Hello, anal swelling is the most common complication after hemorrhoid surgery. Inflammatory edema often appears locally, and occasionally hematoma appears, which is difficult to disappear for a long time, easily leading to connective tissue proliferation and skin vegetation, affecting healing. Therefore, it should be actively prevented. Now the reasons and some prevention and control experiences accumulated by the author are briefly described as follows:

● First, the occurrence of anal swelling:

There are many reasons for postoperative anal swelling, which can be summarized as follows.

1, anatomical factors:

The anal skin is dominated by pudendal nerve of spinal nerve, with abundant peripheral blood vessels and protruding sphincter. Surgery leads to vascular injury, nerve fiber exposure, lymphatic drainage obstruction, and local manifestations are congestion, inflammatory exudation and pain caused by sphincter contraction and compression. Pain and pain reflexively cause sphincter spasm, aggravate the reflux obstacle of blood and lymph, increase exudation, and a large amount of exudate accumulates in loose anal skin, which makes the pain worse. A vicious circle of "pain-sphincter contracture-blood lymphatic reflux disorder-extravasation and congestion-pain" is formed, which is the fundamental reason why anal swelling is easy to be complicated and difficult to eliminate after hemorrhoid surgery.

2. Anesthetic factors: superficial drug injection, concentrated or excessive drug dosage, or subcutaneous hydrops or capillary rupture and bleeding caused by multi-point acupuncture during local anesthesia; And incomplete anesthesia, sphincter spasm, blood and lymphatic reflux disorder.

3. Surgical factors: incomplete excision of external hemorrhoids, too many skin flaps and poor incision drainage; Excessive clamping, pulling and squeezing of residual tissue during operation; The injection site of internal hemorrhoids is too low, and the ligation is too deep and too much; Rough operation and blind injury during operation; There are also lax disinfection, secondary infection and so on.

4, nursing factors: premature release of the heart; Squatting for a long time to earn money or going to the toilet frequently after defecation; Premature bathing after operation, etc.

2. Prevention and treatment of anal swelling

The special anatomical structure of anus determines that every link in the operation process and careless operation are potential factors causing postoperative anal swelling. Therefore, prevention is the key.

1, preoperative: emptying the stool and cleaning the intestine can not only avoid surgical pollution, but also delay the postoperative defecation time.

2. Anesthesia: Shu Yao anesthesia is applied to mixed hemorrhoid surgery. When local anesthesia is used for simple external hemorrhoids, only a small amount of cortex and subcutaneous infiltration (no obvious swelling or blisters in some areas) should be achieved for the purpose of anesthesia of sphincter, so that the liquid medicine can be evenly dispersed and injection edema can be prevented.

3. Operation: Injection ligation of internal hemorrhoids should be performed above the tooth line 1cm to avoid tissue damage below the tooth line; Do not ligate too much, it will hurt the sphincter too deeply, and the adjacent ligation points cannot be in the same plane; When the internal hemorrhoid is simply sutured, the corresponding anal skin should be decompressed, while the external hemorrhoid should be vented, the incision should be designed reasonably, and decompression and drainage should be paid attention to; The incision should be radial V-shaped along the anal fold. The size of the incision should be determined according to the shape of hemorrhoid and the scope of excision. Its length should be longer than the outer edge of hemorrhoid 1cm, and the bottom should be flat. For the appearance and multiple external hemorrhoids, we should pay attention to the overall balance of the incision. Generally, points 3, 5, 7, 1 1 are selected as the incision area, and the flap between incisions should be no less than 1cm. Hemorrhoid tissue under the skin bridge and near the incision should be peeled off quietly to avoid damaging the tissue left by the skin bridge and the clamp. The skin flap of the incision should be smooth, tensionless and redundant. If the incision is large and has tension, it should be fully free and sutured after reducing tension; Those with obvious swelling around the incision should be decompressed and drained. After external hemorrhoidectomy, compound Blaine injection can be injected subcutaneously around the incision to relieve postoperative pain, or chymotrypsin can be injected to relieve local secretion and edema, which has a positive and positive effect on preventing postoperative anal swelling. At the same time, pay attention to aseptic operation to prevent secondary infection. The operation should be standardized and gentle to avoid rude and blind injuries. Then, part of the internal sphincter can be cut off routinely (for the elderly and those with anal weakness) to stop bleeding completely, and the knotted dressing can be attached to the anus to maintain a smooth balance, which is beneficial to the adhesion and fusion of the skin bridge, the wound edge and the deep tissue and accelerate the establishment of a new circulation channel.

4. After operation: ① Antibiotics and painkillers are selected as appropriate, and 6 grams of Maren Pill or Huaijiao Pill are given routinely, and bid② pimple dressing should be kept for more than 24 hours, which is not suitable for premature release; (3) Carefully clean the wound dressing to keep the wound clean; Smooth drainage. If the suture wound shows signs of redness or infection, the suture should be removed as soon as possible and the drainage should be opened. ④ Routine local hot compress or TDP local irradiation was performed within 2-3 days after operation to promote blood circulation, and fumigation and sitz bath were performed after 3 days. ⑤ Do not defecate on the day of operation, but postpone defecation for 1-2 days, encourage patients to eat more fiber-rich foods such as vegetables, fruits and coarse grains, keep defecation unobstructed, and avoid squatting for a long time or going to the toilet frequently; ⑥ Timely handle fecal impaction and urinary retention, and actively treat diseases such as diarrhea and cough; ⑦ Stay in bed for 2-3 days to avoid sedentary standing and strenuous activities.

5, treatment: ① Sanyu Xiao Zhong Decoction (self-made prescription) smoked and washed after defecation, daily 1 time, each time 10-20 minutes; ② External application of Huoxue Xiao Zhong ointment (self-made prescription) or gold ointment; ③ Huoxue Sanyu Decoction, decocted and taken orally, one dose per day; ④ If swelling is serious, connective tissue hyperplasia or thrombosis occurs, surgical treatment should be given.