Hemorrhoids 】 1. Blood in stool: painless intermittent fresh blood after stool is its characteristic, and is also a common symptom in the early stage of internal hemorrhoids. In the light case, it is mostly blood on the surface of the stool, followed by blood dripping, and in the heavy case, it is jet-like bleeding. The blood in the stool often stops on its own, which is important for diagnosis. The first thing you need to do is to get a good deal of money to pay for it. 2. Prolapsed hemorrhoidal nucleus: This is often a late symptom, and most people have blood in their stools first, followed by prolapse. The light one is only prolapsed during defecation, and can return by itself after defecation, the heavy one needs to be pushed back by hand, and the more serious one is prolapsed out of the anus with a little abdominal pressure. 3. pain: simple internal hemorrhoids without pain. When the internal hemorrhoids or mixed hemorrhoids prolapse embedded, embolism and edema, infection, necrosis, thrombosed external hemorrhoids, connective tissue external hemorrhoid infection, there are different degrees of pain. 4. itching: advanced internal hemorrhoids, prolapsed hemorrhoids, connective tissue external hemorrhoids, etc., perianal often have itching discomfort, and even skin eczema, the patient is extremely difficult. Physical examination 】 1. anal diagnosis: in addition to the first stage of internal hemorrhoids, the other three stages of internal hemorrhoids and external hemorrhoids can be seen under the anal diagnosis. For those who have prolapse, you can clearly see the size and number of hemorrhoids and their location after squatting and defecating. Especially when the diagnosis of ring hemorrhoids is more meaningful. 2. Rectal fingerprinting: the main purpose of fingerprinting is to understand the rectum with or without other lesions, especially to except rectal cancer and polyps. Internal hemorrhoids without thrombosis or fibrosis is not easy to find out. 3. anoscopy: first observe the rectal mucosa with or without congestion, edema, ulcers and swollen choices, to exclude other rectal disorders, and then observe the dentate line with or without hemorrhoids, if there is, the hemorrhoids can be seen to the anoscopy protruding, dark red nodules, this time, should pay attention to its number, size and location. Auxiliary examination 】 1. Routine examination before surgery. 2. 2. General examination. Diagnosis 】 According to the history and anorectal examination, the diagnosis of hemorrhoids can be clear. According to the different parts of the hemorrhoids, they are divided into the following three categories: 1. Internal hemorrhoids: located above the dentate line, the surface is covered by mucous membrane and formed by the internal hemorrhoidal venous plexus. Commonly found in the left side of the middle, right anterior and right posterior three places. There is often a history of blood in the stool and prolapse. Internal hemorrhoids are divided into four stages. Stage I: no obvious conscious symptoms, only in defecation with blood, drip blood or blood spray phenomenon, bleeding more. No hemorrhoidal mass prolapses out of the anus. In anoscopy, the rectal column is enlarged in the dentate line and appears as a nodular protrusion. Stage 2: Intermittent blood, dripping or spurting during defecation with moderate bleeding. The hemorrhoidal mass prolapses out of the anus during defecation and retracts on its own after defecation. Stage III: Hemorrhoids prolapse during defecation, or after exertion, walking too long, coughing. Internal hemorrhoids can not be self-retracted after prolapse, and must be held in by hand, or can be retracted only after bed rest. Bleeding less. The fourth stage: hemorrhoidal mass is outside the anus for a long time, can not be retracted or retracted and then immediately prolapsed. The development of hemorrhoids to the latter three stages into mixed hemorrhoids. 2. external hemorrhoids: located below the tooth line, the surface is covered by the skin, formed by the external hemorrhoidal venous plexus. Commonly, there are thrombosed external hemorrhoids, connective tissue external hemorrhoids (dermal drooping), varicose external hemorrhoids and inflammatory external hemorrhoids. 3. Mixed hemorrhoids: in the vicinity of the toothed line, for the skin and mucous membrane junction tissue cover, by the internal hemorrhoidal veins and external hemorrhoidal venous plexus each other anastomosis between the veins of the formation of the two characteristics of the internal hemorrhoids and external hemorrhoids. Differential Diagnosis 】 1. Rectal Cancer: Rectal cancer is often misdiagnosed as hemorrhoids in clinical practice, delaying treatment, the main reason for misdiagnosis is the lack of rectal diagnosis and anoscopy. Therefore, in the diagnosis of hemorrhoids, it is necessary to do the above two examinations. Rectal cancer is an uneven mass or an ulcer with elevated edges, which is brittle and easy to bleed. 2. Rectal polyp: low rectal polyp with tibia if prolapse out of anus, sometimes misdiagnosed as hemorrhoidal prolapse, but the patients are mostly seen in children, the polyp is round, substantial, with tibia, and large mobility. 3. Anorectal prolapse: sometimes misdiagnosed as annular hemorrhoids, but rectal prolapse mucosa was ring-shaped, smooth surface, sphincter relaxation; the latter mucosa was plum petal-like, sphincter is not relaxed. Principle of treatment 】 The treatment of hemorrhoids focuses on reducing or eliminating its main symptoms, rather than hemorrhoidectomy. Therefore, relieve the symptoms of hemorrhoids than the size of hemorrhoids is more meaningful, and is regarded as the standard of treatment effect. 1. Asymptomatic hemorrhoids do not need treatment, only need to pay attention to diet, keep bowel movement, keep the perineum clean, and prevent the occurrence of complications. Only complications such as bleeding, prolapse, thrombosis and incarceration require treatment. 2. The purpose of various non-surgical treatments for internal hemorrhoids is to promote the occlusion of hemorrhoidal veins and fibrosis of the peripheral tissues of hemorrhoids, fix the prolapsed anorectal mucosa in the muscular layer of the rectal wall in order to fix the loose anal cushion so as to achieve the purpose of hemostasis and prevention of prolapse. 3. Surgery is only considered when conservative treatment fails or when the connective tissue supporting the periphery of stage three or four internal hemorrhoids is extensively destroyed, thrombosed external hemorrhoids, and connective tissue external hemorrhoid infections. There are many hemorrhoid treatment methods that can be chosen according to the condition. 1. Conservative treatment: (1) internal medicine; (2) suppositories; (3) fumigation; (4) external medicine; (5) anal dilation therapy. 2. Surgical treatment: (1) withered hemorrhoid method: indications: all stages of internal hemorrhoidal nuclei and mixed hemorrhoids of the internal hemorrhoidal part. Contraindications: a variety of acute diseases, severe chronic diseases, acute inflammation of anorectal, diarrhea, dysentery, bleeding; (2) injection method: indications: no complications of internal hemorrhoids, can be used injection therapy. A stage of internal hemorrhoids, complaining of blood in the stool without prolapse, the most suitable for injection therapy, to control bleeding effect is obvious. The second and third stage of internal hemorrhoids can be injected to prevent or reduce prolapse, hemorrhoidal surgery after bleeding or prolapse can also be injected. For the old and frail, severe hypertension, heart, liver, kidney and other diseases, can be considered with injection treatment. Contraindications: any external hemorrhoids and internal hemorrhoids with complications (such as embolism, infection or ulceration, etc.) are not suitable for injection treatment; (3) ligation method: indications: all stages of internal hemorrhoidal nuclei and mixed hemorrhoids of the internal hemorrhoid part. Contraindications: all kinds of acute diseases, severe chronic diseases, acute inflammation of anorectum, complications of internal hemorrhoids (such as embolism, infection or ulceration, etc.), diarrhea, dysentery, bleeding; (4) ligation: indications: all stages of internal hemorrhoidal nucleus and mixed hemorrhoids of internal hemorrhoidal part. Contraindications: all kinds of acute diseases, severe chronic diseases, acute inflammation of anorectum, internal hemorrhoids with complications (such as embolism, infection or ulceration, etc.), diarrhea, dysentery, bleeding; (5) excision method: indications: for the second, third, fourth stage of the internal hemorrhoids, in particular, external hemorrhoids and hemorrhoids, mainly mixed hemorrhoids. Contraindications: all kinds of acute diseases, severe chronic diseases, acute inflammation of anorectal, diarrhea, dysentery, bleeding; (6) freezing method; (7) laser excision method. Therapeutic efficacy standards 】 1. Cure: after treatment, symptoms, signs disappear, no complications. 2. 2. Improvement: after treatment, symptoms and signs improve. 3. 3. Uncured: without treatment, symptoms, signs and symptoms do not improve. Discharge Criteria 】 】 Clinically cured or improved and stabilized.