Major Innovations in Mixed Hemorrhoid Surgery
1. Suprahemorrhoidal mucosal circumcision, also known as PPH surgery. The theory is based on the new understanding of the pathogenesis of hemorrhoids, PPH surgery is to use a special instrument called “PPH anastomosis” to make a circular excision of the prolapsed rectal mucosa above the hemorrhoids, and the whole procedure only takes about 20 minutes. The procedure takes only about 20 minutes. Since the rectal mucosa above the dentate line is innervated by the visceral nerves, the patient hardly feels any pain after the surgery; and since the surgery not only removes the prolapsed rectal mucosa, but also blocks the terminal anastomotic branch of the terminal rectal artery, eliminating the root cause of the hemorrhoids, the results are more ideal. PPH surgery also has good effect on some hemorrhoids that are very difficult to treat with traditional therapy, such as mixed hemorrhoids, ring hemorrhoids, severe hemorrhoid prolapse, prolapse, etc.
2.Parkes, is submucosal hemorrhoidectomy, this procedure does not damage the overlying squamous epithelium and columnar epithelium, the wound heals better, rarely forms hard scar and stenosis, and significantly reduces postoperative pain and difficulty in urination.
3, injection therapy, the purpose of injection therapy is to inject sclerosing agents into the hemorrhoids around the block, producing a sterile inflammatory response, to achieve small vessel occlusion and hemorrhoids within the block of fiber hyperplasia, sclerosis and atrophy. Commonly used sclerosing agents are elimination of hemorrhoids injection, peony times injection. Injection therapy has been proven through more than 100 years of clinical practice to have no insidious damage to the human body, and has become a world-recognized therapy. The internal hemorrhoids with no complications can be treated with injection therapy. The first-stage internal hemorrhoids, complaining of blood in the stool without prolapse, are most suitable for injection therapy, which can stop bleeding with a single injection for controlling bleeding. The second and third stage internal hemorrhoids can be injected to prevent or reduce prolapse, and the hemorrhoids can still be injected after re-bleeding or prolapse after surgery. For the old and weak, serious hypertension, patients with heart, liver, kidney and other diseases, are available for injection therapy.
The principle is to put a small rubber ring into the root of the internal hemorrhoid through an instrument, and use the strong elasticity of the ring to block the blood flow of the internal hemorrhoid, so that the hemorrhoid will be cured by ischemia, necrosis and fall off. It is suitable for all stages of internal hemorrhoids and the internal hemorrhoid part of mixed hemorrhoids, but stage II and III internal hemorrhoids are the most suitable. It is not suitable for internal hemorrhoids with complications.
5, Chinese medicine treatment, the application of thorny mustard formula lotion sitz bath plus anal plug hemorrhoid suppository, thorny mustard formula composition; thorny mustard, toadstool, horsetail, turbinaria, sumac each 15 grams, wind, honeysuckle, forsythia, bitter ginseng, locust horn each 12 grams, raw Sichuan wu, raw grass wu each 10 grams. It is suitable for patients with all kinds of hemorrhoids.
Innovation of anal fissure treatment
1, conservative treatment, 0.2 nitroglycerin cream for external use, nitroglycerin is a nitric oxide donor, local external application can rapidly reduce the pressure of anal canal, thus increasing anal canal blood perfusion, improving microcirculation and promoting local fissure healing. And it does not damage the anal sphincter, so patients can operate it by themselves, which is very convenient. Nitroglycerin ointment has good therapeutic effect for both acute and chronic anal fissures. 94% of patients’ pain disappeared after the first application, and 84% of patients’ wounds healed within 4 weeks.
2.Surgical treatment, picking out the lower third to half of the internal sphincter and cutting it off under direct vision, is effective.
Innovations in the treatment of perianal abscess and anal fistula
1.Surgical treatment adopts anal saphenous probe to find the inner mouth no longer adopts finding the inner mouth by the outer mouth, high surgical cure rate and one-time eradication, which is the difference between provincial Chinese medicine hospital and other hospitals, and the technology is at the forefront in China.
2, the rectal mucosa closed endoguchi, the external mouth and sinus tract will be removed, with rectal mucosa graft closed endoguchi, less trauma, good healing does not damage the sphincter muscle.
3, there should be fibrin glue to close the internal opening to treat anal fistula, apply antibiotic solution to flush the fistula, make the fistula sterile before injecting fibrin glue, inject fibrin glue antibiotic mixture after removing granulation tissue with a special probe electrocoagulation.
While injecting fibrin glue, finger pressure is applied to the internal orifice, which is covered with Vaseline oil sand strips, and a simple stitch is made to close the internal orifice, or an anteriorly displaced full-thickness rectal wall flap is made, without damaging the anal sphincter and without affecting anal function, with simple operation and no complications.
Innovations in the treatment of rectal prolapse.
1.Injection therapy, method: inject the antihemorrhoid spirit into the submucosa of the rectum or a circle around the rectum, and inject in 4-5 places, 4ml in each place, total 20ml. the injection route can be through the anoscope under direct vision to inject the drug into the submucosa, so that the mucosa and muscle layer adhesion; or through the perianal skin, under the rectal finger diagnosis to do perirectal injection, so that the rectum and the surrounding adhesion fixed.
2, surgical treatment, adults incomplete prolapse or mild complete prolapse, if the sphincter tension is normal or slightly weak, feasible similar to three mother hemorrhoidectomy or glue ring ligature treatment point ligation, also feasible pph treatment.
Treatment of constipation
Constipation refers to a decrease in the number of stools, or difficulty in expulsion, and also refers to the feeling of hard stools or incomplete defecation. There are two types of constipation: organic constipation and functional constipation. Organic constipation can be caused by a variety of organic lesions, such as colon, rectal and anal lesions; malnutrition, systemic failure, endocrine and metabolic diseases, etc. can cause constipation. Functional constipation is mostly caused by functional diseases (such as irritable bowel syndrome), drug abuse and poor diet, bowel movement and lifestyle habits.
[The main manifestations of constipation are reduced stool frequency, prolonged interval, or normal, but the quality of the feces is dry and difficult to discharge; or the quality of the feces is not in, the discharge is not smooth. It may be accompanied by abdominal distension, abdominal pain, loss of appetite, warmth and regurgitation. A fecal mass or a spastic intestinal pattern can often be found in the left lower abdomen.
[Diagnosis>Diagnosis is generally confirmed by history and symptoms. Supplemented by routine stool examination, gastrointestinal X-ray, intestinal endoscopy, etc., it can clarify whether it is functional constipation or organic constipation.
[Treatment >
1, Western medicine treatment: some of these drugs should not be taken for a long time, it is best to choose to use under the guidance of a doctor.
(1) moistening agent: sodium octobutyl iodate, oral, 50-200mg daily. used in hard stools, defecation, rectal disorders and post-operative patients.
(2) Slippery agent: paraffin oil, 15-30ml taken at bedtime, applied to dry stools due to anal disorders.
(3) Stimulant laxative: phenolphthalein, 0.1-0.2g/time. Castor oil, 10-30ml/time.
(4) volume laxative: magnesium sulfate: 10-20g per time. suitable for stomach acid and constipation. 60% lactulose: 10-30ml / time, 3 times / day, suitable for liver coma and constipation.
(5) Suppositories and enemas: open cork, 1 each time, insert into the anus and squeeze the liquid into the rectum. Warm saline 2000~3000ml, warm 500~1000ml, soapy water (75ml plus water to 1000m1) enema. 1830
2.Chinese medicine treatment
(1) heat constipation: dry stool, short red urine, red face and heart, or body heat, dry mouth and bad breath, abdominal distension or pain, red tongue with yellow coating or yellow dryness, smooth pulse. Treatment: Clearing heat and moistening dryness to clear the stool. Remedies: 15 grams of hemp, 10 grams of peony, 10 grams of hedgehog, 10 grams of rhubarb, 10 grams of thick park, 10 grams of almond.
(2) Qi constipation: difficulty in defecation, dry or non-dry stools, with frequent warmth, chest fullness, distension and pain in the abdomen, white tongue coating and string pulse. Treatment: Smooth the Qi and move stagnation. Herbs: 6 grams each of sinkiang, muxiang and rhubarb, 9 grams each of solid, betel nut and ocimum sanctum. Chinese patent medicine: open chest and smooth qi pill.
(3) Qi deficiency: constipation but not knotted, although there is the intention to stool, the toilet to struggle weak, struggle is sweating shortness of breath, accompanied by fatigue and weakness, limbs tired and lazy speech, light tongue albino, weak pulse. Treatment: Benefit Qi, moisten the bowels and open the bowels. Remedy: Astragalus membranaceus 30g, Atractylodes macrocephala 30g, Pericarpium Citri Reticulatae 10g, Fructus Heterophyllus 10g, White honey 20g, Qi deficiency is obvious with the addition of Radix et Rhizoma Ginseng 10g. Chinese patent medicine: tonifying Zhong Yi Qi pill.
(4) Blood deficiency: dry stools, dull complexion, dizziness, palpitations and forgetfulness, pale lips and tongue, thin and astringent pulse. Treatment: Nourish Blood, moisten dryness, and promote laxity. Herbs: Radix Angelicae Sinensis 15g, Radix Rehmanniae Sinensis 15g, Rhizoma Ma Ren 15g, Citrus Aurantium 10g, Herba Cistanches 12g, Rhizoma Rheum 6g. Chinese herbal medicine: laxative pill.
(5) Yin deficiency: dry stools like goat stool, accompanied by thinning of the body, mouth with desire to drink, or palpitations, red cheek, insomnia, dizziness, soreness and weakness of the waist and knees, red tongue with little alveolus, thin pulse. Treatment: Nourishing Yin and moistening the intestines. Remedy: Xuan Shen 10 grams, Mai Dong 15 grams, Sheng Di 24 grams, Yam 20 grams, Cornus officinalis 12 grams, Dan Pi 9 grams, Poria 9 grams, Ze Di 9 grams, Ma Ren 10 grams, Yu Zhu 10 grams, cassia seed 12 grams, honey 30 grams (punch).
3, surgical treatment, constipation surgery generally refers to the most common clinical, various causes of exit obstruction type bowel difficulties.
As long as the patient complains that the stool to the anal opening is not out, and through the fecal imaging and other professional examination to be confirmed, both for the cause of constipation surgery treatment. In the implementation of surgical treatment of constipation, it must be noted that the causes of outlet obstruction type constipation are complex, at least the following causes are recognized: rectocele (rectocele, RC) is the translation of rectal bulge, that is, the protrusion of the anterior wall of the rectum, also known as anterior rectal bulge. It is one of the exit obstruction syndromes. The patient has a weak rectovaginal septum with the rectal wall protruding into the vagina, which is also one of the main factors of defecation difficulties.
This disease is mostly seen in middle-aged and elderly women, but in recent years the onset of male patients has also been reported. The domestic medical community has proposed anterior rectal protrusion defecography, which can be divided into three degrees: namely, mild, with anterior protrusion depth of 0.6 to 1.5 cm; moderate, 1.6 to 3 cm, and severe ≥ 3.1 c), intra-rectal mucosal prolapse, perineal descent syndrome, puborectalis syndrome, internal sphincter dystocia, external sphincter dystocia syndrome, and pelvic floor hernia. Factors of the perianorectal sphincter are the initiating factors of outlet obstruction type constipation and play a dominant role throughout the course of the disease, while other factors may also play a secondary role in the symptoms of difficult defecation to varying degrees. The aim of surgical treatment of constipation is to completely resolve the main contradiction of perianal sphincter relaxation, and to achieve the goal of treatment through comprehensive treatment of rectal protrusion, rectal mucosal prolapse, and many other factors related to local inflammation. The basic surgical methods of comprehensive surgery include: partial dissection and release of the internal sphincter and puborectalis muscle; high point injection of the rectal mucosa; suture reinforcement of the anterior rectal protrusion; and double injection of the internal and external rectum. Our department can now perform comprehensive surgeries such as rectal mucosal punctal injection, external rectal injection, and anterior rectal protrusion repair and reinforcement to remove the causes of defecation difficulties to the maximum extent possible, and the surgeries are minimally invasive, safe, reliable, and have few complications. For slow transmission type defecation disorders, i.e. defecation difficulties caused by poor peristaltic function of the large intestine, considering that the surgical treatment of such defecation difficulties is more traumatic, the more mature and effective surgical methods are: total colectomy or subtotal colectomy.
[Prevention and recuperation>
1.Establish good dietary habits, make reasonable dietary habits, and properly consume vegetables containing more fiber
2.Establish good bowel habits and have regular bowel movements.