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1、Hemorrhoidectomy,FistulainanoandTEMWendieGrunberg3LoopsofexternalsphincterSubcutaneous(C),superficial(B),deep(A)BloodSupply.Therectumandanalcanalaresuppliedbythesuperiorrectalartery(thecontinuationoftheinferiormesentericartery),withassistancefromthemiddleandinferiorrectalarterie
2、s,andbythemediansacralartery.Thesubmucosalvenousplexusabovethepectinatelinedrainsintothesuperiorrectalveins(portalsystem),whichmaybecomevaricose,resultingininternalhemorrhoidsor"piles."Thesubmucosalplexusbelowthepectinatelinedrainsintotheinferiorrectalveins,whichmaybecomevaricos
3、e,resultinginexternalhemorrhoidsorpiles.Theunionsofthesuperiorwiththemiddleandinferiorrectalveinsareimportantportal-systemicanastomoses.InnervationParasympatheticfiberssupplythesmoothmuscle,includingtheinternalsphincter.Sympatheticfibersaremainlyvasomotor.Somaticmotorfiberssuppl
4、ytheexternalsphincter.Sensoryfibersareconcernedwiththereflexcontrolofthesphinctersandwithpain.Theanalcanalisverysensitivebelowthepectinateline,sothatexternalhemorrhoidsmaybeverypainful.Hemrroidectomy-InjectionIndications:Theinjectionofhemorrhoidsisapalliativeprocedure.Thepatient
5、isambulatory.Itmaybeusedforthebleedinginternalhemorrhoidthatdoesnotprolapse.ItisnotapplicabletoexternalhemorrhoidsContraindications:reactiveinflammationorthrombosis,acutefissure,fistulaorperianalabscess,severecryptitisorpapillitis,andanadvanceddegreeofprolapseInjectionAcompletes
6、tudyofthecolonandrectumtoruleoutpolypsoramalignancymustbeperformedbeforeinjection.Theanorectalareaisbestexaminedwithananoscopewhiletheremainderofthecolonrequireseithercolonoscopyorsigmoidoscopyplusbariumenema.InjectionPreoperativepreparationsNopreoperativepreparationisnecessaryo
7、therthanadisposablecommercialenemaself-administeredbythepatient.Injection-ProcedureAnanoscopeisinserted.Thesclerosingsolutionisinjectedabovethehemorrhoidabout3mmbelowthemucosaSlightdistentionofthemucosawillresult,butitshouldnotblanch.Oneto2mLofsolutionisusuallysufficientforonehe
8、morrhoid.Nomorethanthreesitesareinjectedatasing