Mixed hemorrhoids, especially circular mixed hemorrhoids, are used to remove external hemorrhoids. Whether it is a fusiform or V-shaped incision, it is prone to postoperative edema of the retained skin flap to form new external hemorrhoids, anal fissure caused by poor healing of the incision, anal stenosis, etc. For the sequelae, the ∧-shaped flap free fixation technique is used to replace the traditional incision, which avoids the occurrence of the above sequelae and shortens the healing time.
Ordinary mixed hemorrhoid surgery method: first use 1:1 Xiaozhiling injection to inject 2ml into the hemorrhoidal artery area of mixed hemorrhoids; start from the central tooth line of the hemorrhoids, make incisions on the edges of the outer hemorrhoids to separate the skin and hemorrhoids Tissue, make the free skin flap ∧ shape; blunt and sharp strip the varicose vein mass under the tooth line to 0.3CM on the tooth line, ligate together with internal hemorrhoids, remove and retain 1/3 of the pedicle; trim the free skin Flap, gently pull the tip of the skin flap to the root of the ligation of the hemorrhoids to ensure that the tension of the flap is not too high or too low; use a skin suture needle to pass one of the ligatures through the tip of the flap, and ligate the two The thread is knotted so that the flap is fixed to the root of the ligated hemorrhoid. Treat other mixed hemorrhoids in the same way. Surgical method for circular mixed hemorrhoids: select 4 to 5 larger hemorrhoids according to their natural boundaries, and inject 2ml of 1:1 Xiaozhiling injection into the hemorrhoidal artery area of these hemorrhoids. The submucosa and the lamina propria of the hemorrhoids were injected with 1:1 Xiaozhiling injection, 2~4ml for each hemorrhoid, and the total injection of Xiaozhiling should not exceed 30ml; use the general mixed hemorrhoid surgery method to select 4 ~ 5 larger hemorrhoids were stripped and ligated with skin flaps, the varicose veins under the skin tag between the two fixed flaps were removed, and the mucosal was ligated by suspension in the area of the suprahemorrhoidal artery between the two ligated hemorrhoids to make the skin The incision is completely intact. Pressure bandaging with pythagorean gauze. Control the defecation for 24 to 72 hours after the operation. After each defecation cleansing, the hemorrhoids shall be embolized into the anus with Ma Yinglong and bandaged until healed. Patients with circular mixed hemorrhoids should choose the ∧-shaped flap free fixation in the middle at 6 o'clock and 12 o'clock to avoid postoperative cracks and new connective tissue hyperplasia.
Surgical treatment of mixed hemorrhoids, postoperative edema of the incision, secondary bleeding, pain, poor healing, etc. during the healing period; epidermis, mucosal ectropion, anal stenosis, defecation disorder and even recurrence may be left in the long term. The author believes that the occurrence of the above symptoms is closely related to the choice of surgical procedures. Traditional V-shaped incisions and shuttle incisions often fail to completely remove the varicose veins below the tooth line, which will cause postoperative edema and bleeding of the external hemorrhoid stump, which is also an important factor in postoperative pain; residual external hemorrhoid tissue Healing between the incisions is slow, and the skin between the incisions may have fibrosis at the edge of the incision before heals, resulting in poor incision healing and the formation of anal fissures. The author has also used other surgical incisions reported, which are often unsatisfactory or too complicated. This surgical method preserves the skin and mucous membrane at the dent line to the maximum extent, and at the same time completely removes the varicose vein tissue below the dent line. Therefore, the incidence of edema and hemorrhage is low, and there are few new epidermis after operation. Because the incision is conjoined and bandaged under pressure, it not only takes a short healing time but also plays a role of decompression and drainage. The postoperative incision is healed earlier than the hemorrhoids fall off. The key to this operation is whether the skin incision is well aligned and the fixed skin is free. Whether the valve tension is suitable or not, there is no anal fissure, defecation disorder, anal stenosis, and mucosal ectropion in the follow-up, and the patients are highly satisfied. The picture below shows the comparison before and after surgery and the healing time of circular mixed hemorrhoids.