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The previous article is full of pictures and texts, and teaches you how to treat hemorrhoids under endoscopy (1) introduces the anatomy, pathophysiology, classification and grading of hemorrhoids, and has a theoretical understanding of the formation of hemorrhoids.
In this article, we will focus on the discussion Problems related to hemorrhoid treatment.
1.
The choice of hemorrhoids treatment There are many ways to treat hemorrhoids.
The basic treatment is to change diet and lifestyle: such as proper fluid and fiber intake, and good bowel habits to reduce symptoms and frequency.
It can also be treated with drugs: such as laxatives, stool softeners, penetrants, and intravenous active drugs.
It is reported in the literature that oral fiber laxatives have a good therapeutic effect on patients with hemorrhoids, which can relieve hemorrhoid symptoms and reduce bleeding.
Use oral fiber for laxatives After the administration, the patient's symptoms did not improve and the risk of sustained was reduced by 53% [1].
In addition to basic dietary lifestyle changes and drug treatments, there are sitz baths, magnetic therapy, etc.
, for those who are ineffective in non-surgical treatment and diagnosed with grade I, II and some grade III internal hemorrhoids, they can be treated with band ligation, sclerotherapy, etc.
For some symptomatic external hemorrhoids, internal hemorrhoids and external hemorrhoids with prolapse (grade III-IV), surgical methods can also be used, including hemorrhoidectomy, anastomosis hemorrhoidectomy, Doppler-guided hemorrhoid artery ligation, etc.
Table 1: Treatment of hemorrhoids Table 2: Related guidelines for hemorrhoids treatment In short, the treatment of hemorrhoids needs to choose an appropriate treatment plan according to factors such as the severity of hemorrhoids and patient tolerance.
Three principles should be grasped during the treatment process: (1) Hemorrhoids without any symptoms do not require treatment; (2) The purpose of hemorrhoid treatment is to eliminate or alleviate the symptoms, not to eliminate the hemorrhoids; (3) The effect standard of hemorrhoids treatment is to relieve the symptoms of hemorrhoids than to change the size of the hemorrhoids.
Meaningful [3].
The treatment of hemorrhoids under endoscopy makes the operation more minimally invasive, which eliminates symptoms while maintaining the integrity of the anal structure and function.
The treatment of hemorrhoids under endoscopy includes two surgical methods: sclerotherapy and band ligation.
This series of articles focuses on the treatment of hemorrhoids under endoscopy.
Before discussing the treatment of hemorrhoids under endoscopy, we also need to clarify the anatomical position of the dentate line under the endoscopy, the concept of mother hemorrhoids, and the manifestations of hemorrhoids during the active period under endoscopy.
2.
The position and significance of the dentate line Figure 1: The position of the dentate line (internal view of the rectum) Figure 2: The position of the dentate line The dentate line is located at the lower end of the anal column, where the skin of the anal canal and the rectal mucosa join , The serrated circular line formed by the connection between the edge of the anal flap and the lower end of the anal column is also the dividing line between internal and external hemorrhoids; the dentate line is rich in neuroreceptors, which plays an important role in defecation control and is innervated by somatic nerves.
, It is painful, it is the double yellow line that must not be touched during our endoscopic operation.
The ring tissue belt in the 1.
0cm-1.
5cm area above the dentate line is the anal cushion area (the area between the black arrow and the red arrow in Figure 2), which is the area where hemorrhoids occur and develop.
Under normal conditions, the color tone is slightly whitish.
The transitional area from the columnar epithelium of the rectal mucosa to the stratified squamous epithelium.
Endoscopic hemorrhoid sclerosis and band ligation treatment are all carried out around this area.
3.
The concept of female hemorrhoids The most common locations for internal hemorrhoids are lithotomy 3 o'clock, 7 o'clock and 11 o'clock.
This is because the arteries and veins of the hemorrhoids are mostly distributed in these three positions.
These three positions are also known as the mother hemorrhoids of internal hemorrhoids.
Hemorrhoids in other areas are called sub-hemorrhoids.
In general, female hemorrhoids are larger and more common than sub-hemorrhoids, and they are prone to bleeding and prolapse.
Figure 3 (marked at 3, 7 and 11 in figure b is the position of the lithotomy position) is a schematic diagram of the location of female hemorrhoids under the front and inverted lenses after adjusting to the left decubitus position.
It is necessary to focus on this observation during endoscopic observation The location of hemorrhoids and their severity.
If there are many hemorrhoids during the flip-end endoscopic observation, the location of the mother hemorrhoids should also be identified.
Priority should be given to treatment when undergoing endoscopic sclerosis or band ligation treatment.
Figure 3: Schematic diagram of the location of female hemorrhoids 4.
Endoscopic appearance of hemorrhoids during active period.
During active hemorrhoids, hemorrhoids under endoscope appear as enlarged internal hemorrhoids (mostly in the area of female hemorrhoids), surface red sign or blood bubble sign, on the straight line of the anus The texture of the blood vessels of the limbal mucosa is fuzzy, showing fine-grained changes.
In severe cases, erosion, ulcers and active bleeding can be seen.
The rectal mucosa on the hemorrhoids is loose, and the internal hemorrhoids can be seen to prolapse locally or even in a circular shape.
Figure 4: Endoscopic manifestations of hemorrhoids during active period This article introduces the treatment of hemorrhoids, the anatomical position of the dentate line, the concept of mother hemorrhoids, and the manifestations of hemorrhoids during active endoscope.
In the next article, we will continue to introduce endoscopic hemorrhoids Problems related to sclerotherapy.
Reference materials: [1]ALONSO-COELLO P, GUYATT G, HEELS-ANSDELL D, et al.
Laxatives for the treatment of emorrhoids[J].
Cochrane Data-base Syst Rev,2005(4):CD004649.
[2]Indian J Surg.
2017 Feb;79(1):58-61.
DISEASES OF THE COLON&RECTUM VOLUME 61:(2018)[3] Guidelines for the Clinical Diagnosis and Treatment of Hemorrhoids in China (2020) Colorectal and Anal Surgery October 2020 Vol.
26 No.
Phase 5
The previous article is full of pictures and texts, and teaches you how to treat hemorrhoids under endoscopy (1) introduces the anatomy, pathophysiology, classification and grading of hemorrhoids, and has a theoretical understanding of the formation of hemorrhoids.
In this article, we will focus on the discussion Problems related to hemorrhoid treatment.
1.
The choice of hemorrhoids treatment There are many ways to treat hemorrhoids.
The basic treatment is to change diet and lifestyle: such as proper fluid and fiber intake, and good bowel habits to reduce symptoms and frequency.
It can also be treated with drugs: such as laxatives, stool softeners, penetrants, and intravenous active drugs.
It is reported in the literature that oral fiber laxatives have a good therapeutic effect on patients with hemorrhoids, which can relieve hemorrhoid symptoms and reduce bleeding.
Use oral fiber for laxatives After the administration, the patient's symptoms did not improve and the risk of sustained was reduced by 53% [1].
In addition to basic dietary lifestyle changes and drug treatments, there are sitz baths, magnetic therapy, etc.
, for those who are ineffective in non-surgical treatment and diagnosed with grade I, II and some grade III internal hemorrhoids, they can be treated with band ligation, sclerotherapy, etc.
For some symptomatic external hemorrhoids, internal hemorrhoids and external hemorrhoids with prolapse (grade III-IV), surgical methods can also be used, including hemorrhoidectomy, anastomosis hemorrhoidectomy, Doppler-guided hemorrhoid artery ligation, etc.
Table 1: Treatment of hemorrhoids Table 2: Related guidelines for hemorrhoids treatment In short, the treatment of hemorrhoids needs to choose an appropriate treatment plan according to factors such as the severity of hemorrhoids and patient tolerance.
Three principles should be grasped during the treatment process: (1) Hemorrhoids without any symptoms do not require treatment; (2) The purpose of hemorrhoid treatment is to eliminate or alleviate the symptoms, not to eliminate the hemorrhoids; (3) The effect standard of hemorrhoids treatment is to relieve the symptoms of hemorrhoids than to change the size of the hemorrhoids.
Meaningful [3].
The treatment of hemorrhoids under endoscopy makes the operation more minimally invasive, which eliminates symptoms while maintaining the integrity of the anal structure and function.
The treatment of hemorrhoids under endoscopy includes two surgical methods: sclerotherapy and band ligation.
This series of articles focuses on the treatment of hemorrhoids under endoscopy.
Before discussing the treatment of hemorrhoids under endoscopy, we also need to clarify the anatomical position of the dentate line under the endoscopy, the concept of mother hemorrhoids, and the manifestations of hemorrhoids during the active period under endoscopy.
2.
The position and significance of the dentate line Figure 1: The position of the dentate line (internal view of the rectum) Figure 2: The position of the dentate line The dentate line is located at the lower end of the anal column, where the skin of the anal canal and the rectal mucosa join , The serrated circular line formed by the connection between the edge of the anal flap and the lower end of the anal column is also the dividing line between internal and external hemorrhoids; the dentate line is rich in neuroreceptors, which plays an important role in defecation control and is innervated by somatic nerves.
, It is painful, it is the double yellow line that must not be touched during our endoscopic operation.
The ring tissue belt in the 1.
0cm-1.
5cm area above the dentate line is the anal cushion area (the area between the black arrow and the red arrow in Figure 2), which is the area where hemorrhoids occur and develop.
Under normal conditions, the color tone is slightly whitish.
The transitional area from the columnar epithelium of the rectal mucosa to the stratified squamous epithelium.
Endoscopic hemorrhoid sclerosis and band ligation treatment are all carried out around this area.
3.
The concept of female hemorrhoids The most common locations for internal hemorrhoids are lithotomy 3 o'clock, 7 o'clock and 11 o'clock.
This is because the arteries and veins of the hemorrhoids are mostly distributed in these three positions.
These three positions are also known as the mother hemorrhoids of internal hemorrhoids.
Hemorrhoids in other areas are called sub-hemorrhoids.
In general, female hemorrhoids are larger and more common than sub-hemorrhoids, and they are prone to bleeding and prolapse.
Figure 3 (marked at 3, 7 and 11 in figure b is the position of the lithotomy position) is a schematic diagram of the location of female hemorrhoids under the front and inverted lenses after adjusting to the left decubitus position.
It is necessary to focus on this observation during endoscopic observation The location of hemorrhoids and their severity.
If there are many hemorrhoids during the flip-end endoscopic observation, the location of the mother hemorrhoids should also be identified.
Priority should be given to treatment when undergoing endoscopic sclerosis or band ligation treatment.
Figure 3: Schematic diagram of the location of female hemorrhoids 4.
Endoscopic appearance of hemorrhoids during active period.
During active hemorrhoids, hemorrhoids under endoscope appear as enlarged internal hemorrhoids (mostly in the area of female hemorrhoids), surface red sign or blood bubble sign, on the straight line of the anus The texture of the blood vessels of the limbal mucosa is fuzzy, showing fine-grained changes.
In severe cases, erosion, ulcers and active bleeding can be seen.
The rectal mucosa on the hemorrhoids is loose, and the internal hemorrhoids can be seen to prolapse locally or even in a circular shape.
Figure 4: Endoscopic manifestations of hemorrhoids during active period This article introduces the treatment of hemorrhoids, the anatomical position of the dentate line, the concept of mother hemorrhoids, and the manifestations of hemorrhoids during active endoscope.
In the next article, we will continue to introduce endoscopic hemorrhoids Problems related to sclerotherapy.
Reference materials: [1]ALONSO-COELLO P, GUYATT G, HEELS-ANSDELL D, et al.
Laxatives for the treatment of emorrhoids[J].
Cochrane Data-base Syst Rev,2005(4):CD004649.
[2]Indian J Surg.
2017 Feb;79(1):58-61.
DISEASES OF THE COLON&RECTUM VOLUME 61:(2018)[3] Guidelines for the Clinical Diagnosis and Treatment of Hemorrhoids in China (2020) Colorectal and Anal Surgery October 2020 Vol.
26 No.
Phase 5
