Internal hemorrhoidectomy

Sputum is a soft venous mass formed by blood stasis, dilatation and flexion of the rectal submucosal and anal canal venous plexus. The cause of sputum is not fully understood. There are varicose veins theory, anal canal stenosis theory and anal canal padding theory, but the latter are more prevalent. Most scholars believe that sputum is a tissue pad located in the anal canal and rectum, called anal vascular pad, referred to as "anal pad", which is an anatomical phenomenon that occurs after birth. When the anal cushion is slack, hypertrophy, hemorrhage or prolapse , that is, the symptoms of convulsions. The anal cushion consists of three parts: 1 vein, or sinus; 2 connective tissue; 3 smooth muscle attached to the muscle wall of the anal canal (also known as Treitz muscle). Connective tissue and smooth muscle constitute the supporting tissue of the sinus. Under normal circumstances, the anal cushion adheres loosely to the muscle wall, and after defecation, it contracts back to the anal canal by its own fiber contraction. When the anal cushion is congested or hypertrophied, it is easily injured and hemorrhage, and can be removed from the anal canal. The degree of congestion of the anal cushion is affected by the pressure of the anal canal (such as constipation, pregnancy, etc.), and also with hormones, biochemical factors and emotions. related. Divided into three categories according to their location: 1 internal hemorrhoids: the surface is covered with mucous membranes, located above the tooth line, formed by the internal iliac vein plexus. Common in the left side of the left, right front and right rear three, called the primary internal hemorrhoids (mother). There are 1 to 4 secondary internal hemorrhoids, often connected with right rear and left middle female. The veins at the right anterior palate are no longer branched, so they often occur in a single occurrence without the concomitant sputum. 2 external hemorrhoids: the surface is covered by the skin, located below the tooth line, formed by the external iliac vein plexus. Common thrombosis external hemorrhoids, connective tissue external hemorrhoids (skin), varicose veins and inflammatory external hemorrhoids. 3 mixed sputum: in the vicinity of the tooth line, covered by the skin mucosal junction tissue, formed by the veins of the internal iliac vein and the external iliac vein plexus. There are two characteristics of guilt and nephew. The guilt is divided into 4 phases. No. 1: no obvious symptoms, only blood, blood or blood spurting occurred during defecation, bleeding more. The block does not come out of the anus. An anoscope examination showed that the rectal column was enlarged on the tooth line and showed nodular protrusion. The second phase: intermittent blood in the stool, blood or blood spurting, moderate bleeding. When the bowel movements come out of the anus, the defecation will be returned. No. 3: During the defecation, the internal hemorrhoids are prolapsed, or after exerting fatigue, walking for too long, and taking out when coughing. After the internal hemorrhoids are released, they cannot be returned by themselves. They must be hand-in or rest in bed before they can return. Less bleeding. No. 4: The sputum block is outside the anus for a long time, and can not be retracted after being returned or returned. The development of the latter three stages into a mixed sputum, due to the larger sputum block, has been involved in the internal and external iliac plexus and the surface is covered by rectal mucosa and anal canal skin. Therefore, mixing is the result of increasing . Treating diseases: guilt Indication 1. The prolapsed mandible is required to be manually removed or often removed from the anus outside the anus (ie, during the third and fourth periods). 2. Intravenous treatment with unsatisfactory results through injection therapy or other non-surgical treatments. 3. When the sputum has polyps, hypertrophy or anal fistula. 4. Mix . Contraindications 1. The internal hemorrhoids are accompanied by complications such as acute infection, ulcer, necrosis or embolism, and the operation is suspended. 2. Secondary internal hemorrhoids, such as portal hypertension and heart failure, must be treated for the primary cause, and should not be performed. 3. It is not advisable to have this operation during pregnancy. Preoperative preparation 1. Less slag diet 1 to 2d. 2. Shaving in the surgical area. 3. The front row is full and urinate. 4. If necessary, enema before surgery. Surgical procedure 1. After anesthesia, use the tissue forceps to clamp the skin of the block and pull it outward to reveal the internal hemorrhoids. Make a V-shaped incision on the skin on both sides of the base of the block. Be careful to cut only the skin and do not cut the venous plexus. 2. Clip the skin, bluntly separate the external iliac vein plexus with a gauze-coated finger, separate upwards along the external iliac venous plexus and the internal sphincter, and cut the mucosa on both sides of the sac block a little, fully revealing the pedicle and inner part of the sac The lower edge of the sphincter. 3. Use the curved vascular clamp to clamp the pedicle of the sacral block, and ligature the pedicle with the 7th thick thread, and then sew together through the suture to prevent the ligation from being stabbed, and finally cut off the sputum. If the block is large, the pedicle of the block can be continuously sutured with a 2-0 chrome gut. The skin incision does not have to be sutured for drainage. 4. Use the same method to remove the other two females. Generally, between the two chopped blocks, a normal mucosa and skin with a width of about 1 cm must be preserved to avoid anal stenosis. The wound is coated with Vaseline gauze. complication Wound bleeding It often occurs within 24 hours after surgery, mostly due to incomplete hemostasis or poor knotting. Secondary secondary bleeding is common 7 to 10 days after surgery, mostly caused by tissue necrosis or suture loss. Early postoperative hemorrhage is often difficult to detect early. Because of the action of the anal sphincter, the blood flows back into the intestine without going to the anus. Therefore, the phenomenon of "staining red dressing" cannot be found clinically. Therefore, this "hidden bleeding" is often not easy to find early. The following phenomena may be the early signs of "hidden bleeding": 1 urgent urgency, paroxysmal bowel and lower abdominal pain; 2 patients with dizziness, nausea, cold sweat and pulse fast and other symptoms of collapse. In the case of the above, the digital rectal examination or microscopic examination should be carried out in time for timely diagnosis and treatment. Hemostasis measures: 1 use airbag compression to stop bleeding; 2 If there is no airbag, you can use the 30th anal tube, wrap the Vaseline gauze, tie the ends with silk thread, apply an anesthetic ointment outside, and insert it into the anus to stop bleeding. Finally, use a wide gel to tighten the gluteus maximus on both sides to help stop bleeding. Generally, this method can stop bleeding. If it does not work, it is necessary to stop bleeding under anesthesia. 2. Anal stenosis uncommon. It can occur more than 3 nucleus nucleus at a time, or after multiple operations. Common causes are: excessive removal of the anal skin, or excessive scarring of the skin resulting in scar contracture. If it has already occurred, you need to use your fingers to expand the anus regularly. 3. Anal incontinence Cutting or damaging the anal sphincter can cause anal incontinence. If the anal canal is placed for too long, or even more than 48 hours, it can also cause temporary anal incontinence. If the incontinence condition has not improved after 6 months of observation, surgery is required. 4. About wound complications 1 wound infection is not uncommon. In severe cases, it can spread to the honeycomb tissue around the anal canal and cause abscess. Potassium permanganate warm water bath, has the effect of preventing infection. If there is an infection, it can be controlled with antibiotics. 2 wound edema: can be done with hot compress or 50% magnesium sulfate wet compress. 3 skin sputum: due to anal skin edema, infection or fiber proliferation. Patients with symptoms need surgical resection. 5. Urinary retention This is the most common complication after fistula or other anal canal surgery. Reasons: 1 bladder nerve disorder after spinal anesthesia; 2 reflex of anal sphincter spasm; 3 direct stimulation of local anal canal. The following measures can be taken to prevent urinary retention: 1 Instruct the patient to limit drinking water within 12 hours before and during the day after surgery to cause mild dehydration. Marti recommends intraoperative intravenous infusion to be limited to 100ml. Some people think that this is a very important measure to prevent urinary retention, because before the anesthesia disappears, the bladder expands prematurely, often causing urinary retention; 2 postoperative sedatives can not be used too much; 3 early wake-up activities; 4 preferably using local anesthesia ; 5 anal skin wounds should not be sutured as much as possible, after the operation of the rectum, do not put anal canal or large gauze for compression and hemostasis, can reduce postoperative pain and reflex urinary retention; 6 first urination should strive to go to the toilet to urinate, causing Conditioned reflex. If the patient still fails to urinate 6 to 8 hours after surgery, 0.25 mg of carboylcholine can be injected subcutaneously. Those who failed to urinate 12 hours after surgery should be catheterized.