Speculation of the Mechanism and Preventive Treatment of Postoperative Hemorrhage after Hemorroidectomy

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  • 痔核手術後の遅発性出血の機序と対策

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Delayed hemorrhage after hemorrhoidectomy is a complication which happens around the period of the proliferative phase and extends to the time of the remodeling phase. The cause of bleeding does not correspond to increased plasmin activity or impaired coagulation in the blood stream and subsequent wound healing. It is suspected that bleeding occasionally occurs in the normal process of wound healing at the time of activation of plasminogen activator in the extracellular matrix induced by vascular endothelial growth factor. Fluctuation of blood platelets is related to cytokine activity which is involved in reconstruction of the wound. Functional disorder of platelets leads to the possibility of delayed hemorrhage until the time of the maturity phase. In the hemorrhoidal mucosa above the lamina muscularis, dilated vessels which are denuded in the anal canal are connected vertically to arterio-venous anastomosis in the submucosa and occasionally cause bleeding. It is estimated that angiogenesis, especially the new formation of arterio-venous anastomic vessels which were generated in the extracellular matrix, are part of the bleeding. A new suture technique was devised for preventing delayed hemorrhage after hemorrhoidectomy.<br>

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