gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2019-18-4-100-109gnck-1520Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВЫБОР МЕТОДА ЛЕЧЕНИЯ ПАЦИЕНТОВ С ГЕМОРРОИДАЛЬНОЙ БОЛЕЗНЬЮ (РЕЗУЛЬТАТЫ НАБЛЮДАТЕЛЬНОЙ ПРОГРАММЫ RE-VISION)THE CHOICE OF TREATMENT IN PATIENTS WITH HEMORRHOIDAL DISEASE (THE RESULTS OF THE OBSERVATIONAL PROGRAM RE-VISION)ЗагрядскийЕ. А.ZagriadskiyE. A.

ул. Большая Молчановка, д. 32, строение 1, Москва, 121069

proctolog52@rambler.ruБогомазовА. М.BogomazovA. M.ГоловкоЕ. Б.GolovkoE. В.МЦ «ОН КЛИНИК»РоссияMedical Center «ON-CLINIC»Russian FederationМЦ «Южный»Russian FederationMedical Center «South»Russian FederationКлиники «МЕДСИ МСК 12»Russian FederationClinic «MEDSI MSK 12»Russian Federation201921122019184100109Copyright © Загрядский Е.А., Богомазов А.М., Головко Е.Б., 20192019Загрядский Е.А., Богомазов А.М., Головко Е.Б.Zagriadskiy E.A., Bogomazov A.M., Golovko E.В.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1520ЦЕЛЬ

ЦЕЛЬ. Анализ подходов к лечению пациентов с различными стадиями геморроя. Чем руководствуется специалист в том или ином клиническом случае, выбирая методику лечения?

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. Исследование основано на анализе клинико-инструментального обследования 804 пациентов с I-IV стадией геморроя. Возраст больных 44,8±13,2 (19-83) лет. В исследование вошло 392 (48,8) мужчин и 412(51,2) женщин.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Системная терапия МОФФ (Детралекс, Сервье) в сочетании с приемом пищевых волокон и топическим лечением эффективно снижает выраженность основных клинических проявлений геморроя. Благодаря этому, 200 (24,8%) пациентам с I-IV стадией геморроя врачи выбрали консервативное лечение в связи с достигнутым положительным клиническим эффектом. Сочетание системной флеботропной терапии (МОФФ) с миниинвазивным и хирургическим лечением было проведено у 355 (44,2%) и 249 (31,0%) больных с II-IV стадиями геморроя, соответственно. Миниинвазивное лечение выполнялось у пациентов с не выраженным наружным геморроидальным комплексом. В 210 (54,7%) случаях хирургическое лечение выполнено у пациентов с выраженным наружным геморроидальным комплексом.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Комплексная терапия геморроя с применением МОФФ (Детралекс), показывает свою эффективность для купирования основных клинических проявлений заболевания у пациентов I-II стадии геморроя. Пациенты с III и IV стадией геморроя требуют использования мининвазивного и хирургического лечения. На выбор характера лечения влияет не только стадия геморроя, но и особенности его анатомического статуса. Использование МОФФ (Детралекс) позволяет снять обострение заболевания и выбрать адекватный метод малоинвазивного или хирургического лечения для каждого конкретного пациента.

AIM

AIM: analysis of approaches to the treatment of different stages of hemorrhoids to clarify what factors provides the choice of a method of treatment modality.

PATIENTS AND METHODS

PATIENTS AND METHODS: the study is based on the analysis of clinical and instrumental examination of 804 patients with stage I-IV hemor-rhoids. It included 412 (51.2%) females aged 19-83 (44.8±13.2) years.

 RESULTS

 RESULTS: micronized purified flavonoid fraction (MPFF) in combination with dietary fiber intake and topical treatment effectively reduces the severity of the main clinical manifestations of hemorrhoids. Due to this, in 200 (24.8%) cases of stage I-IV hemorrhoids, doctors chose conservative treatment in connection with the achieved positive clinical effect. The combination of systemic phlebotropic therapy (MPFF) with minimally invasive and surgery was carried out in 355(44.2%) and 249 (31.0%) cases of stage II-IV hemorrhoids, respectively. Minimally invasive procedures were performed in patients with a minimal changes of external hemorrhoidal piles. In 210 (54.7%) cases, surgery was performed in patients with a significant changes of external hemorrhoidal piles.

CONCLUSION

CONCLUSION: multimodal treatment of hemorrhoids with the use of MPFF, shows its effectiveness for elimination of the main clinical manifesta-tions of the disease in hemorrhoids stage I-II. Patients with stage III and IV hemorrhoids require the use of a minimally invasive procedures and excisional surgery. The choice of the method is influenced not only by the hemorrhoid stage, but also by the anatomical features. The use of MPFF allows to remove the acute changes and to select an optimal method of minimally invasive or surgical procedure individually.

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The authors declare that there are no conflicts of interest present.