Circumferential mixed hemorrhoids is the most common and serious hemorrhoidal disease in the clinic, external stripping and internal ligation is still the main surgical treatment of circumferential mixed hemorrhoids, easy to produce a long postoperative course, postoperative anal pain, anal edema and other complications, in order to reduce the complications, the authors have been using external stripping and internal ligation plus internal sphincter partially cut off the circumferential mixed hemorrhoids since 2006 to treat circumferential mixed hemorrhoids to get a certain degree of efficacy, is now reported as follows. 1, data and methods 1.1 general information: in accordance with the diagnostic criteria formulated by the anal and intestinal surgery group of the Chinese medical association of surgery in April 2000, 180 cases of annular mixed hemorrhoids were included in the hospitalized patients, randomly divided into two groups, 90 cases in the treatment group, of which 48 cases were male and 42 cases were female, the age of 25-70 years old, the duration of the disease is 5-35 years old, of which 52 cases were accompanied by ingrown hemorrhoids. In the control group, there were 90 cases, including 49 males and 41 females, aged 25-70 years old, with a disease duration of 5-35 years, including 51 cases with inlay. There was no statistically significant difference in the general information of patients in the two groups (P>0.05).1.2 Exclusion criteria Both groups of cases were excluded from the cases of old age and infirmity, anal sphincter relaxation, anorectal other neoplastic diseases and anorectal prolapse cases. 1.3 Treatment methods 1.3.1 preoperative preparation constipation patients are served with the hospital preparation Qingning capsule regulating stool to normal; with embedded edema first given anti-inflammatory, the hospital preparation Niboran sitz baths, external application of the hospital preparation Sanyuang cream, to be embedded in the reduction of edema before surgery. 1.3.2 Anesthesia: Sacral anesthesia or saddle anesthesia, or local infiltration anesthesia were used in both groups. 1.3.3 Surgical methods The treatment group used external peeling and internal ligation[2] plus internal sphincterotomy. After successful anesthesia, patients take the right or left lateral position, routine iodine-vodine disinfection spreading towel, intra-anal disinfection, expanding the anus to relax the anus, fully exposing the lesion site, you can see the natural demarcation of hemorrhoidal nuclei in the internal hemorrhoidal area, find out the number of hemorrhoidal nuclei and their distribution, design the segmentation plan and location, and according to the number of hemorrhoidal nuclei, the group is handled. Internal and external hemorrhoid area each clamp a tissue clamp, pull up the skin, mucous membrane, in the external hemorrhoid on both sides of the skin as a “V” shaped incision, the hemorrhoidal nucleus from the sphincter muscle at the stripping to the dentate line on the 0.2 ~ 0.3cm, clamp on the dentate line on the hemorrhoidal nucleus of the part of the basal part of the hemorrhoidal nucleus, clamp the bottom of the 8 zig-zag suture, after the excision of hemorrhoidal nucleus residual end of the reinforcement of the ligation a. The same way to deal with the rest of the hemorrhoidal nucleus. The same method to deal with the rest of the hemorrhoids, but ligation of hemorrhoids as far as possible not in the same horizontal line. At the same time, the choice of lateral internal sphincterotomy, generally choose in the lateral 9 points or 3 points. If it is cut posteriorly, postoperative anal effusion is likely to occur. If the sphincter is cut anteriorly, the sphincter function will be reduced and anal incontinence will easily occur after the operation. Methods: Firstly, press the lateral side of the anal canal with fingers to confirm the intermuscular groove of the internal sphincter of the anus, at this time, you can feel the ring-like outline of the internal sphincter, start with the resected internal hemorrhoids, and carefully peel off the subcutis of the anal canal between the sphincter and the internal sphincter with hemostatic forceps to show the whitish internal sphincter fibers, and then clamp the internal sphincter from bottom to top by using two small forceps, and then cut the internal sphincter between two forceps to reach the level of the dentate line upward for about 1/2. The anal canal was well stretched to accommodate two fingers, and the incision was not sutured. In the control group, the patients were operated according to the above traditional external peeling and internal ligature without lateral internal sphincterotomy. 1.3.4 Postoperative treatment After the operation, patients of both groups were treated with our preparation Nibosan sitz bath after defecation, and our preparation Yuhong ointment was used to change the medication once a day, from the third day of the operation onwards, one Sanshuang suppository of our preparation was routinely inserted into the patient’s body every day, and static antibiotics (sodium cefotaxime) were used to treat the patient for 4 days. 1.4 Efficacy standard Cure: Normal bowel movement, no blood in the stool and no pain, disappearance of hemorrhoids on anal examination, healing of trauma surface, and normal anogenital function. The function of anus is normal. Improvement: normal bowel movement, no bleeding and prolapse, or feeling mild anal discomfort, anal examination shows that there are still a few mild internal or external hemorrhoids. Ineffective: the condition is basically the same as before, there is no obvious improvement in symptoms, and the anal examination is basically the same as before the operation. 2.Results 2.1 Treatment results 180 patients treated with two surgical methods of external stripping and internal ligation plus internal sphincterotomy (treatment group) and traditional external stripping and internal ligation (control group) were cured, and there was no difference between the two groups. 2.2 Observation of postoperative trauma healing time, postoperative pain degree, edema degree, recovery days 2.2.1 Observation of trauma healing time of the two groups was statistically analyzed using SPSS11.5, and the results are shown in Table 1. Groups Trauma healing time (t/d) Treatment group (n=90) 19.68±3.38 Control group (n=90) 25.15±2.30 Table 1 Trauma healing time of the two groups Comparison ( ± s), p < 0.05 2.2.2 Postoperative pain and edema Observation standards were all referred to the unified standards formulated by the 1975 National Anal and Intestinal Academic Conference. ①pain Ⅰ °: slight anal pain, do not need to deal with; Ⅱ °: anal pain, no obvious pain expression, can be relieved by taking general painkillers; Ⅲ °: anal pain is heavier, there is a painful expression, need to use pethidine (dulcolax) class of drugs to stop pain; ② edema Ⅰ °: local mild edema, does not affect the activities; Ⅱ °: local obvious edema, activities are impeded. SPSS11.5 was used for statistical analysis.