Internal hemorrhoidectomy

1. Internal hemorrhoids that are repeatedly bleeding after injection therapy or sputum treatment. 2. The internal hemorrhoids can be repaid or can not be returned. Indication 1. Internal hemorrhoids that are repeatedly bleeding after injection therapy or sputum treatment. 2. The internal hemorrhoids can be repaid or can not be returned. Contraindications 1. Infection with internal hemorrhoids, even when there is edema, ulcer, necrosis, thrombosis, the tissue is fragile, it is not easy to suture during operation, and the suture is easy to fall off after operation. The operation area can increase scars due to infection, causing anal canal stenosis. Surgery is performed after the infection has subsided. 2. Meat plaque caused by portal hypertension, heart failure or compression of the inferior vena cava should not be removed. 3. It is not suitable for surgery during pregnancy and menstruation. Preoperative preparation 1. Do a good physical examination, pay attention to pregnancy, portal hypertension, intra-abdominal tumor or rectal cancer. Local examination should pay attention to the abnormality of the sphincter function, the local condition of the sputum and the presence or absence of arterial pulsation. 2. Enter the low slag diet 1 day before surgery. 3. Soap water enema 1 time before surgery. The enema should be cleaned 2 to 3 hours before surgery (if you can drain your stool, you can not enema). Surgical procedure 1. Position, disinfection: stone removal. The patient's buttocks must be raised beyond the edge of the operating table. The perianal skin was disinfected with 1:1000 benzalkonium chloride or 0.75% pyrrolidone iodine. The anal canal is also disinfected several times with the above-mentioned liquid cotton ball. 2. Dilatation of the anal canal: The surgeon uses both hands to indicate the finger and the middle finger to apply liquid paraffin. First, extend a finger into the anal canal, then extend the other finger back to the back. Gradually separate the left and right fingers to expand the anal canal, and then insert the middle finger to expand. For a few minutes, the sphincter is fully relaxed. 3. Local examination: check the number, size, location of the nucleus and the presence or absence of arterial pulsation, and wipe your hands. 4. Expose the nucleus: use the tissue clamp to clamp the skin of the lower end of the nucleus and pull it outward to make the tooth line fully exposed. 5. Cut the skin and clamp the base of the nucleus: the skin clamped by the tissue clamp is cut into a V shape about 2 cm below the tooth line, and the tip is outward. Use a nucleus forceps or a long curved hemostat above the tooth line, along the longitudinal direction of the rectum. The shaft clamps the base of the nucleus lifted up (be careful not to pinch the mucosa of other parts). 6. Sew the upper end of the nucleus of the nucleus: at the upper end of the base of the nucleus, bend the tip of the hemostasis of the hemostatic forceps, touch the pulsation of the artery, and sew a needle with the 2-0 gut through the submucosal layer to keep the gut without cutting. 7. Excision of the nucleus: along the concave surface of the hemostatic forceps, the nucleus is removed at the base of the nucleus. 8. Stitching: The retained gut is bypassed by a hemostat for continuous suturing (without a skin incision), then the hemostat is withdrawn and the suture is tightened while retracting. Finally, the inner and outer ends are ligated to each other. 9. Cut the remaining intestines one by one according to the same method. 10. Trim the leather edge, spread a layer of Vaseline gauze on the wound, and cover it with dry gauze. complication 1. Bleeding: There are two reasons for postoperative bleeding in internal hemorrhoids. The former is caused by slippage due to tight knots; the latter occurs about 7 to 10 days after surgery, due to infection at the ligation site. Due to the action of the anal sphincter, the blood flows back into the intestine without going to the anus, so the phenomenon of "staining red dressing" cannot be found clinically. Therefore, this "acute bleeding" is often not easy to find early. 2, stenosis: careful surgical operation and early anal canal expansion can prevent anal canal stenosis. The stenosis can be at the anal rim, the tooth line or the tooth line. Stenosis at the anal margin is mainly due to excessive removal of the skin and mucosa of the anal margin, causing the wound to contract and causing anal stenosis. The scar is often accompanied by an anal fissure, which is caused by tearing during defecation. The use of manual methods and instruments to expand the anus is ineffective, often requiring multiple surgical treatments. 3, urinary retention: urinary retention is the most common complication after sputum or other anal canal surgery, prevention of urinary retention.