2021年11月10日星期三

Various questions about hemorrhoid surgery in "doctor's notes"

Mr. Zhang is a reader on the toilet. Each squat time is no less than 1 hour. After a defecation at the end of September, he found that a circle of meat came out of his anus, swollen like steamed bread, painful and restless. Mr. Zhang bought hemorrhoids ointment for external use, but there was no relief for several days. Finally, he couldn't resist the persuasion of his family and came to the anorectal clinic of Suzhou high tech Zone People's hospital. After physical examination, the doctor told Mr. Zhang that the steamed bread was an inflamed and edematous hemorrhoids. The inflamed hemorrhoids were embedded in the anal door, and some tissues were erosive and necrotic. After being hospitalized, Tang Lingjiao, director of anorectal department, successfully implemented "internal hemorrhoid elastic line ligation + external hemorrhoidectomy", which solved his pain.

It is not difficult to find that patients with acute hemorrhoids such as Mr. Zhang have clinical symptoms before the onset. If there is a history of repeated bloody stool and anal mass prolapse, but they all ignore the diagnosis and treatment of the disease because of their lack of attention, and affected by traditional ideas, most patients believe that hemorrhoids must wait until they are very serious before surgical intervention. However, with the update of medical technology, the indications of hemorrhoid surgery have been adjusted again.

Which patients need surgical intervention? 1、 Internal hemorrhoids with repeated bleeding: internal hemorrhoids grow in the anus. The main symptom is painless hematochezia, which usually occurs intermittently; Patients with anemia and other complications caused by hematochezia should undergo surgical intervention as soon as possible; 2、 Hemorrhoids prolapse and anus irregularity: Anal mass prolapse without obvious pain; However, hemorrhoids prolapse affects life, and the paper after defecation cannot be wiped clean, and even leads to anal pruritus and eczema. Surgical resection should be carried out as soon as possible; 3、 Acute attack of hemorrhoids: thrombotic external hemorrhoids, inflammatory external hemorrhoids and mixed hemorrhoids are incarcerated. Emergency operation or operation after detumescence treatment shall be carried out as appropriate; 4、 Patients with long course of hemorrhoids: clinically, there are often some elderly patients with hemorrhoids, or bloody stool attack, or hemorrhoid nucleus inflammation and necrosis. Because of their age, they are often complicated with chronic diseases such as coronary heart disease, hypertension and atrial fibrillation. They have surgical contraindications or high surgical risk, and they are unable to perform hemorrhoid surgery in time, resulting in unbearable pain.

Therefore, hemorrhoids have been ill for a long time. Even those without symptoms should have elective surgery. Don't wait until you are old to think of surgery. And the hemorrhoids are small, the surgical wound is small, the recovery is faster, and the corresponding pain will be lighter. On the contrary, the postoperative patients suffer a lot and the recovery time is long. Today, with the diversification of hemorrhoid surgery methods, we should abandon the traditional concept and do not wait until the onset of hemorrhoids.

What are the ways to carry out hemorrhoid surgery in anorectal Department of Suzhou high tech Zone People's hospital? 1、 Injection of sclerosing agent for internal hemorrhoids: it is suitable for II °, III ° internal hemorrhoids and elderly hemorrhoids whose bleeding cannot be removed, with good hemostatic effect; 2、 Internal hemorrhoid elastic line ligation: at present, it is the mainstream operation for the treatment of internal hemorrhoids in the anorectal boundary. At the same time, it can ligate the hemorrhoid mucosa, enhance the suspension effect of anal pad, with small wound, fast recovery time and low long-term recurrence rate. It is applicable to patients with II ° and III ° internal hemorrhoids and those with mixed hemorrhoid bleeding who cannot be removed; 3、 Hemorrhoid artery ligation under ultrasound guidance: it can block the arterial blood supply of hemorrhoid nucleus and reduce the probability of postoperative bleeding and recurrence of internal hemorrhoids. It is used as an adjuvant treatment for hemorrhagic internal hemorrhoids with almost no trauma; 4、 External resection and internal ligation of mixed hemorrhoids: traditional operation of mixed hemorrhoids, classic operation and low recurrence rate; 5、 Internal hemorrhoid elastic line ligation + external hemorrhoidectomy: it is applicable to most patients with mixed hemorrhoids. Compared with traditional surgery, it can significantly reduce the incision, reduce the probability of postoperative massive bleeding, reduce patient pain, reduce the recurrence rate and shorten the hospital stay; 6、 Suprahemorrhoid mucosal circumcision and nailing (PPH): This is a minimally invasive operation for hemorrhoids publicized by some hospitals. Because patients may have some discomfort after the operation, many hospitals at home and abroad have gradually eliminated this operation method, only for a small number of patients with circular mixed hemorrhoids and rectal prolapse.

Is laser surgery credible? In the process of anorectal outpatient diagnosis and treatment, it is found that many patients will believe the laser surgery on the Internet. Tang Lingjiao, director of anorectal department, pointed out: up to now, there is no formal literature report on hemorrhoids laser surgery. Some small clinics in remote areas may have carried out laser surgery in the past, but laser is only a means to remove hemorrhoids. Like scalpels and scissors, it does not reduce wounds and patients' pain, and is not recognized by mainstream medicine, Patients should not be blindly praised.

The anorectal Department of Suzhou high tech Zone People's hospital has carried out hemorrhoid surgery for many years, with various surgical methods. Different treatment schemes need to be formulated for different patients and different types of hemorrhoids. Light patients can be discharged within 2-3 days, and severe patients can be hospitalized for 5-7 days. The key depends on the type of hemorrhoids and postoperative recovery. (He Yu)

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