-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
- Cosmetic Ingredient
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Only for medical professionals to read and refer to endoscopic apron band ligation treatment.
The main purpose of traditional surgical hemorrhoid surgery is to eliminate hemorrhoids, while hemorrhoid band ligation is affected by the theory of lower anal cushion.
The main purpose is to eliminate symptoms.
Rubber bands are used for band ligation and anal cushion is used for lifting.
Block the blood supply of hemorrhoids and eliminate the symptoms of hemorrhoids [1].
At present, apron band ligation has become the first choice for the treatment of symptomatic hemorrhoids.
The endoscopic apron band ligation for internal hemorrhoids discussed in this article has the advantages of good vision, flexible operation, accurate positioning, and fewer complications.
The apron shrinks and compresses the internal hemorrhoids.
The blood vessels block the superior rectal artery and reduce the blood supply of the internal hemorrhoids, thereby causing avascular necrosis.
The hemorrhoids will gradually fall off, and the residual wounds can gradually heal after the hemorrhoids fall off.
After the hemorrhoids fall off, the position of the anal cushion will gradually move up.
And after the operation, the mucosal muscle fiber adhesion occurs, so that the fixed position of the anal cushion is relatively high, so that the lower rectum returns to the original normal structure [2].
The advantage of endoscopic multi-ring ligation is that there is no damage to the surrounding tissue structure during the operation, which reduces the pain of the patient during and after the operation.
Indications 1.
Hemorrhoids with symptoms of bleeding and prolapse, including hemorrhoids in stage I, II, and III and internal hemorrhoids of mixed hemorrhoids; 2.
Long pedicle neoplasms; 3.
Mucosal prolapse/difficulty defecation; 4.
Treatment of hemorrhoids bleeding in critical cases; 5.
Treatment before resection of polyps on the surface of hemorrhoids; 6.
Adjuvant treatment and remedial treatment for other anorectal diseases after surgery.
Contraindications 1.
Severe heart, brain, lung, liver, and kidney failure cannot tolerate the treatment of internal hemorrhoids; 2.
With inflammatory bowel disease; 3.
Dentate line area with unexplained ulcers; 4.
Acute anal inflammation and embedment Pain, anal fistula; 5.
Immune deficiency, bleeding tendency, history of pelvic radiotherapy and susceptibility to infection; 6.
Patients who are not suitable for colonoscopy (such as pregnancy, etc.
); 7.
Recently (within 3 months) sclerosing agent injection treatment History; 8.
Diabetes patients with poor blood sugar control; 9.
Patients with physical symptoms and mental disorders. Preoperative preparation 1.
Preoperative related examinations, such as blood routine, coagulation function, biochemistry, electrocardiogram, etc.
; 2.
It is recommended to complete colonoscopy before treatment to exclude other colon diseases; 3.
Choose treatment according to the degree of internal hemorrhoid prolapse and the experience of the surgeon Method (inverted mirror/sequential mirror); 4.
Treatment plan for special circumstances such as complications during the operation; 5.
Evaluation of anesthesia methods: awake, sedation, general anesthesia, etc.
Equipment preparation 1.
Endoscope: It is recommended to choose a gastroscope, which is convenient to install the band ligation device and inverted mirror treatment; 2.
The band ligation device.
Patient preparation 1.
Preoperative diet education prepare a diet with less residue according to the intestinal tract; 2.
Concept education: inform patients that asymptomatic internal hemorrhoids do not require treatment.
Internal hemorrhoid treatment aims to eliminate and reduce the symptoms of hemorrhoids rather than changing the size of hemorrhoids and establish the psychological expectations of patients ; 3.
Preoperative talk (methods of operation, possible complications and treatments when complications occur, etc.
); 4.
Mental preparation.
Complete the procedure of colonoscopy to exclude other related diseases, choose an endoscope with a better angle to install the ligator, enter the endoscope to the anus, flip the endoscope, determine the position of the internal hemorrhoids (focus on the position of the mother hemorrhoids), fully inject air to expose the field of vision, and make it clear The position of the dentate line (to be far away from the dentate line), determine the ligation site (recommended ligation site: use the straight anal line as the reference line, ligate at the oral end of the hemorrhoids), and place the transparent cap on the side of the straight anal mouth The suction sleeve takes the head end of the hemorrhoids and part of the oral rectal mucosa, so that the transparent cap is in full contact with the hemorrhoid mucosa at the place to be ligated, and the endoscopic suction button is activated to generate a negative pressure of 8 to 13 kPa, and the internal hemorrhoids to be ligated are inhaled In the transparent cap, after the hemorrhoid mucosa in the transparent cap is full of view, continue to attract, turn the multi-ring ligation handle clockwise to release the rubber ring completely, then release the gastroscope suction button, inject a little air, and slowly send out the ligation ball With a transparent cap, repeat the above operation until the treatment is completed.
Intraoperative details During the banding process, the following principles must be mastered: 1.
Stay away from the dentate line to avoid accidentally banding the skin to cause pain and recent prolapse; 2.
Abandon the urge to eliminate the main body of hemorrhoids, and clarify the purpose of treating hemorrhoids ； 3.
Generally 3-5 points are enough, depending on the size of hemorrhoids, the number of mother hemorrhoids and sub-hemorrhoids, and the degree of prolapse to determine the position and number of loops; 4.
For heavier hemorrhoids If the prolapse of the hemorrhoids is still obvious after ligation, vertical tandem ligation can be used to improve the symptoms of prolapse; 5.
After the inverted mirror multi-point ligation, the field of vision is limited due to the presence of the ligation ball, which affects the observation of the remaining internal hemorrhoids, so it is necessary to ligate the most Severe internal hemorrhoids (maternal hemorrhoids), the remaining inconvenience can be observed under the orthoscope to supplement the ligation of internal hemorrhoids; 6.
For internal hemorrhoids with severe prolapse and unsatisfactory ligation, multiple ligation can be used.
After the postoperative care, stay in bed and rest on the day after the operation, eat less residue within a week, mainly light, easy to digest, and nutritious, avoid eating spicy and other irritating foods; avoid strenuous exercise, sitting for a long time, riding a bicycle for two weeks, and maintain Good living habits, rest more; maintain smooth stools, avoid forced stools, excessive squatting, defecation and weight-bearing walking, especially for patients with constipation, take lactulose for 48 hours after surgery, 3 times a day, 10ml once, for 3-5 days .
Treatment of postoperative complications 1.
Bleeding: There are many factors, consider excessive exercise, cycling, forced defecation, premature fall of the ligation ring (usually the ligation ring falls off within 5-7 days) or ulcers after ligation, generally Patients with a small amount of bleeding after defecation 3-7 days after surgery should be closely observed without special treatment.
2.
Anal swelling and bowel sensation: It often occurs when there are many banding points, which may be related to the anal mucosal irritation and the banding position is closer to the dentate line.
Generally, it does not need to be treated, and it relieves itself more than 3-5 days after surgery.
3.
Pain: Consider the ligation site is closer to the dentate line and ligation of external hemorrhoids.
Those with mild symptoms can be left untreated, or tetracaine hydrochloride/lidocaine mortar plugs can be given, and those who cannot tolerate the severe ones can use it.
Analgesics or analgesics.
4.
Urinary retention and dysuria: It may be caused by anesthesia, surgical irritation, wound pain, etc.
, which may cause reflex bladder neck sphincter spasm and cause dysuria after surgery.
Hot compresses in the bladder area and acupuncture treatment can be given.
In severe cases, catheterization may be given.
5.
Postoperative anal canal stenosis: After hemorrhoids are ligated, the basal mucosa is drawn up.
After about 1 week, the hemorrhoids fall off, the wound shrinks, and the remaining rectal mucosal defects are small and easy to repair.
Generally, anal canal stenosis is not easy to appear. 6.
Postoperative anti-infection: Use 1:5000 potassium permanganate solution to sit in the bath after the operation, once a day, and give a laxative medicine at the same time, generally do not need to use antibiotics.
This issue introduces endoscopic rubber band ligation treatment.
Articles related to endoscopic internal hemorrhoid treatment have been introduced from basic anatomy of internal hemorrhoids to endoscopic treatment.
I hope that it will be helpful to physicians who want to carry out endoscopic internal hemorrhoid treatment.
Follow-up Collect some specific problems encountered during the operation according to the situation, welcome to continue to pay attention.
Reference materials: [1] Jie Suping.
Analysis of the effect of endoscopic band ligation in the treatment of internal hemorrhoid hemorrhage[J].
China Medical Device Information,2018,24(24):106-107.
[2]WEHRMANN T,RIPHAUS A ,FEINSTEIN J,et al.
Hemorrhoidal elastic band ligation with flexible videoendoscopes:a prospective,randomized comparison with the onventional technique that uses rigid proctoscopes[J].
Gastrointest Endosc,2004,60(2):1-195
The main purpose of traditional surgical hemorrhoid surgery is to eliminate hemorrhoids, while hemorrhoid band ligation is affected by the theory of lower anal cushion.
The main purpose is to eliminate symptoms.
Rubber bands are used for band ligation and anal cushion is used for lifting.
Block the blood supply of hemorrhoids and eliminate the symptoms of hemorrhoids [1].
At present, apron band ligation has become the first choice for the treatment of symptomatic hemorrhoids.
The endoscopic apron band ligation for internal hemorrhoids discussed in this article has the advantages of good vision, flexible operation, accurate positioning, and fewer complications.
The apron shrinks and compresses the internal hemorrhoids.
The blood vessels block the superior rectal artery and reduce the blood supply of the internal hemorrhoids, thereby causing avascular necrosis.
The hemorrhoids will gradually fall off, and the residual wounds can gradually heal after the hemorrhoids fall off.
After the hemorrhoids fall off, the position of the anal cushion will gradually move up.
And after the operation, the mucosal muscle fiber adhesion occurs, so that the fixed position of the anal cushion is relatively high, so that the lower rectum returns to the original normal structure [2].
The advantage of endoscopic multi-ring ligation is that there is no damage to the surrounding tissue structure during the operation, which reduces the pain of the patient during and after the operation.
Indications 1.
Hemorrhoids with symptoms of bleeding and prolapse, including hemorrhoids in stage I, II, and III and internal hemorrhoids of mixed hemorrhoids; 2.
Long pedicle neoplasms; 3.
Mucosal prolapse/difficulty defecation; 4.
Treatment of hemorrhoids bleeding in critical cases; 5.
Treatment before resection of polyps on the surface of hemorrhoids; 6.
Adjuvant treatment and remedial treatment for other anorectal diseases after surgery.
Contraindications 1.
Severe heart, brain, lung, liver, and kidney failure cannot tolerate the treatment of internal hemorrhoids; 2.
With inflammatory bowel disease; 3.
Dentate line area with unexplained ulcers; 4.
Acute anal inflammation and embedment Pain, anal fistula; 5.
Immune deficiency, bleeding tendency, history of pelvic radiotherapy and susceptibility to infection; 6.
Patients who are not suitable for colonoscopy (such as pregnancy, etc.
); 7.
Recently (within 3 months) sclerosing agent injection treatment History; 8.
Diabetes patients with poor blood sugar control; 9.
Patients with physical symptoms and mental disorders. Preoperative preparation 1.
Preoperative related examinations, such as blood routine, coagulation function, biochemistry, electrocardiogram, etc.
; 2.
It is recommended to complete colonoscopy before treatment to exclude other colon diseases; 3.
Choose treatment according to the degree of internal hemorrhoid prolapse and the experience of the surgeon Method (inverted mirror/sequential mirror); 4.
Treatment plan for special circumstances such as complications during the operation; 5.
Evaluation of anesthesia methods: awake, sedation, general anesthesia, etc.
Equipment preparation 1.
Endoscope: It is recommended to choose a gastroscope, which is convenient to install the band ligation device and inverted mirror treatment; 2.
The band ligation device.
Patient preparation 1.
Preoperative diet education prepare a diet with less residue according to the intestinal tract; 2.
Concept education: inform patients that asymptomatic internal hemorrhoids do not require treatment.
Internal hemorrhoid treatment aims to eliminate and reduce the symptoms of hemorrhoids rather than changing the size of hemorrhoids and establish the psychological expectations of patients ; 3.
Preoperative talk (methods of operation, possible complications and treatments when complications occur, etc.
); 4.
Mental preparation.
Complete the procedure of colonoscopy to exclude other related diseases, choose an endoscope with a better angle to install the ligator, enter the endoscope to the anus, flip the endoscope, determine the position of the internal hemorrhoids (focus on the position of the mother hemorrhoids), fully inject air to expose the field of vision, and make it clear The position of the dentate line (to be far away from the dentate line), determine the ligation site (recommended ligation site: use the straight anal line as the reference line, ligate at the oral end of the hemorrhoids), and place the transparent cap on the side of the straight anal mouth The suction sleeve takes the head end of the hemorrhoids and part of the oral rectal mucosa, so that the transparent cap is in full contact with the hemorrhoid mucosa at the place to be ligated, and the endoscopic suction button is activated to generate a negative pressure of 8 to 13 kPa, and the internal hemorrhoids to be ligated are inhaled In the transparent cap, after the hemorrhoid mucosa in the transparent cap is full of view, continue to attract, turn the multi-ring ligation handle clockwise to release the rubber ring completely, then release the gastroscope suction button, inject a little air, and slowly send out the ligation ball With a transparent cap, repeat the above operation until the treatment is completed.
Intraoperative details During the banding process, the following principles must be mastered: 1.
Stay away from the dentate line to avoid accidentally banding the skin to cause pain and recent prolapse; 2.
Abandon the urge to eliminate the main body of hemorrhoids, and clarify the purpose of treating hemorrhoids ； 3.
Generally 3-5 points are enough, depending on the size of hemorrhoids, the number of mother hemorrhoids and sub-hemorrhoids, and the degree of prolapse to determine the position and number of loops; 4.
For heavier hemorrhoids If the prolapse of the hemorrhoids is still obvious after ligation, vertical tandem ligation can be used to improve the symptoms of prolapse; 5.
After the inverted mirror multi-point ligation, the field of vision is limited due to the presence of the ligation ball, which affects the observation of the remaining internal hemorrhoids, so it is necessary to ligate the most Severe internal hemorrhoids (maternal hemorrhoids), the remaining inconvenience can be observed under the orthoscope to supplement the ligation of internal hemorrhoids; 6.
For internal hemorrhoids with severe prolapse and unsatisfactory ligation, multiple ligation can be used.
After the postoperative care, stay in bed and rest on the day after the operation, eat less residue within a week, mainly light, easy to digest, and nutritious, avoid eating spicy and other irritating foods; avoid strenuous exercise, sitting for a long time, riding a bicycle for two weeks, and maintain Good living habits, rest more; maintain smooth stools, avoid forced stools, excessive squatting, defecation and weight-bearing walking, especially for patients with constipation, take lactulose for 48 hours after surgery, 3 times a day, 10ml once, for 3-5 days .
Treatment of postoperative complications 1.
Bleeding: There are many factors, consider excessive exercise, cycling, forced defecation, premature fall of the ligation ring (usually the ligation ring falls off within 5-7 days) or ulcers after ligation, generally Patients with a small amount of bleeding after defecation 3-7 days after surgery should be closely observed without special treatment.
2.
Anal swelling and bowel sensation: It often occurs when there are many banding points, which may be related to the anal mucosal irritation and the banding position is closer to the dentate line.
Generally, it does not need to be treated, and it relieves itself more than 3-5 days after surgery.
3.
Pain: Consider the ligation site is closer to the dentate line and ligation of external hemorrhoids.
Those with mild symptoms can be left untreated, or tetracaine hydrochloride/lidocaine mortar plugs can be given, and those who cannot tolerate the severe ones can use it.
Analgesics or analgesics.
4.
Urinary retention and dysuria: It may be caused by anesthesia, surgical irritation, wound pain, etc.
, which may cause reflex bladder neck sphincter spasm and cause dysuria after surgery.
Hot compresses in the bladder area and acupuncture treatment can be given.
In severe cases, catheterization may be given.
5.
Postoperative anal canal stenosis: After hemorrhoids are ligated, the basal mucosa is drawn up.
After about 1 week, the hemorrhoids fall off, the wound shrinks, and the remaining rectal mucosal defects are small and easy to repair.
Generally, anal canal stenosis is not easy to appear. 6.
Postoperative anti-infection: Use 1:5000 potassium permanganate solution to sit in the bath after the operation, once a day, and give a laxative medicine at the same time, generally do not need to use antibiotics.
This issue introduces endoscopic rubber band ligation treatment.
Articles related to endoscopic internal hemorrhoid treatment have been introduced from basic anatomy of internal hemorrhoids to endoscopic treatment.
I hope that it will be helpful to physicians who want to carry out endoscopic internal hemorrhoid treatment.
Follow-up Collect some specific problems encountered during the operation according to the situation, welcome to continue to pay attention.
Reference materials: [1] Jie Suping.
Analysis of the effect of endoscopic band ligation in the treatment of internal hemorrhoid hemorrhage[J].
China Medical Device Information,2018,24(24):106-107.
[2]WEHRMANN T,RIPHAUS A ,FEINSTEIN J,et al.
Hemorrhoidal elastic band ligation with flexible videoendoscopes:a prospective,randomized comparison with the onventional technique that uses rigid proctoscopes[J].
Gastrointest Endosc,2004,60(2):1-195
