混合痔手术治疗概况

Overview of Surgical Treatment of Mixed Hemorrhoids

临床治疗混合痔的手术法分为传统中医手术法和微创手术法。传统中医手术方法包括枯痔钉法、中药注射法、中医结扎法、外剥内扎术等;微创手术法包括痔上黏膜环切术、选择性痔上黏膜吻合术、自动弹力线套扎术、超声多普勒引导下痔动脉结扎术等。目前,每种术式都存在一些问题:传统术式疗效突出,术后不易复发,但其对机体损伤较大,操作范围为神经丰富的齿线附近,增加了患者术后的疼痛感等不良反应的发生率,患者术后恢复较慢,但术中配合中药注射法可有效缓解术后出血、疼痛等不良反应;西医微创疗法较传统术式痛苦小,恢复快,患者接受度高,但仍存在远期易复发和操作不规范导致的手术安全性等问题。因此,临床应该熟悉各种术式的适应证和禁忌证,规范操作,同时应根据病情轻重、患者自身的身体条件以及本人的意愿等选择合适的手术方式,将患者的痛苦降到最低。今后,应详细研究肛肠的解剖结构和痔疮的发病机理,不断探索手术术式,寻求既能根治混合痔,又能减轻患者痛苦的方法。

The surgical methods for clinical treatment of mixed hemorrhoids are divided into TCM surgery and minimally invasive surgery.TCM surgical methods include dry hemorrhoid nail method,Chinese medicinal injection method,TCM ligation method;external stripping and internal ligation method,etc.,while minimally invasive surgical methods include circumcision of hemorrhoid mucosa,selective hemorrhoid mucosal anastomosis,automatic elastic thread ligation surgery,hemorrhoidal artery ligation guided by ultrasound Doppler,etc.At present,each type of surgery has some problems:Traditional surgery has outstanding efficacy and is not easy to recur after surgery,but it causes significant damage to the body.The operating range is near the nerve-rich tooth line,which increases the probability of postoperative pain and other adverse reactions in patients.Patients recover slowly after surgery,but intraoperative cooperation with Chinese medicinal injection can effectively alleviate postoperative bleeding,pain and other adverse reactions.Minimally invasive Western medicine therapy has lower pain,faster recovery,and higher patient acceptance compared to traditional surgical methods.However,there are still issues with long-term recurrence and surgical safety caused by non-standard operations.Therefore,clinical doctors should be familiar with the indications and contraindications of various surgical methods,standardize the operation,and choose appropriate surgical methods based on the severity of the condition,the patient's own physical conditions,and his or her own wish to minimize the pain.In the future,it is necessary to conduct a detailed study of the anatomical structure of the anus and the pathogenesis of hemorrhoids,continuously explore surgical methods,and seek methods that can both cure mixed hemorrhoids and alleviate patient pain.