1. Diagnosis of mixed hemorrhoids
Generally, it is judged whether it is mixed hemorrhoids based on medical history, symptoms and signs. Personally, we can diagnose mixed hemorrhoids if we meet the following three points.
1. Have an obvious history of disease;
2. There are obvious symptoms, such as blood in the stool (bright red), prolapsed mass, protruding mass, anal discomfort, pain, etc.;
3. Specialist physical examination: under anoscope, the mucosa near the dentinal line of the rectum is uplifted, cherry-shaped, varying in size, and the surface is ruddy, purplish red, or dark red, or hyperemia, edema, erosion, oozing, or fibrosis The color is off-white. It usually occurs at 3, 7, and 11 o'clock near the tooth line at the lithotomy position, where the tooth line is fused and blurred.
2. Operation method
There are many surgical methods for mixed hemorrhoids. With the development of science and technology, minimally invasive surgery is constantly being created and improved clinically. Now briefly introduce the current surgical methods. However, I still need to remind everyone that the choice of surgery method needs to be selected based on the specific analysis of each person's specific situation. Do not ask the medical staff what kind of surgery method to perform after consulting the information online.
1. Traditional surgery
Divided into external stripping and internal ligation, external stripping and internal ligation segmented ligation, and simple ligation;
1.1 External stripping and internal ligation is the most classic and long-established method of mixed hemorrhoid surgery. It seems simple, but in fact it is the most technical method. In the industry, there is: can make "external stripping and internal ligation" beautiful. You are the best in anorectal department. However, as people's requirements for reducing pain are getting higher and higher, simple external stripping and internal ligation are relatively more painful, and the trauma area is more than that of minimally invasive surgery.
1.2 External stripping and internal ligation segmented ligation The surgical method is changed according to the type of mixed hemorrhoids in the external stripping and internal ligation, mainly for the treatment of circular mixed hemorrhoids and internal hemorrhoids partially fused into a circle. This operation can only be performed by an excellent surgeon and the effect is ideal, and the difficulty is relatively large. However, the current minimally invasive procedures can solve this problem at any time, and the treatment is ideal. We will talk about it below.
1.3 Simple ligation It is not too obvious to deal with external hemorrhoids, so it is a surgical method used for mixed hemorrhoids.
2. Minimally invasive surgery
2.1 Band ligation
Band ligation is a simple operation for the treatment of internal hemorrhoids. This operation requires the aid of an instrument called a hemorrhoid ligator to complete the operation. When dealing with mixed hemorrhoids, it is often necessary to combine external stripping and internal ligation. Relatively less painful, strong ability to deal with single hemorrhoids, but also relatively expensive, and there is a risk of apron slippage. Clinical observations are not suitable for mixed hemorrhoids with more severe prolapse and severe mucosal relaxation. Usually, during or before surgery The effect is good for 4 days, but when the hemorrhoids shrink, the effect of the improvement will be reduced by a small part. At present, the quality of the ligator also has a certain relationship with the curative effect. At present, the ligator includes a continuous hemorrhoid ligator, a hemorrhoid combo hemorrhoid ligator, and an elastic thread hemorrhoid ligator. The three have their own strengths and weaknesses.
2.2 PPH, TST operation PPH operation is the circumcision and anastomosis of the hemorrhoids, and the TST operation is the selective hemorrhoidectomy and anastomosis. TST is an upgraded version of PPH. It is proposed based on the theory of PPH treatment and combined with external stripping and internal ligation. It is currently one of the preferred minimally invasive treatments for mixed hemorrhoids. Many, fewer postoperative complications. PPH surgery is currently undergoing more clinical developments. The surgical procedure is effective and easy to operate. It is especially effective for circular mixed hemorrhoids, but its complications are relatively high. Clinical reports include postoperative hemorrhage and mild rectal bleeding. Narrow and so on. Whether it is PPH or TST, the long-term curative effect is better, as long as the operation is proper, it is an ideal surgical method. However, it is very important that these two operations are also realized by machinery, which are staplers of better material. Therefore, it is expensive. It is also the reason why this surgical method cannot be widely carried out in clinical practice.
2.3 Doppler-guided hemorrhoidal artery ligation This operation is mainly to ligate the artery supplying hemorrhoids in a high position, accurately and selectively. It is equipped with a special anoscope, which can be equipped with a Doppler ultrasound probe with a side view. Through the guidance of Doppler ultrasound, the submucosal artery near the anal canal from the upper part of the anus can be determined. The window above the Puller ultrasound probe can suture or ligate these arteries. By cutting off the blood vessel supply, hemorrhoids atrophy and disappear. The operation has been carried out in Shanghai and Beijing, and the effect is good. However, this operation cannot treat external hemorrhoids, and the effect of treatment of prolapsed hemorrhoids needs further demonstration.
Zhang Liangliang and Jun Tong Xizhi