2021年1月22日星期五

hemorrhoids how to treat,Surgery Talk (2): What is surgery?

    As a surgeon, we often talk about performing surgery, so what is the essence of surgery?

    From the perspective of traditional Chinese medicine, I think the essence of surgery is to "remove evil and strengthen the body." To "eliminate evil" is to get rid of the lesion, and "to strengthen the body" is to protect normal tissue. The basic principles are: dispel evil without hurting the righteousness, and strengthen the righteousness without leaving blood stasis (evil). "Quieting evil without hurting righteousness" means trying not to damage normal tissues as much as possible in the process of cutting off the lesion; "strengthening the righteousness without leaving blood stasis (evil)" means removing the lesions as cleanly as possible while protecting normal tissues. This coincides with our modern western medicine minimally invasive surgery and precision surgery philosophy!

    From the perspective of modern western medicine, I believe that surgery will experience the development from traditional (major invasive) surgery to minimally invasive surgery and precision surgery, and will eventually reach the stage of development of non-invasive surgery.

    I often discuss with many experts in anorectal surgery across the country that modern Western medicine minimally invasive surgery and precision surgery are developing rapidly, but the anus is always a restricted area for them. The reason is that the function of the anus is very unique and delicate. It not only needs to protect the fine and fine bowel control, defecation function and perfect shape of the anus, but also to remove the lesion and relieve pain, so minimally invasive surgery on the anus is very difficult. Therefore, based on the essence of Chinese medicine that surgery is "eliminating evil and strengthening the body", I have conducted a lot of explorations and formed a certain understanding.

    The direct parties of the operation are the doctor and the patient, so minimally invasive anorectal surgery must take into account the two different angles of the doctor and the patient. From the patient's point of view, minimally invasive surgery should achieve less trauma, light pain, fast healing, and easy postoperative functions; from the doctor's point of view, minimally invasive surgery should try to protect the integrity of the anal canal skin (anal cushion) and anal sphincter Sex, good-looking postoperative appearance.

    For different diseases, minimally invasive surgery should have different focuses. For hemorrhoid surgery, focus on the patient’s feelings, that is, to eliminate the patient’s symptoms. For anal fistula surgery, focus on the doctor’s grasp of the fistula and internal opening, which is to accurately grasp the relationship between the fistula and the sphincter and the position of the internal opening .

    There are more and more detection methods and surgical instruments and methods for anorectal diseases, but our operations should be smaller and simpler. This is in line with the concept of minimally invasive. Therefore, based on the fine anatomy of the anorectal, disease pathogenesis and a large number of clinical practice summaries, the minimally invasive surgery for hemorrhoids is summarized as "reduction, lifting, breaking, and cutting", and the minimally invasive surgery for anal fistulas is summarized as "opening and hanging". , Sewing and cutting".

    The object of medical work is people, so we must treat patients as real people, not things. This requires doctors not only to have extensive theoretical knowledge and rich clinical experience, but also to have a benevolent humanistic feeling and profound literary foundation, as well as a broad philosophical mind and selfless dedication.

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