1, hemorrhoid surgery which kinds of methods? Internal hemorrhoid surgery: simple ligation, segmental penetrating ligation, internal hemorrhoidectomy, internal hemorrhoidal circumcision, embedded internal hemorrhoid external stripping and internal ligation. External hemorrhoid surgery: thrombosed external hemorrhoid stripping and removal, external hemorrhoidectomy, external hemorrhoidectomy suture and so on. Mixed hemorrhoid surgery: external stripping and internal ligation, external stripping and internal ligation injection, excision and suturing. 2, anastomosis method of treatment of hemorrhoids and conventional surgical method compared to what are the advantages and disadvantages? According to the modern theory of hemorrhoids, the ideal surgical treatment of hemorrhoids should be on the basis of not changing the normal tissue structure and physiological function of the anus, so that the excessive hypertrophy and expansion of hemorrhoidal tissue back to normal. In the early nineties, the famous Italian doctor Longo took the lead in proposing a revolutionary hemorrhoidal surgical method, the application of circular anastomosis to eliminate mucosal and hemorrhoidal prolapse surgery, commonly known as the anastomosis method of hemorrhoidal surgery, the exact name of the “hemorrhoidal mucosal and submucosal circumferential incision, anal cushion suspension,” also referred to as the PPH method. The principle is to excise the mucous membrane at the 4-centimeter mark on the dentate line and lift up the prolapsed hemorrhoids. The anastomosis method is simple, short and has less intraoperative bleeding. Since the anal cushion is not removed, the ability to control bowel movement is basically unaffected, there is no anal edema, anal stenosis, mild degree of pain commonly seen after traditional surgery, postoperative treatment is simple, and the patient recovers normal life faster, which has been carried out in China and has accumulated a certain number of cases (more than 6,000 cases). However, the cost of surgery is high, and recently there have been postoperative anastomotic hemorrhage, surgery is ineffective, parianal infection, severe perianal pain and other cases reported, so the indications should be strictly controlled, and at present is mainly used for Ⅲ, Ⅳ degree of prolapsed internal hemorrhoids treatment. 3, hemorrhoid surgery without pain after the line? What kinds of means? Hemorrhoid surgery without pain mainly rely on intraoperative anesthesia, there are posterior perineal block anesthesia, sacral block anesthesia, spinal anesthesia (lumbar anesthesia), epidural anesthesia, general anesthesia and other methods. However, either local anesthesia, lumbar anesthesia or sacral anesthesia is only a solution to the problem of pain relief during and for a short time after surgery. After anal surgery patients often due to traumatic pain up to ten days and very painful. In recent years, the anorectal department widely used long-acting pain reliever is a main component of methylene blue compound injection, which basically solves the problem of post-anal surgery pain, as long as the correct mastery of the operation method and dose, the pain effect can be up to 1 ~ 3 weeks. In addition, after the operation in the anus into the anti-inflammatory analgesic suppository, postoperative oral or intramuscular analgesic, as well as surgery in the careful, fine operation, minimize tissue damage, postoperative local edema to a minimum, are a good way to avoid postoperative pain. 4, hemorrhoid surgery often after what complications and the corresponding precautions are? (1) postoperative pain: generally there are different degrees of pain after surgery, but will be quickly relieved. If there is an exact cause of pain, it should be treated promptly. (2) Urinary retention: the main reason is that pain causes spasm of anal sphincter, which reflexively causes spasm of urethral sphincter innervated by homologous nerves and produces urinary storage. (3) Edema: mainly due to surgical injury, so that the lymphatic and blood reflux is blocked. Or part of the wound suture outside drainage incision is not good and cause edema, can make the tissue proliferation to form skin flap. (4) Bleeding: bleeding within 24 hours after surgery is primary bleeding, mostly due to incomplete hemostasis or postoperative ligature line slipping; bleeding after 24 hours is secondary bleeding, mostly seen in 7 to 14 days after surgery, caused by thrombus dislodgement of the trauma, which needs to be stopped immediately. (5) Infection: poor sterilization during surgery, poor drainage of the wound after surgery, and poor dressing change are all causes of infection. (6) Anal canal stenosis: it is mostly seen in the resection of external hemorrhoids when removing too much anal and anal canal skin, or injection method when injecting too much, too deep, so that the necrosis is too large to form a scar contracture and lead to stenosis, and not using finger dilatation to dilate the anus after surgery is also an important reason. (7) other complications still have constipation, anal skin, mucosal prolapse, pseudo polyps, anal fistula, anal itching, fecal incontinence and recurrence. 5.How to prevent and deal with urinary retention after hemorrhoid surgery? The main methods to prevent postoperative urinary retention are: ① preoperative work on the patient’s mind, relieve tension; ② empty the bladder before entering the operating room; ③ limit the amount of fluid; ④ choose effective anesthesia, so that the sphincter muscle is fully relaxed; ⑤ surgical operation should be careful, to avoid unnecessary tissue damage; ⑥ postoperative rectal lumen tamponade can not be too much, too tight; ⑦ patients with urinary tract diseases, should be appropriate preoperative treatment. Postoperative urinary retention treatment: ① eliminate ideological concerns, choose the appropriate environment and position, and strive to urinate; ② hot compresses on the perineum or lower abdomen to relieve the spasm of the urethra, bladder sphincter; ③ such as the dressing is too tight, can be properly relaxed after 2 hours after the operation; ④ smooth muscle contraction of the bladder, can be injected into the muscle of neostigmine; ⑤ due to the pain caused by pain, the application of effective painkillers, or the use of the Changqiang point Closure therapy to relieve pain; ⑥ Acupuncture: take acupuncture points Zhongji, Guanyuan, Qihai, Sanyinjiao, etc.; ⑦ Catheterization: if other methods are ineffective and the bladder is distended, catheterization should be performed. 6.What are the causes of bleeding after hemorrhoid surgery? How to prevent? Clinical observation found that the etiology of postoperative bleeding includes two major aspects: systemic factors and local factors. Systemic factors include coagulation disorders caused by some underlying diseases; local factors are bleeding caused by improper surgical operation, incomplete hemostasis or slippage of ligature during operation, or secondary infection, tissue necrosis, and rupture of blood vessels. Generally speaking, heavy bleeding within 24 hours after surgery is definitely the result of technical errors, often caused by improper ligation of the hemorrhoidal clitoris; and delayed bleeding (7 to 10 days)-generally the result of infection of the hemorrhoidal clitoral area. The triggers of hemorrhage after hemorrhoid surgery are diarrhea, constipation, infection, immune deficiency, soaking the anus in hot water for too long, squatting for a long time, anus rage, alcoholism, eating spicy and irritating food, excessive fatigue and strenuous activities. In addition, high blood pressure patients, hemorrhagic quality patients, bronchitis violent cough are easy to promote hemorrhage. Because of this, hemorrhoid patients should pay full attention to rest after surgery, regulate diet, and try to avoid the above triggers to prevent hemorrhage. 7, how to deal with bleeding after hemorrhoid surgery? Fresh wounds after hemorrhoid surgery are bound to have a repair phase during the growth process. Fresh granulation proliferation, such as defecation friction too much, it may cause a small amount of wound bleeding or toilet paper stained with blood, found in the postoperative period of 7 to 10 days, these conditions, completely normal phenomenon, no need for special treatment. If the patient bleeds a lot, bleeds more than that, and is in shock or semi-shock state, fluid or blood transfusion should be given immediately to rapidly replenish the blood volume and correct the shock, and antibacterial and hemostatic drugs should be given at the same time to control the infection and improve the blood coagulation. At the same time of fluid transfusion, under local anesthesia or sacral anesthesia, remove the blood accumulated in the intestinal lumen. Under anoscopy, find the bleeding point, and use “0” gauge intestinal thread or fine silk thread to pass through the suture to stop bleeding. For those who can’t find the obvious bleeding point, but the bleeding is obvious, can use the airbag to stop the bleeding by compression, or spread thrombin on the trauma, and then fill in the pressure with gelatin sponge. It is best to place an anal tube when anorectal stuffing is used to stop bleeding, which is conducive to exhaustion and also timely detection of rebleeding. For those with high bleeding sites, ice saline with epinephrine can be used as a retention enema. For patients who have gone home, the first do not be nervous, can be escorted to the nearest hospital emergency room, never pay attention to the patient should not be transported long distances, so as to avoid accidents on the way. 8, hemorrhoid surgery after the wound will not be infected? How to prevent? Although hemorrhoidectomy is performed on a site where a large number of various bacteria are present, surprisingly there are not many complications of postoperative infection. There are hypotheses that liver clearance reduces the entry of rectal flora into the circulation, or that infection is reduced by the fact that the wounds after hemorrhoidal surgery are usually open and drainage is patent plus sitz baths are part of routine postoperative care. However, if the operation does not pay attention to the aseptic operation, or the operation damage to the anal sinus, complication of sinusitis or even inflammation spread along the anal glands, or the patient is old and frail, accompanied by diabetes mellitus, etc., or will cause wound infection. Prevention of postoperative infection, in the operation should strengthen the concept of asepsis, strict aseptic operation; after surgery, after defecation cleaning the anus, timely dressing change; postoperative infection formed abscess, should be timely incision and drainage of pus. For fever, white blood cell increase, local redness, swelling and hot pain, should be timely application of antibiotics, control infection. 9, why hemorrhoid surgery after the local still have “lumps”, even more than before the operation? Local lumps after hemorrhoid surgery is caused by local tissue edema, when the edema subsides the lumps naturally disappear. The causes of local edema after anal surgery are: (1) internal hemorrhoid ligation or injection, resulting in hemorrhoidal static reflux obstacles, or hemorrhoidal core prolapse incarceration, blood reflux obstacles; (2) improper operation, affecting the anal part of the lymphatic blood reflux, resulting in postoperative incision flap edema, inflammation; (3) the day of the postoperative defecation or squatting for too long, anal vein blood stasis, or due to anal pain reflexes caused by sphincter spasms resulting in reflux obstacles. (4) postoperative local infection and inflammation, increased exudation, tissue edema; (5) constipation, fecal matter blockage in the rectum, local compression of the anal vein stasis and edema. 10.Will hemorrhoids recur after surgery? Hemorrhoids are flesh-like tissues that grow in the human body’s excretory opening – the anus, its growth, development, and people’s living habits, work and study environment, walking and tiring, diet and sleep are not unrelated, and thus commonly referred to as “ten people nine hemorrhoids”. In a person’s life, as long as you live a normal life, never in the anus does not produce the slightest venous stasis as well as varicose veins, unless the excreta do not pass through the anus. Therefore, everyone will have a mild or serious anal disease, the so-called no hemorrhoids, but is symptomless. In view of this, any hemorrhoid surgery can only be to reduce or make the symptoms disappear, the local tissue as far as possible to restore the original state or pathological changes completely disappeared, can never therefore make the anorectal part of the venous blood vessels are no longer stagnant, varicose into the venous blood vessels, and does not lead to hemorrhoids. From this, hemorrhoids recurrence is certain, but there is a difference between light and heavy, the length of time, the so-called “cure hemorrhoids” reference is not appropriate. 11, hemorrhoid patients after surgery for anal function exercise what is the significance? How to carry out? The recurrence rate of hemorrhoids after surgery is very high, and actively carrying out anal function exercise can help reduce the recurrence after surgery. Because the normal physiological role of the anus, mainly in the contraction and expansion of the anus, hemorrhoid patients after surgery, the anal sphincter more than different degrees of damage, at this time, effective anal function exercise, can improve local blood circulation, reduce hemorrhoidal venous stasis and expansion, enhance the contraction and diastolic capacity of the anal sphincter, increase the anorectal part of the resistance to disease, to avoid and reduce the recurrence of hemorrhoids. For patients with incomplete anal incontinence, anal function exercise is particularly important. The methods of anal function exercise, there are mainly the following kinds: (1) anal exercise: the patient contracted the anus for 5 seconds by himself, and then stretched for 5 seconds, so continue to carry on for 5 minutes, once a day. (2) Anal lifting exercise: it means to consciously collect and lift the anus upward with the idea, 1 to 2 times a day, 30 times each time. (3) Anal contraction exercise: before defecation, in defecation and after defecation during this period of time, with about 5 minutes of time, active contraction and diastole anal sphincter, can play a role in improving local blood circulation, enhance the ability of anal sphincter. (4) expanding the anus health care exercise: with the right index finger coated with a small amount of lubricating effect of hemorrhoid ointment or antibiotic ointment, first in the anus at the massage for 1 minute to 2 minutes, and then slowly into the anal canal, the general depth of the two knuckles, the front left after the right four directions to expand the anus, about 3 minutes, after the index finger can be pulled out of the anus can be coated with a very small amount of hemorrhoid ointment can be, once a day, adhere to the half a month to 1 month.