The current treatments for mixed hemorrhoids are.
A, conservative treatment: mainly the use of drugs through oral, external, plugging, fumigation methods to achieve the purpose of relieving symptoms.
1, drug external application or anal plug. Usually use drugs that have a protective effect on the mucosa of hemorrhoids, reduce local inflammation, and promote wound healing.
2.Oral medication. Usually use drugs that have the ability to clear heat and cool the blood, laxative and anti-inflammatory to heal the wound.
3.Fumigation. Usually use drugs that clear heat and detoxify the blood, activate blood stasis, astringent and fixed detoxification to fumigate the anus or prolapsed hemorrhoids to prevent edema, impaction and thrombosis of mixed hemorrhoids, suitable for old and frail patients, or combined with other patients such as heart, liver and kidney insufficiency.
Second, surgical treatment (minimally invasive treatment).
1.PPH surgery.
PPH is currently recognized as the “gold standard” for the treatment of mixed hemorrhoids by the World Society of Proctology. The surgery is performed by means of a tubular anastomosis, in which a certain width of mucosa and submucosa of the lower rectum is removed circumferentially above the prolapsed hemorrhoid under the anoscope, while the mucosa is stapled above and below the anastomosis, so that the prolapsed hemorrhoid is suspended and lifted, while the blood supply to the hemorrhoid is cut off, achieving the therapeutic effect of stopping bleeding and preventing the prolapse of the hemorrhoid.
Advantages.
(1) Safety: No need to remove the anal cushion, which preserves the normal function of the anus to the greatest extent and avoids complications such as anal stenosis and anal incontinence.
(2) Minimal pain: Pulling the prolapsed hemorrhoid back to its original position, while cutting off the blood vessels supplying blood to the hemorrhoid, without damaging the perianal skin, so there is almost no pain after the operation.
(3) Small trauma and quick recovery: The anastomotic circumferential excision of the mucosa is a non-open wound with little bleeding, eliminating the need for postoperative medication changes and allowing a quick return to normal life.
(4) Complete preservation of the anal cushion: more in line with human anatomy and physiology, because the operation is performed on top of the hemorrhoids, complete preservation of the anal cushion.
(5) Wide range of treatment: pan-annular hemorrhoids, multivalve hemorrhoids, huge isolated hemorrhoids, internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, ring hemorrhoids, embedded hemorrhoids, rectal mucosal prolapse, prolapse, etc.
(6) Suitable for many people: Because of less damage, it is especially suitable for middle-aged and elderly people, white-collar people who pay attention to efficiency and those who relapse from traditional treatment, and patients with mild prolapse and internal prolapse of rectal mucosa.
2.RPH (automatic hemorrhoid ligation).
Automatic hemorrhoid ligation (RPH) is developed from the traditional ligation therapy of Chinese medicine in the motherland. This method is performed by a specially designed automatic hemorrhoid ligature that is placed at an appropriate location 1.5 to 75px above the dentate line. The ligature is applied to the base of the mucosa on the hemorrhoid or hemorrhoids, blocking the blood supply to the hemorrhoid or reducing venous backflow through the tightening and strangulation of the ligature, reducing congestion and hypertrophy or stagnation of blood flow in the hemorrhoid, causing ischemia, atrophy, and necrosis, and the ligature tissue gradually falls off and the traumatic tissue is repaired and healed.
Advantages.
(1) The whole process of ligation treatment is automated, time-saving, labor-saving, practical and easy.
(2) One person alone can complete the operation, which takes only 5 to 10 minutes.
(3) No anesthesia, no hospitalization, and low price.
(4) The pain is mild and complications are rare.
(5) No scar left after surgery, no damage to the normal structure and appearance of the rectum and anal canal, which brings great convenience to the subsequent treatment.
Disadvantages.
It cannot be used for the treatment of simple external hemorrhoids, the external part of mixed hemorrhoids, anal papillary hypertrophy, and rectal polyps with suspected malignant changes.
Indications.
Internal hemorrhoids of all stages (best results in stages I-III); internal hemorrhoid part of mixed hemorrhoids; RPH can be used as a complementary treatment for those with incomplete retraction of hemorrhoid mass or anal cushion after PPH or other therapies.
Other.
Rectal focal lesions, such as rectal polyps, rectal hemangioma or vascular malformation, etc.
3. Polyglactin injection therapy.
This method has little damage, fast onset of action, few adverse reactions, easy to operate, light pain, quick recovery, no hospitalization, and basically all healing of the hemorrhoid nucleus after 1 injection. It is suitable for all stages of internal hemorrhoids, varicose mixed hemorrhoids and circumferential mixed hemorrhoids.
Contraindications.
(1) Acute onset of hemorrhoidal thrombosis and the subsequent 3-4 weeks. Injection therapy can be applied even after the thrombus has subsided.
(2) Other anal canal diseases that are not suitable for injection therapy, such as anal fissure, anal fistula (anorectal fistula), tumor, etc.
(3) For external hemorrhoids or mixed hemorrhoids mainly external hemorrhoids, injection therapy can easily cause severe pain to the patient by injecting the medicine into the skin. Therefore, injection therapy should not be used for external hemorrhoids and huge internal hemorrhoids with skin overlay.
(4) Patients who have received injection therapy many times, foreign experts in Belgium in 1986 provided Chinese doctors with several patients they thought were very serious, and these patients recovered well under the treatment of injection therapy by Chinese doctors, and this technique won the Eureka Invention Award that year.
4. Doppler hemorrhoidal artery ligation.
The hemorrhoid artery ultrasound Doppler system is an organic system that combines Doppler ultrasound exploration and hemorrhoid artery vascular ligation surgery as an efficient, easy, safe, minimally painful, minimally invasive, and short hospital stay. The system is based on the ultrasound emitted and received by the probe to precisely locate the hemorrhoidal artery, display the depth of the period, and perform arterial ligation treatment on the dentate line through the front true window of the probe, which has the characteristics of precise location, rapid ligation and minimally invasive.
5.TST technique.
Also known as selective suprahemorrhoidal mucosal anastomosis, is a new technology developed on the basis of PPH procedure.TST minimally invasive technique utilizes a specially designed anorectal mirror to form different open-loop windows, using an anastomosis probe, locking the hemorrhoid nucleus, regulating the scope of hemorrhoid mucosa removal for the size and amount of hemorrhoid nucleus, and protecting the normal function of the anus to the maximum extent. It is mainly suitable for patients with stage III and IV hemorrhoids with mainly non-circular prolapse.
Precise positioning.
Using the special anoscope, it can precisely locate the prolapsed mucosa and successfully and safely selectively remove the suprahemorrhoidal mucosa at the prolapsed area, which is in line with the theory of liner downward migration and reduces surgical trauma.
With advantages.
Minimal pain, high safety, and short recovery time. the ST procedure takes relatively short surgical time, less intraoperative bleeding, shorter postoperative recovery time, and a lower incidence of postoperative anal pain and edema.