall off, and then the wound heals by itself, and the deep tissue is fixed due to fiber healing. It is suitable for Ⅰ, Ⅱ degree (stage) internal hemorrhoids and internal hemorrhoids of mixed hemorrhoids, and has a good effect on Ⅲ degree (stage) hemorrhoids.
(2) Surgical treatment
The indications for surgical treatment are those who have developed internal hemorrhoids to grade III, IV (stage), or grade II (stage) internal hemorrhoids with severe bleeding; acute incarcerated hemorrhoids, necrotic hemorrhoids, mixed hemorrhoids, and external hemorrhoids with significant symptoms and signs; Non-surgical treatment is ineffective and there is no contraindication to surgery. The classic surgical methods are as follows.
1. Circular hemorrhoidectomy (Whitehead surgery)
This surgical method has a large resection area and is considered to be a relatively thorough operation, which has a good effect on relieving hemorrhoid prolapse and bleeding. However, the operation time is long and bleeding is much. 10% of patients after operation have more serious complications, such as mucosal ectropion and anal stenosis, loss of anal canal sensation, and anal incontinence. It is rarely used at present.
2. Open and closed hemorrhoidectomy
The most classic are the Milligan-Morgan technique and Ferguson technique. Milligan-Morgan operation is also called open hemorrhoidectomy, external stripping and internal ligation. The principle of this operation is to retain sufficient skin bridge after stripping and removing the main hemorrhoid tissue to prevent postoperative anal stenosis and open the incision for secondary healing. Ferguson operation is also called closed hemorrhoidectomy. The basic steps are similar to Milligan-Morgan operation, but the final incision is sutured with absorbable thread.
These two kinds of surgery have good curative effect on hemorrhoid bleeding, prolapse and other symptoms. Compared with circumcision of hemorrhoids, it has fewer complications and is safer. However, for circular hemorrhoids and grade IV internal hemorrhoids, this operation may often leave some small hemorrhoid tissues.
3. Circumcision and nailing of hemorrhoids (PPH)
PPH is also called circumcision of prolapse and hemorrhoids. It is based on the theory of anal cushion and is a new technique for the treatment of annular prolapsed hemorrhoids. The Ethicon Endoscopic Surgery Department of Johnson & Johnson Medical Equipment Co., Ltd. cooperated with the Italian scholar Dr. Antonio longo to successfully develop a special treatment for Ⅱ-Ⅳ degree hemorrhoids in 1993, without damaging the normal physiological function of the anal cushion and significantly shortening the operation Hemorrhoids anastomosis that takes time and greatly reduces postoperative pain. It performs circular excision of the rectal mucosa and submucosa tissue. Effective treatment of severe prolapsed internal hemorrhoids. So far, 300,000 hemorrhoids patients worldwide have successfully performed PPH surgery. In China, since 2000, nearly 15,000 patients have successfully undergone the operation.
Scope of application
It has a very ideal therapeutic effect on internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, ring hemorrhoids, severe hemorrhoid prolapse, and rectal prolapse. Used for the treatment of internal hemorrhoids of degree III and IV.
Principle of operation
Use a special circular stapler to insert into the rectum through the anus, circularly excise the mucosa and submucosal tissues of the intestinal wall at the lower end of the rectum, and perform an anastomosis at the same time as the excision, so that the prolapsed anal cushion is lifted up and restored to its normal anatomical position Suspension, meanwhile, cuts off the arterial blood branch supplying hemorrhoids, and plays the role of "cut-off", so as to achieve the goal of radical cure.
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. 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. 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 target: 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.
The three departments of General Surgery treat each patient with hemorrhoids in strict accordance with the characteristics of each patient’s hemorrhoids and adopt corresponding treatment methods. It is necessary to pay attention to the treatment effect and also pay attention to potential complications, especially the possibility of serious complications. prevention. Follow the most effective, safest, simplest and most economical principles to bring the greatest therapeutic effect to patients. Those who can be treated with drugs do not need to use equipment for treatment, and those who can use equipment for treatment do not need to use surgery. The surgical method should be as far as possible Use simple, economical, and equally effective surgical methods to avoid excessive surgery and minimize the treatment costs for patients.
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