Clinical application analysis of in-situ skin bridge radial fixation in modified external stripping and internal ligation
Abstract To explore the clinical value of in situ skin bridge radial fixation in modified external dissection and internal ligation in the treatment of multiple and circular mixed hemorrhoids in situ skin bridge survival. 198 patients with multiple and circular mixed hemorrhoids were fixed radially with an in-situ skin bridge on the basis of modified external dissection and internal ligation. The results show that the radial fixation of the skin bridge in situ has obvious effects on preventing edema, hematoma, and necrosis of the skin bridge in situ, shortening the course of treatment.
Key words Mixed hemorrhoids In-situ skin bridge Radial fixation Modified external stripping and internal ligation Edema
Traditional external stripping and internal ligation is the most commonly used procedure for the clinical treatment of mixed hemorrhoids at home and abroad①. Our department has made some improvements on the basis of this operation. At present, improved external stripping and internal ligation is the routine clinical treatment of mixed hemorrhoids in our department. Surgical style. Using this method combined with in situ skin bridge radial fixation to treat 198 cases of multiple and circular mixed hemorrhoids found a higher survival rate of in situ skin bridge. The curative effect and complications of this operation are now clinically observed and analyzed.
1 Materials and methods
1.2 After the operation method, after the simplified sacral anesthesia is successful, the knees and chests are taken, and the traditional external dissection and internal ligation are changed to the traditional external hemorrhoid base incision after the conventional disinfection and draping. The external hemorrhoid base incision is a small “v”-shaped incision on the external hemorrhoid body in the mother hemorrhoid area. After extending the incision along the body of the hemorrhoid, the direction is changed to adduction and upward and go longitudinally near the tooth line. Use sharp and blunt dissection of the hemorrhoidal venous plexus to near the tooth line. Use curved blood forceps to clamp the base of the internal hemorrhoid, and use double 10 Double ligation of internal hemorrhoids with silk thread Use the same method to treat other hemorrhoids, but the in-situ skin and mucous membrane bridge should be fully preserved between the incisions. Because of the hemorrhoid body incision in this method, the in situ skin bridge retains sufficient width, but at the same time the hemorrhoidal venous plexus under the skin bridge is relatively large. The skin edges of the incisions on both sides must be lifted and turned, and the skin under the skin bridge must be cleaned sharply. Remaining hemorrhoid tissues such as vein loops causes excessive looseness of the skin bridge and becomes redundant. In order to preserve the in-situ skin bridge completely and fully survive without causing skin edema and subcutaneous hematoma, we use an in-situ skin bridge. The central radial fixation is appropriately fixed with bilateral skin bridge semi-closed sutures. The standard of suture is flexible and flexible according to the width and slackness of the original skin bridge. However, the suture should not be too tight or loose, so as to achieve fixation and make the original position. The skin bridge is flat and the subcutaneous tissue of the skin is fully adhered and anastomosed as the benchmark.
Postoperative treatment The patients were given the same antibiotics, hemostatic drugs, tannin suppositories, microwave and other treatments after the operation, and they were given a liquid diet 6 hours after the operation and soft food on the second day. The suture was removed on the 7th day.
After the above treatment, 8 cases of 198 patients had skin bridge edema in situ, no subcutaneous bridge hematoma, no skin bridge inactivation, and the healing period was 10-18 days, with an average of 12 days. The results show that the radial in situ skin bridge fixation is effective in protecting the skin bridge in situ, preventing edema, hematoma, and inactivation of the skin bridge, and it has a buffer effect on the high incidence of anal dysfunction caused by excessive postoperative trauma. Make the patient's course of disease significantly shorten.
The skin of the anal canal is special, which plays an important role in maintaining the normal function of the anus. Excessive or complete removal of the skin of the anal canal during the operation can cause anal dysfunction such as skin defects in the anal canal, anal stenosis, mucosal ectropion, and extraglandular overflow. Although there are many clinical treatment methods for hemorrhoids, they will cause damage to the skin of the anal canal to varying degrees. During hemorrhoid surgery, the original blood and lymph circulation channels are destroyed and local circulation is blocked due to the removal and stripping of the local tissues of the anus. In addition, the increase in local capillary osmotic pressure can easily cause edema of the skin bridge after anal surgery, hematoma and even necrosis, resulting in dysfunction such as scarring, contracture, and stenosis of the anal canal skin. Therefore, in the treatment of mixed hemorrhoids, in-situ skin The bridge has an important meaning. Since the skin bridge in situ is indwelled, it is necessary to ensure its full survival and its complications. In order to prevent and reduce the in situ skin bridge edema, subcutaneous hematoma, and excessive tension caused by the skin bridge tear, the hemorrhoid tissues such as the vein loop under the skin bridge must be completely removed and peeled off during the operation, and the in situ skin bridge radially fixed and combined The semi-closed suture can make the skin and the subcutaneous tissue fully anastomosed and flat and facilitate drainage. In situ skin bridge radial fixation combined with modified modified external dissection and internal ligation for the treatment of multiple and circular mixed hemorrhoids can preserve enough skin of the anal canal, and can reduce skin edema, hematoma and necrotic inactivation, and promote the early postoperative hemorrhoids restore. Its advantages are: (1) The skin bridge in situ is fully retained, and it will not cause anal stenosis, mucosal ectropion, glandular overflow and other anal dysfunction due to excessive scar contracture due to skin defects in the anal canal; (2) skin bridge in situ Radial fixation can prevent the skin bridge from being overly loosened due to the complete removal of hemorrhoid tissue such as venous loops under the skin bridge and free from the subcutaneous tissue to cause subcutaneous hematoma, and it is beneficial to the drainage of both sides of the skin edge to reduce the formation of edema. And it will not cause the skin bridge to tear due to excessive tension; (3) The radial in situ skin bridge fixation conforms to the physiological characteristics of the anal canal ③, it will not block the blood and lymph circulation in the anal canal due to sutures to achieve The purpose of early healing is to significantly shorten the course of the disease and reduce the occurrence of postoperative complications and sequelae.
① Zhang Dongming, Wang Yucheng. Pelvic floor and anal disease. Guiyang: Guizhou Science and Technology Press, 2000.399.
②Li Chunyu, Zhang Yousheng. Practical Anal Surgery. Shenyang: Liaoning Science and Technology Press, 2005.11.
③Zhang Dongming. Anal local anatomy and surgery. Hefei: Anhui Science and Technology Press. 2006.4(2).22.