crh-rectal-pain-and-bleeding-presenttion---noar 医学课件.ppt

* Tucks/Anusol-1.12% hydrocortisone acetate $6/.7 oz. Preparation H Anti-Itch Cream Hydrocortisone 1%-1% hydrocortisone, BHA, carboxymethylcellulose sodium, cetyl alcohol, citric acid, edetate disodium, glycerin, glyceryl oleate, glyceryl stearate, lanolin, methylparaben, petrolatum, propyl gallate, propylene glycol, propylparaben, simethicone, sodium benzoate, sodium lauryl sulfate, stearyl alcohol, water, xanthan gum * * Relief of the spasm by local anesthetic injection can relax the spasm and give immediate improvement. Rubber band ligation is more effective than IRC for bleeding. SGO 1987 Dec;165(6):479-82 Rubber band ligation is more effective than IRC for Grade III and IV. Rev Esp Enferm Dig. 2001 Apr;93(4):239-47 PPH-Ethicon Endo-Surgery. Stapled hemorrhoidopexy. Circumferential band of mucosa and submucosa removed and area stapled. Interrupts blood supply and fixes tissue to rectal wall. Does not treat external disease. Avoid in pts. with sphincter injury/incontinence. Harmonic Scalpel-Ethicon Endo-Surgery. Uses ultrasonic waves that reduces lateral heat damage. LigaSure-Valleylab, Tyco Health. Bipolar device that limits lateral damage. These two devices may decrease postoperative pain but results are inconsistent and adds to expense of procedure. * Uncontrollable intra-abdominal bleeding necessitating low anterior resection of the rectum after stapled hemorrhoidopexy Surg Today 2007;37(3):254-7 Stapled hemorrhoidopexy. Complications and 2-year follow-up. Chir Ital. 2006 Nov-Dec;58(6)753-60 Reinterventions after complicated or failed stapled hemorrhoidopexy. Dis Colon Rectum 2004 Nov;47(11):1846-51 Inflammatory polyps: a cause of late bleeding in stapled hemorrhoidectomy. Dis Colon Rectum. 2006 Dec;49(12):1910-3 Prospective randomized clinical trial comparing two different circular staplers for mucosectomy in the treatment of hemorrhoids * Lower complication rate when banding done one at a time and constipation increases recurrence-Rubber Band ligatio