Intramucosal prolapse of the rectum is the proximal rectal mucosa and submucosa folded into the distal intestinal lumen or anal canal during defecation, not exceeding the outer edge of the anus, and persisting after fecal discharge, accompanied by defecation obstruction, with a predominance of females, and is a common clinical type of outlet-obstructive constipation, which is treated with many methods, but with widely varying results and many complications. For this kind of patients, we take non-surgical treatment for 6 months, and for those who have no obvious relief, we take surgical treatment, in order to seek a method with less pain and clear efficacy, we use rectal mucosa transverse suture combined with elimination injection, and we have achieved satisfactory efficacy. 1, data and methods 1.1 Clinical data In 2011-2014, we admitted 62 patients with rectal intramucosal prolapse, all of them met the diagnostic criteria of rectal intramucosal prolapse, including 2 men and 60 women, aged 32-65 years old, average age 48.5 years old, with a history of constipation of 1.5-12 years, and all of the patients’ anal fingerprinting could be detected with a sense of fullness of the accumulation of the intramucosa in the rectum, with no occupying manifestations, and defecation The angiogram showed that the depth of the trochlea was 16mm, IRIII.III degree. The 62 patients were randomly divided into the treatment group and the control group of 31 cases each, the treatment group performed transverse suture of rectal mucosa combined with elimination injection, and the control group performed PPH alone, the average age of the two groups of patients, the history of constipation and the difference in fecal imaging was not statistically significant (P>0.05), see the following table: 1.2 treatment methods (1) the control group patients took the chest and knee position, routine disinfection and spreading of toweling, hard lumbar joint anesthesia, anorectal diagnostics, and the treatment group was divided into the control group of 31 cases each, the treatment group was divided into the control group of 31 cases each. After knowing that there is no space-occupying lesion in the rectum, slowly dilate the anus to accommodate 4 fingers for 5min, disinfect the anorectum again, at about 87.5px above the dentate line, use 3-0 microchord to enter the needle at 3 and 9 points, make double purse-string suture in the submucosa, with the two purse-string spacing of 0.5-25px or so, draw out the lead line at 3,9 points, and place the nail holder on top of the purse-string suture line, tighten the purse-string and tie the knot, and use a banding device to pull out the tail end of the purse-string from the rectum. The end of the purse-string was pulled out of the anastomosis side hole with the banding device, and the broken end of the purse-string was clamped by the hemostatic forceps, maintaining a certain tension, confirming that the resected mucosa had already entered the anastomotic trocar end, and then the anastomosis was struck off, keeping the closure for more than 30 s. The anastomosis was loosened and withdrawn. After the anastomosis was relaxed and withdrawn, the integrity of the resected mucosa was checked, and the anastomosis was checked to see if there was any active bleeding, and if there was bleeding, the anastomosis could be closed with absorbable suture line with a figure of eight. After complete hemostasis, a drain was placed in the anal canal and a pressure dressing was applied. (2) Treatment group Half an hour preoperative enema to clean the intestinal tract. Patients take the chest and knee position, routine disinfection and spreading of towels, perianal local anesthesia, relaxation of anal sphincter, routine expansion of the anus four fingers to keep 5min, connected to the cold light source of the long anoscope into the anal canal to the upper end of the rectum, up to the junction of the straight B, and then again disinfection of the rectal lumen, the visible mucosa of the rectum to the upper to the lower part of the several half-annular folds elevated to the mucous membrane of the rectal anterior wall elevated for the first in the innermost end of the first half-annular fold elevation out of the middle with the Tissue forceps to pick up, needle holder clamp through the introduction of No. 10 Mousseline straight round needle against the base of the rectum vertical through the folds, and then a long needle holder in the upper edge of the folds clamped straight round needle along the rectal lumen through the inverted down the intestinal lumen, pulling the No. 10 line at the ends of the knot, the thread pusher pushed the knot section to the mucosa to tighten the ligature, and repeated ligature. The knot was then closed and ligated sequentially at 12.5px intervals on both sides of the knot, with 3-4 sutures in each half-loop of mucosa. The anoscopy was retracted in turn, and the next crease was sutured in the same way until 100px above the dentate line, and an inverted triangular three-point suture was performed at the anterior wall of the lower rectum to strengthen the weak spot of the anterior wall of the rectum. All the sutures are about 20 stitches. After the completion of the suture, the rectal cavity was sterilized again, and the mucosa between the base of the suture and the suture money was injected with 1:1 anorectal injection in order, about 20 ml of anorectal injection was injected, after the injection was completed, the anoscope was massaged back and forth into the rectal mucosa, so as to facilitate the uniform absorption of anorectal injection. After the operation, the intestinal lumen was checked for bleeding, and after there was no bleeding, the anal tube was built-in drainage tube and filled and bandaged. The two groups of patients were given a semi-liquid diet after the operation, intravenous antibiotics and hemostatic drugs for 7d, the next day routine dressing change, after defecation, the anus was cleaned with homemade thorn wash in a sitz bath, and the anus was plugged with anal tamponade suppositories. 1.3 Observation and evaluation indexes Observe and record the patients’ operation (operation time, intraoperative bleeding, postoperative pain, hospitalization time). Follow-up record the patients’ defecation situation at the 1st time, 1 week, 1 month and 3 months after operation, and observe the complications. 1.4 Criteria for determining the efficacy Cure: the rectal mucosa returns to normal, the bowel movement is smooth, there is no sense of obstruction during defecation, there is no drop after defecation, there is no accumulation of rectal mucosa on palpation, and the intestinal lumen is empty. Improvement: the bowel movement is still smooth, with occasional feeling of incompletion after defecation, occasional falling discomfort after defecation, and partial accumulation of rectal mucosa on palpation. Ineffective: no obvious change from before treatment. 1.5 Evaluation method After treatment, patients start to evaluate and record from the first defecation (generally 1d after operation), mainly record whether defecation is smooth, whether there is a sense of obstruction during defecation, whether there is a feeling of falling in the perianal area after defecation, whether there is a sense of fullness of mucous membrane accumulation in the rectum of the anus finger, and then evaluate the effect of the treatment according to the clinical manifestations and examination results, and record the contents. Record the defecation situation from the first day after the operation, and follow up once each in the 1st month, 3rd month, 6th month and 1 year, adopting the method of combining telephone interview and outpatient reexamination, the contents include defecation situation, fingering situation, length of time of defecation, and whether there are any complications. 2.1 Comparison of the surgical conditions of patients in the two groups Intraoperative bleeding, postoperative pain, and hospitalization time, postoperative complications in the treatment group were better than those in the control group, and the difference was statistically significant. 2.2 Comparison of the near- and long-term effects of the two groups of patients was obtained through the hospitalization and post-discharge telephone follow-up, and the patients defecated at different times. significance (P>0.05), the difference between the two groups of patients defecation at 3 months after surgery is statistically significant 2.3 Postoperative complications, the control group has 2 patients bleeding within 24 hours, after timely treatment and then stop the bleeding, there are 5 patients with postoperative perianal sagging sensation is obvious, there are 3 patients with rectal mucosal prolapse recurrence in 3 months postoperative rechecking, defecation difficulty is not relieved, 5 patients with anal canal stenosis situation, the treatment group has no obvious Complications in the treatment group, the rest of the patients had no obvious pain, urinary retention and other complications,. 3, Discussion Rectal mucosal prolapse is mostly caused by the decline of the organs of the elderly, women have too many children, kidney deficiency and loss of regeneration, and the sinking of the middle qi leads to the deficiency of the large intestine, which is piled up on the anus, and the difficulty of defecation, which shows that the deficiency of the middle qi plays an extremely important role in the pathogenesis of the rectal mucosal prolapse, so the “Internal Path” “deficiency can be replenished”, “astringency can be fixed off”. Therefore, the internal path “deficiency is supplemented” and “astringency can fix the prolapse” as the treatment principle. The components of the elimination of the main alum, five times, has a strong astringent, hemostatic, protein coagulation, bacteriostatic effect, injected into the rectal submucosa can produce aseptic inflammation, causing local tissue fibrosis, so that the relaxation of the rectal mucosa and the muscular layer of the adhesion of the fixed, and no longer move, to achieve the purpose of the injection of the fixation of the purpose of the elimination of the. There is a certain period of time for the effect of elimination, so the transverse suture fixation in the flaccid rectal mucosa along the mucosa plays the role of steel skeleton in the construction, and the injection of elimination plays the role of concrete, and the two add up to completely fix the rectal mucosa, so that the mucosa will no longer be flaccid and move downward, and be more secure. The key point of injection is to operate aseptically, sterilization should be strict, injection under direct vision, injection should be in the innermost end of the injection, respectively, injection of the base of the ligature line and the mucosa between the adjacent ligature line, each point of the injection of 0.5 ml or so, in order to mucosal elevation of the appearance of the red stripe is appropriate, the injection should be uniform, the injection should not be too shallow, too deep, do not inject into the rectal muscularis propria, not to penetrate the lumen of the intestinal cavity, generally a total of 20 ml or so of the injection. 20ml or so. This method has the advantages of safety, simple operation, clear efficacy, no obvious complications, low cost, relative to the grassroots hospitals, patients with limited economic capacity, which reduces the cost of treatment for patients, but also clear therapeutic effect, no need to fast before and after the operation, the second day of the operation can be defecated, can be completed under local anesthesia, but also to avoid the anal canal stenosis caused by the PPH operation, according to the operator’s experience, the anesthesia in the operation Adequate, the anal sphincter to be completely relaxed, the correct choice of transverse suture site, generally in the straight B junction of the first half ring fold began, each fold suture 3-4 stitches, to avoid ring suture on the same plane. Suturing to 3cm above the dentate line is sufficient.