Hemorrhoids are the most common disease in our anorectology department (three common diseases in anorectology: hemorrhoids, fistulas and fissures), and as the saying goes, “nine out of ten people have hemorrhoids”, which indicates the high incidence of hemorrhoids in the population. According to Thomson’s new theory, the modern concept of hemorrhoids was unanimously established at the 9th Colorectal Surgery Symposium held in Kölnberg, Germany in 1984, after a symposium on hemorrhoids in the UK in 1977, the American, British and Australian Society of Anal Surgery in 1979, and finally in 1984: the anal cushion is the normal anatomical structure of the anal canal, regardless of age, sex and race. Only when the anal cushion tissue is pathologically altered, displaced and combined with bleeding, prolapse, pain and other symptoms, it is called a disease, namely hemorrhoid disease (hemonhoideldisease). The principle of surgical treatment for mixed hemorrhoids: internal hemorrhoids: remove the pathologically altered and displaced anal cushion tissue and preserve the normal cushion tissue; external hemorrhoids: peel and remove the subcutaneous tissue in the external hemorrhoid nucleus and preserve as much of the anal epithelium as possible. We adopt the high ligation of mixed hemorrhoids to preserve the anal epithelium and lining, and the indications for the surgery are mainly for mixed hemorrhoids of degree II or above that require surgical treatment. The high ligation with preservation of the anal epithelium and lining is based on the Takano type hemorrhoid curettage with preservation of the anal epithelium and lining by Mr. Masahiro Takano of Japan, which preserves as much anal epithelium and lining as possible and makes high internal hemorrhoid ligation to reduce the trauma, reduce the trauma of the root of the ligated hemorrhoid and the trauma of the dislodged hemorrhoid, reduce trauma bleeding, reflect the principle of minimally invasive surgery, and can minimize postoperative anal swelling and avoid It can minimize postoperative anal swelling and avoid secondary hemorrhage. High ligation of mixed hemorrhoids with preservation of anal epithelium and liner: 1. Anesthesia selection: Generally, local anesthesia (0.66% lidocaine 10-20ml with 2 drops of epinephrine) is used, and lumbar anesthesia with low concentration of ropivacaine is used for circumferential mixed hemorrhoids. 2.Operation method: After satisfactory anesthesia, appropriate anal dilatation, finger diagnosis and anoscopy, comprehensive inspection of the anal situation, according to the size and distribution of the hemorrhoid body reasonable choice of surgical incision, curved forceps lift the base of the external hemorrhoid, radial sharp separation of external hemorrhoid tissue to 0.5-2cm on the tooth line (according to the size of the hemorrhoid nucleus), make a linear incision, peel subcutaneous tissue, as far as possible to retain the flap. A large curved forceps is used to lift and clamp the corresponding part of the internal hemorrhoid, ligate the internal hemorrhoid tissue with a 10-gauge ligature, and cut off the excess hemorrhoid tip. For multiple surgical incisions, care should be taken to preserve the anal skin bridge between the incisions, trim the surgical incisions, stop bleeding with electrocoagulation and, if necessary, No. 1 silk sutures to stop bleeding, methylene blue local seal (5 ml ropivacaine + 5 ml saline + 1 ml methylene blue + 0.5 ml dexamethasone injection + 2 drops of epinephrine using 2 ml, superficially injected in the subdental incision), diclofenac sodium suppository 1 capsule in the anus, gelatin sponge or beprin The incision is filled with collagen sponge and fixed with external pressure bandage, without stuffing the drainage tube. 3, surgical features: 1) external hemorrhoid removal to take the superficial hemorrhoid nucleus rather than the traditional base of the nucleus, into the anal canal excision to the top of the nucleus, save the anal epithelium and lining. (2) Clamp the nucleus at the upper part of the nucleus base, preserving the normal lining without pathological changes, too base is easy to injure the deep large blood vessels leading to bleeding and anal swelling is obvious. 3) Excision to the top of the elevated nucleus, depending on the size of the nucleus, to 0.5-2cm above the dentate line, the root of the ligature becomes smaller and the ligature is tighter, avoiding primary bleeding due to slippage of the ligature; the nucleus is dislodged and the wound is small, avoiding secondary hemorrhage and reducing the probability of occurrence to almost “0 The probability of occurrence is almost reduced to “0”. 4) “Large hemorrhoids into small hemorrhoids”, after removing most of the hemorrhoid nucleus, the remaining hemorrhoid tissue is ligated and then some of the hemorrhoid tips are removed, so that the pressure in the anal canal is reduced and no sclerosing agent is injected into the internal hemorrhoid area, avoiding the retention of too many and too large hemorrhoid tips leading to anal swelling and obvious bowel movements. In this case, the patient followed the principle of minimally invasive surgery, which damaged the skin of the anal canal as little as possible and avoided anal stenosis; the postoperative pain was mild, the trauma was small, and the healing time was about 10 days, reflecting the concept of “minimally invasive” and “painless” anorectal surgery. It solves the problems of postoperative anal pain, anal swelling, anal stenosis, postoperative hemorrhage and urinary retention in traditional surgery, and avoids the embarrassment of “big pain for small diseases”.