Mixed hemorrhoids are the most common disease in anorectology, and their specific clinical manifestations include blood in the stool, prolapsed internal hemorrhoids, mucus overflow, pain, etc. In terms of their pathogenesis, there are mainly the varicose veins theory, the vascular proliferation theory, the inflammatory changes theory, and the anal cushion subluxation theory, and each of these theories has its own focus. The formation of hemorrhoids ultimately boils down to “bruising”, with early hemorrhoids being venous stasis, and mid- to late-stage stasis accompanied by a break in the elastic fibers that maintain the normal position of the blood vessels. The main reason for the classification of mixed hemorrhoids is the nature of the part below the dentate line, which is divided into varicose mixed hemorrhoids, connective tissue hyperplasia mixed hemorrhoids, and inflammatory mixed hemorrhoids, but these classifications are not separate, many mixed hemorrhoids have two or three types of mixed hemorrhoids, but only have a focus. The severity of mixed hemorrhoids is divided into 3 stages, stage 1: 1 to 2 hemorrhoids, mainly internal or external hemorrhoids; stage 2: 3 or more hemorrhoids, but the boundaries between the hemorrhoids are clear; stage 3: the boundaries between the hemorrhoids disappear and the hemorrhoids come out of the anus in a ring shape, also known as annular mixed hemorrhoids. The key to surgical treatment of mixed hemorrhoids is how to deal with the contradiction of effectively removing the nucleus while maximizing the protection of anal function, which is especially important for the treatment of cricoid mixed hemorrhoids. The method of peeling and ligating the hemorrhoid nucleus is usually used in conjunction with peony injection, although the demarcation between the nucleus is unclear, the most serious parts of the hemorrhoid are usually still located in the main hemorrhoid area at 3, 7 and 11 points, so the peeling and ligating parts are generally based on these locations, but the actual operation should also be flexible according to the actual situation, after the main hemorrhoid nucleus is ligated and removed, other locations will be further processed In the actual operation, we should also be flexible according to the actual situation, after the main nucleus is ligated and removed, other locations will be further treated. The following are the main points of the specific operation: 1. The surgical incision should be narrow rather than wide and long rather than short, i.e. a long and thin shuttle-shaped incision. The purpose is to reduce the damage to the skin of the anal canal and to prevent the occurrence of anal stenosis; the purpose is to prevent postoperative edema by the usual drainage. 2. The principles of ligation: different locations, different sizes, different planes and different depths. Different locations are for the distribution of hemorrhoids, different sizes are based on the size of hemorrhoids; different planes require the ligature position to be staggered to prevent the ligature position from forming a narrow ring; different depths are mainly based on the degree of anal relaxation, the anal relaxation can be ligated a little deeper, the anal tightness less ligated, but the ligature site should not reach the muscle layer, ligature to the muscle layer can easily lead to painful spasm of the anal sphincter, and the ligature line is easy to bleed. The actual operation of the hemostat ligature site should be able to sway around as appropriate. 3, ligature site should pay attention to the balance of the right ligature, even if the left hemorrhoid nucleus is not very obvious, should also be a small amount of ligature, on the one hand, so that the left and right sides to achieve a balance of force, on the other hand, the anal canal dentate area of the arteriovenous distribution is circular, there are a large number of anastomotic branches, one side of the ligature, the opposite side is not treated, will inevitably lead to compensatory expansion of blood vessels, causing edema. 4, peony. 4, peony times the application of injection points: see hemorrhoids into the needle, back needle to give drugs, first small, then large, full as degree. In order to prevent the injection of the drug into the muscle layer, the needle tip should encounter the feeling of muscular resistance after the needle tip is pierced, and then back off the needle slightly, so that the needle tip can be swayed left and right is appropriate; first small and then large is to prevent the hemorrhoid nucleus from becoming large after the injection of the drug to obscure the field of view, causing the small hemorrhoid nucleus to be missed; fullness is the degree: the hemorrhoid nucleus should be uniformly elevated immediately after the injection, and the surface color becomes slightly lighter, if too deep, the elevation is not If it is too deep, the elevation will not be obvious, such as piercing the blood vessels, the submucosa becomes purple, if it is too shallow, the elevation will be excessive in a very small area.