The systematic treatment of inflammatory cricoid mixed hemorrhoids: Inflammatory cricoid mixed hemorrhoids are based on mixed hemorrhoids in which the internal hemorrhoids prolapse outside the anus and fail to return in time to stimulate the anus and cause sphincter spasm, resulting in a high degree of edema in the hemorrhoidal vein and lymphatic reflux obstruction, and a large number of thrombus formation, and the patient shows severe anal pain, so early surgery is advocated to release the hemorrhoidal vein and lymphatic reflux obstruction. The main symptoms are painful edema at the anal verge and postoperative discomfort. From 2010 to now, 76 cases of inflammatory embedded mixed hemorrhoids were treated with external peeling and internal ligation injection in our department, and the efficacy was satisfactory with postoperative system support treatment, which is reported as follows. 1.Clinical data All 76 cases were consistent with the diagnosis of inflammatory circumscribed mixed hemorrhoids, 39 men and 37 women, aged 18-65 years, all with a history of 4-20 years and complicating embedded 1-11 days. The patients all had prolapsed anal masses, mostly in the form of rings, which could not be retracted, anal cramping pain, dramatic increase in the volume of the hemorrhoid nucleus, high local edema, thrombosis, some with erosion, necrosis, oozing blood, and even secondary infection. Combined with old anal fissure 28 cases. 2. Methods 1) Preoperative preparation: Patients were perfected with relevant preoperative examinations to exclude contraindications to surgery, fasted as much as possible before surgery, and took 20 ml of cannabis oil orally 12 hours before surgery, or emptied the intestine thoroughly with sodium phosphate enema solution 1 hour before surgery. 2）Surgical method: lumbar anesthesia or local anesthesia, mostly in the left or right lateral position, routine disinfection of the operating area, laying of towels, incorporation of the dislodged embedded hemorrhoids into the anus, disinfection of the anal canal and anal finger inspection, massage the anus with fingers, and then dilate and relax the anus to observe the site, size and number of hemorrhoid nuclei. The incision is designed according to the size of the annular mixed hemorrhoid nucleus, the protrusion of the external hemorrhoid and its distribution, and the three parent hemorrhoid areas are selected as the external peeling and internal ligation sites. The length of the incision is 3:1 with the width of the hemorrhoid, and the subcutaneous tissues and varicose veins are bluntly peeled off to 0.3 cm above the dentate line, and the base of the hemorrhoid nucleus is clamped with large curved forceps, and the hemorrhoid nucleus and the peeled tissues are ligated with “8” sutures under No.7 silk pliers. The external hemorrhoid is removed along with the ligated internal hemorrhoid, and the marker is left in place, and the hemorrhoid tip is returned to the anus; a mucosal bridge of about 1 cm should be retained between the ligated hemorrhoids, and the ligated points are not on the same plane; for larger hemorrhoids that are fused into a semi-annular mass, the large hemorrhoid can be artificially divided into several small hemorrhoids and treated separately, and the potential thrombus in the subcutaneous tissue can be fully stripped from both sides by widening the incision. Trim the cut edge and observe whether the incision is aligned. The incision is adequately hemostatic by electrocoagulation and the internal sphincter is released in a large “V” shaped incision on the posterior half of the incision to prevent anal stenosis. A longitudinal decompression incision should be made for unligated hemorrhoid tissue that is still significantly swollen under anesthesia to avoid postoperative skin formation. After placing the anoscope to remove the blood in the intestinal cavity, 20 ml of 1:1 concentration of hemorrhoid eliminating spirit is injected first at 3, 7 and 11 o’clock in the truncated position in the superior femoral artery area, especially in the submucosal layer above the original embedded edema area. The excised trauma can be injected with methylene blue long-acting analgesic for pain relief. The injection should be uniform, and the needle should not be too deep to provide the best pain relief. After the anoscope is placed in the anus to explore the intestinal cavity, and there is no active bleeding at the nucleus ligature point, 1 compound keratanic acid suppository is placed, oil gauze is placed in the drainage, and the exhaust tube (soft drainage tube is appropriate) is placed in the anus, the tower gauze block is compressed, and the “d” bandage is fixed with pressure, after the operation. (3) postoperative treatment: postoperative anti-infection treatment for 3 days, rest in a flat position on the day of surgery, hot water bags throughout the hot compresses on the abdomen, active prevention of urinary retention, full fluid diet for 1 day, control the stool for 24 hours, after 3 days change to a general diet; regular bowel movements, oral laxatives to soften the stool; daily and after the stool with Chinese herbal sitz bath, daily microwave therapy once, drug change with compound keratanate cream with metronidazole sand strips placed in the anus, skin edge In case of edema, the gauze strip was diluted with magnesium sulfate injection and placed at the edema of the skin edge. If the patient had obvious severe pain during defecation and poor defecation, it could be combined with nitroglycerin tablets ground into powder and mixed with anti-inflammatory cream to apply on the trauma with a concentration of 0.2% to relieve spasmodic pain. 3. Results: 51 cases of strangulated pain disappeared after surgery in 76 patients, and 25 cases were significantly reduced. The average hospital stay was 7 days, and the patients were cured in 20-25 days. No complications such as postoperative hemorrhage, infection, anal canal stricture and fecal incontinence were seen, and the ability to control stool was good and the appearance was flat. 4.Discussion Due to various reasons, the hemorrhoid tissue is held by the sphincter muscle spasm, so that the blood flow and lymphatic flow in the venous plexus is obviously blocked, but at this time, the arterial blood is still constantly input, resulting in the volume of the prolapsed hemorrhoid nucleus increasing, the anal tissue blood flow is impaired, tissue edema and ischemia and hypoxia, resulting in the accumulation of acidic metabolites in the tissue, further causing continuous spasm of the internal sphincter muscle, resulting in the impaction of hemorrhoids, and the patient is in great pain. In the past, conservative treatment was mostly used, and early local anesthesia was used to reset the hemorrhoid, which was barely incorporated into the anus and required further elective surgery. Emergency surgery for embedded hemorrhoids is safe, feasible, and significantly better than elective surgery. Surgery to remove the acute attack of mixed hemorrhoids can remove the diseased prolapsed mixed hemorrhoid tissue, eliminate prolapse, reduce edema, thrombus compression stimulation; cutting off part of the sphincter muscle can release the sphincter muscle spasm, block the dominant link of pathological vicious cycle, so that the blood and lymphatic reflux in the anus is smooth, promote the body local as soon as possible on a new basis to establish and restore the physiological balance; through the arterial pulsation area on the hemorrhoid and After the injection of appropriate amount of hemorrhoid eliminating spirit into the submucosa above the area of serious edema of the lesion, the hemorrhoid tissues can be converged, atrophied and relatively fixed, which can prevent postoperative complications and skin bridge edema, etc. and promote the repair of the trauma edge. Therefore, early and timely surgical treatment of embedded hemorrhoids is a positive treatment method. Treatment with this method can rapidly eliminate the lesion, release the sphincter spasm, and improve blood and lymphatic circulation. The author has learned in the course of clinical systemic treatment that: (1) during the surgical procedure, lumbar or sacral anesthesia should be performed as much as possible, the anus should be relaxed and fully exposed, and local infiltration anesthesia should not be used as much as possible to avoid postoperative anal edge edema; (2) care should be taken that the incisions should not be too wide or too large to avoid damaging too much anal canal and anal edge skin, which is not conducive to wound healing, and that the thrombus and clot should be stripped thoroughly, and the hemorrhoidal vein plexus under the skin bridge should be removed as much as possible to avoid postoperative edema. (3) Avoid excessive pulling and clamping of normal tissues at the trauma edge, complete hemostasis, not too much stuffing, and placement of exhaust tube to avoid abdominal cramps; (4) The ligature points at the base of hemorrhoids should not be on the same level, and those with large hemorrhoids can be ligated in sections to prevent poor ligation and dislodgement of the thread; the ligature range should not be too large to reduce the anal canal tension, reduce (5) Encourage the patient to eat more and do more anal lifting exercises for 7-10 days after surgery, and it is appropriate to have formed dry stool to play the role of anal dilation. Anal plug compound keratanate suppositories to repair the mucosa of the internal anal hemorrhoid area to avoid the patient’s long-term intra-anal drop discomfort foreign body sensation.