Hemorrhoids are a common and frequently-occurring disease. Since the 1970s, with the in-depth study of anatomy, histology and pathophysiology, people have had a new understanding of the nature and treatment of hemorrhoids. In the treatment of hemorrhoids, the concept of curing every hemorrhoid has been abandoned. Asymptomatic hemorrhoids do not require treatment. The treatment of symptomatic hemorrhoids is mainly to correct pathophysiological changes and relieve symptoms, rather than eliminate hemorrhoids. The scope of surgery should not be arbitrarily expanded. It is recommended to preserve the anal cushion tissue as much as possible during the operation. In the surgical method, the hemorrhoids are removed as thoroughly as possible in the past, and the prolapsed anal cushion is replaced by surgery. The tissue structure of the anal cushion is retained as much as possible during the operation to achieve no or as little impact as possible after the operation The purpose of the fine control function of the anus. Therefore, minimally invasive surgery to eliminate symptoms and repair anal cushions has become the direction of anorectal surgeons. In recent years, color Doppler ultrasound-guided hemorrhoid artery ligation and anal cushion repair are a simple and safe minimally invasive surgical treatment, providing new treatments for anorectal surgeons in Europe, the United States, Russia, Australia, South Korea and other countries The method has become the gospel for patients with hemorrhoids. This article reviews the development history of hemorrhoid artery ligation and anal pad repair under the guidance of color Doppler ultrasound, surgical indications and contraindications, surgical operation points, surgical treatment effects and complications, and surgical treatment principles.
1. The development history of hemorrhoid artery ligation and anal pad repair under color Doppler ultrasound guidance. In 1995, Japanese scholar Morinaga et al. reported the use of Moricor rectoscope with Doppler ultrasound probe for hemorrhoid artery ligation. Arterial ligation is simple, safe, and very effective. Subsequently, Hungary, Germany, Italy, Russia and other countries have successively developed Doppler ultrasound diagnostic and therapeutic instruments for hemorrhoid artery ligation, which promoted the widespread development of this new technology. However, ultrasound-guided hemorrhoid artery ligation has its limitations. The bleeding symptoms may be improved immediately after the operation, but the improvement of hemorrhoid prolapse is difficult because it takes a long time for hemorrhoids to shrink. So Scheyer proposed color Doppler ultrasound-guided hemorrhoid artery ligation and anal pad repair, and specially designed a rectal mirror of the hemorrhoid treatment system to help standardize the application of this operation. At present, the curative effect of this operation can completely relieve symptoms in 85% of patients, and 90% of patients are satisfied with the curative effect.
2. Surgical indications and contraindications The follow-up study of color Doppler ultrasound-guided hemorrhoid artery ligation and anal cushion repair for patients with stage I-IV hemorrhoids believes that this operation is suitable for all stages of hemorrhoids, especially III-IV The minimally invasive minimally invasive surgery for hemorrhoids. Regarding contraindications, Sohn et al. clearly pointed out that hemorrhoid artery ligation is not suitable for patients with external hemorrhoids and patients taking warfarin or aspirin during treatment with anticoagulants.
3. Operation points The operation of hemorrhoid artery ligation and anal cushion repair under color Doppler ultrasound guidance is relatively easy to master. The equipment and instruments required for the operation include: Doppler ultrasound hemorrhoid artery detection and diagnosis instrument, Doppler ultrasound sensor, and operation window Special anoscope with internal light source, special long-handled needle holder, suture needle, knot pusher, long thread cutter, etc. Bladder lithotomy is mostly used in the surgical position. The anesthesia can be local or spinal anesthesia, or general anesthesia.
The first step of the operation is to perform ligation of the hemorrhoidal artery, ligating all possible hemorrhoidal arteries. Generally, each patient can find 3-6 hemorrhoid arteries, and for individual patients with very large hemorrhoids, more than 6 hemorrhoid arteries can be found. The second step is to suture and fix the prolapsed hemorrhoids. Most patients undergo mucosal fixation at three positions: 3, 7 and 11 o'clock. Insert the anoscope, and the operating window should be fixed to the position of the mucosa. Use absorbable 2-0 suture from the dentate line about 5cm to close to the dentate line. Suture and knot the prolapsed hemorrhoids. Doppler ultrasound hemorrhoid artery detection diagnostic instrument can detect the depth of hemorrhoid artery and blood flow velocity, and guide the surgeon to control the appropriate suture depth.
4. Principles of Surgical Treatment Shelygin et al. and Schurman et al. believed that ligating the distal branch of the superior rectal artery reduces the blood flow into the hemorrhoids, and the "8" stitching of the hemorrhoidal artery on the dentate line at 2-3 cm also serves to suspend the hemorrhoids. The role of hanging fixed in the anorectal muscle layer, thereby reducing the prolapse of hemorrhoids. The essence of anal cushion repair is anal cushion fixation. Through longitudinal sutures, the prolapsed hemorrhoids are sutured and fixed on the supporting tissue of the submucosa to achieve the purpose of lifting the prolapsed hemorrhoids. Through color Doppler ultrasound-guided hemorrhoid artery ligation and anal pad repair, the blood supply of the hemorrhoids is reduced, and the blood supply of the arterial network is blocked, but the remaining arteries can still provide adequate blood nutrition for the tissue.
V. Efficacy and complications At present, clinical studies of hemorrhoid artery ligation and anal pad repair under the guidance of color Doppler ultrasound have found that the short-term effect of the operation is very positive, but the long-term effect needs further observation and evaluation. In recent years, clinical reports have not found serious surgical complications. Intraoperative and postoperative pain are generally mild, and moderate or higher pain that requires analgesic treatment is rare. Moreover, the incidence of pain is also very low. Mostly between 2%-8%. Although the hemorrhoidal artery of the anal canal was ligated, there were no signs of ischemia in the anal canal, and there were no complications such as ulcers and necrosis.
In short, color Doppler ultrasound-guided hemorrhoid artery ligation and anal cushion repair are a minimally invasive treatment technique for hemorrhoids, which can provide anorectal surgeons with a new choice when treating hemorrhoids. With the further development of clinical applications of this operation, Its understanding will be more profound.
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