gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2016-0-3-13-17gnck-28Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ПРОФИЛАКТИКИ И ЛЕЧЕНИЯ ГЕМОРРОЯ В ДОРОДОВОМ И РАННЕМ ПОСЛЕРОДОВОМ ПЕРИОДЕMODERN POSSIBILITIES TO PREVENTION AND TREATMENT OF HEMORRHOIDS IN PRENATAL AND EARLY POSTNATAL PERIODВасильевС. В.VasilievS. V.noemail@neicon.ruПоповД. Е.PopovD. E.noemail@neicon.ruНедозимованыйА. И.NedozimovanyA. I.noemail@neicon.ruСоколоваОльга СергеевнаSokolovaO. S.sokolova3109557@gmail.comГБОУ высшего профессионального образования «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» МЗ РФРоссияPavlov First Saint-Petersburg State Medical UniversityRussian Federation201630092016031317Copyright © Васильев С.В., Попов Д.Е., Недозимованый А.И., Соколова О.С., 20162016Васильев С.В., Попов Д.Е., Недозимованый А.И., Соколова О.С.Vasiliev S.V., Popov D.E., Nedozimovany A.I., Sokolova O.S.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/28

ЦЕЛЬ. Поиск оптимального подхода к профилактике и лечению геморроя у беременных в дородовом периоде и у родильниц в раннем послеродовом периоде. МАТЕРИАЛ И МЕТОДЫ. На основании сравнительных результатов лечения геморроя с использованием топических и системных лекарственных препаратов у 113 беременных определена эффективность профилактической и лечебной тактики при геморроидальной болезни во время беременности и в раннем послеродовом периоде. Разработаны оптимальные по эффективности и безопасности схемы лечения обострений геморроя у этой категории пациенток. РЕЗУЛЬТАТЫ. Применение представленных схем лечения и профилактики позволяет значительно снизить риск обострения геморроя и уменьшить сроки купирования симптомов у беременных и родильниц. Опыт применения препарата Детралекс свидетельствует об эффективности и хорошей переносимости данного средства при использовании у беременных, как с целью лечения, так и профилактики послеродовых обострений геморроя.

AIM. To work up the optimal approach to the prevention and treatment of hemorrhoids in pregnant women in antenatal and postpartum women in the immediate postpartum period. MATERIAL AND METHODS. Based on the comparative results of treatment of hemorrhoids using topical and systemic medicinal drugs in 113 pregnant women determined the effectiveness of preventive and therapeutic tactics in respect of haemorrhoidal disease in pregnancy and the early postpartum period.. Treatment schemes designed for optimum efficiency and safety of treatment of acute hemorrhoids in this patient's category. RESULTS. The use of investigated schemes for treatment and prevention can significantly reduce the risk of exacerbation of the hemorrhoids and reduce the terms of relief of symptoms in pregnant and postpartum women. The experience of the Detralex (Daflon 500) demonstrates the effectiveness and good tolerability of this product when used in pregnant women for treatment and prevention of postpartum exacerbation of hemorrhoids.

геморройбеременностьпрофилактикалечениеДетралексhemorrhoidspregnancypreventiontreatmentDetralex (Daflon 500)ReferencesБлагодарный Л.А. Эффективность флеботропных препаратов. Результаты метаанализа (на основе Кокрановского центрального реестра контролируемых исследований, Cochrane Central Register of Controlled Trials). - М., 2015. - 24 с.Благодарный Л.А. Эффективность флеботропных препаратов. Результаты метаанализа (на основе Кокрановского центрального реестра контролируемых исследований, Cochrane Central Register of Controlled Trials). - М., 2015. - 24 с.Елохина Т.Б., Тютюнник В.Л., Балушкина А.А. Геморрой: принципы терапии в акушерской практике. Русский медицинский журнал. - 2010. -т. 18. - № 4. - с. 200-203.Елохина Т.Б., Тютюнник В.Л., Балушкина А.А. Геморрой: принципы терапии в акушерской практике. Русский медицинский журнал. - 2010. -т. 18. - № 4. - с. 200-203.Allegra C., Bartolo M., Carioti B. et al. An original microhaemorheological approach to the pharmacological effects of Daflon 500 mg in severe chronic venous insufficiency. Int. J. Microcirc. Clin. Exp. - 1995. -vol. 15, Suppl. 1. - p. 50-54.Allegra C., Bartolo M., Carioti B. et al. An original microhaemorheological approach to the pharmacological effects of Daflon 500 mg in severe chronic venous insufficiency. Int. J. Microcirc. Clin. Exp. - 1995. -vol. 15, Suppl. 1. - p. 50-54.Annoni F., Boccasanta P. Treatments of acute symptoms ofhaemorrhoidal disease with 0-(B-hydroxyethyl) -rutosides at high oral doses. Minerva Medica. - 1986 -vol. 77 (37). - p. 1663-1668.Annoni F., Boccasanta P. Treatments of acute symptoms ofhaemorrhoidal disease with 0-(B-hydroxyethyl) -rutosides at high oral doses. Minerva Medica. - 1986 -vol. 77 (37). - p. 1663-1668.Babaikere M.M., Huang H.G., Re W.N. et al. How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World Journal of Gastroenterology. - 2011. - vol. 17 (11). - p. 14481456.Babaikere M.M., Huang H.G., Re W.N. et al. How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World Journal of Gastroenterology. - 2011. - vol. 17 (11). - p. 14481456.Basile M., Gidaro S., Pacella M. et al. Parenteral Troxerutin and Carbazochrome Combination in the Treatment of Posthemorrhoidectomy Status: A Randomized, Double-blind, Placebo-controlled, Phase IV Study. Current Medical Research And Opinion. - 2001. - vol. 17 (4). - p. 256-261.Basile M., Gidaro S., Pacella M. et al. Parenteral Troxerutin and Carbazochrome Combination in the Treatment of Posthemorrhoidectomy Status: A Randomized, Double-blind, Placebo-controlled, Phase IV Study. Current Medical Research And Opinion. - 2001. - vol. 17 (4). - p. 256-261.Basile M., Gidaro S., Pacella M. et al. Troxerutin Carbazochrome Combination Versus Placebo in the Treatment of Posthemorrhoidectomy Symptoms; A Single-Center, Randomized, Double-Blind, PlaceboControlled Study. Current Therapeutic Research. - 2002. - vol. 63 (9). - p. 527-535.Basile M., Gidaro S., Pacella M. et al. Troxerutin Carbazochrome Combination Versus Placebo in the Treatment of Posthemorrhoidectomy Symptoms; A Single-Center, Randomized, Double-Blind, PlaceboControlled Study. Current Therapeutic Research. - 2002. - vol. 63 (9). - p. 527-535.Belcaro G., Cesarone M.R., Errichi B. et al. Pycnogenol Treatment of Acute Hemorrhoidal Episodes. Phytotherapy Research. - 2010. - vol. 24. -p. 438-444.Belcaro G., Cesarone M.R., Errichi B. et al. Pycnogenol Treatment of Acute Hemorrhoidal Episodes. Phytotherapy Research. - 2010. - vol. 24. -p. 438-444.Chauvenet M., Libeskind M. Interest of hemisynthesisdiosmin in the hemorrhoidal crisis: double blipd randomized multicentric trial versus placebo. Revue Francaise de Gastroenterologie. -1994. - vol. 30. - p. 642-647.Chauvenet M., Libeskind M. Interest of hemisynthesisdiosmin in the hemorrhoidal crisis: double blipd randomized multicentric trial versus placebo. Revue Francaise de Gastroenterologie. -1994. - vol. 30. - p. 642-647.Colak T., Akca T., Dirlik M. et al. Micronized Flavonoids in Pain Control AfterHemorrhoidectomy; A Prospective Randomized Controlled Study. Surgery Today. - 2003. - vol. 33. - p. 828-832.Colak T., Akca T., Dirlik M. et al. Micronized Flavonoids in Pain Control AfterHemorrhoidectomy; A Prospective Randomized Controlled Study. Surgery Today. - 2003. - vol. 33. - p. 828-832.Cospite M., Cospite V. Treatment of Haemorrhoids with Daflon 500 mg. Phlebology Suppl. - 1992. -vol. 2. - p. 53-56.Cospite M., Cospite V. Treatment of Haemorrhoids with Daflon 500 mg. Phlebology Suppl. - 1992. -vol. 2. - p. 53-56.Cospite M. Double-Blind, Placebo-Controlled Evaluation of Clinical Activity and Safety of Daflon 500 mg in the Treatment of Acute Hemorrhoids. Angiology June. - 1994. - vol. 6 (2). - p. 566-573.Cospite M. Double-Blind, Placebo-Controlled Evaluation of Clinical Activity and Safety of Daflon 500 mg in the Treatment of Acute Hemorrhoids. Angiology June. - 1994. - vol. 6 (2). - p. 566-573.Debien P., Denis J. Treatment of functional signs of acute hemorrhoidal crisis: A multicenter, randomized, diomine semisynthetic combination Ginkgobiloba extract-heptaminol-troxerutin. Actualites Therapeutiques. - 1996. - vol. 25. -p. 259-264.Debien P., Denis J. Treatment of functional signs of acute hemorrhoidal crisis: A multicenter, randomized, diomine semisynthetic combination Ginkgobiloba extract-heptaminol-troxerutin. Actualites Therapeutiques. - 1996. - vol. 25. -p. 259-264.Derbyshire E., Davies J., Costarelli V. et al. Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. Matern. Child. Nutr. - 2006. - vol. 2. - p. 127-134.Derbyshire E., Davies J., Costarelli V. et al. Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. Matern. Child. Nutr. - 2006. - vol. 2. - p. 127-134.Dimitroulopoulos D., Tsamakidis K., Xinopoulos D. et al. Prospective, Randomized, Controlled, Observer-Blinded Trial of Combined Infrared Photocoagulation and Micronized Purified Flavonoid Fraction Versus Each Alone for the Treatment of Hemorrhoidal Disease. Clinical Therapeutics. - 2005. - vol. 6. - p. 746-754.Dimitroulopoulos D., Tsamakidis K., Xinopoulos D. et al. Prospective, Randomized, Controlled, Observer-Blinded Trial of Combined Infrared Photocoagulation and Micronized Purified Flavonoid Fraction Versus Each Alone for the Treatment of Hemorrhoidal Disease. Clinical Therapeutics. - 2005. - vol. 6. - p. 746-754.Godeberge P. Daflon 500 mg in the Treatment of Hemorrhoidal Disease: A demonstrated efficacy in comparison with placebo. Angiology. - l994. - vol. 45 (6, Part 2). - p. 574-578.Godeberge P. Daflon 500 mg in the Treatment of Hemorrhoidal Disease: A demonstrated efficacy in comparison with placebo. Angiology. - l994. - vol. 45 (6, Part 2). - p. 574-578.Guilhou J.J., Dereure O., Marzin L. et al. Efficacy of Daflon 500 mg in venous leg ulcer healing: a doubleblind, randomized, controlled versus placebo trial in 107 patients. Angiology. - 1997. - vol. 48 (1). -p. 77-85.Guilhou J.J., Dereure O., Marzin L. et al. Efficacy of Daflon 500 mg in venous leg ulcer healing: a doubleblind, randomized, controlled versus placebo trial in 107 patients. Angiology. - 1997. - vol. 48 (1). -p. 77-85.Ho Y.H., Foo C.L., Seow-Choen F. et al. Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy. British Journal of Surgery. - 1995. - vol. 82. -p. 1034-1035.Ho Y.H., Foo C.L., Seow-Choen F. et al. Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy. British Journal of Surgery. - 1995. - vol. 82. -p. 1034-1035.Ho Y.H., Tan M., Seow-Cheon F. Micronized Purified Flavonidic Fraction Compared Favorably with Rubber Band Ligation and Fiber Alone in the Management of Bleeding Hemorrhoids. Diseases of the Colon & the rectum. - 2000. - vol. 43 (l). - p. 66-69.Ho Y.H., Tan M., Seow-Cheon F. Micronized Purified Flavonidic Fraction Compared Favorably with Rubber Band Ligation and Fiber Alone in the Management of Bleeding Hemorrhoids. Diseases of the Colon & the rectum. - 2000. - vol. 43 (l). - p. 66-69.Ibegbuna V., Nicolaides A.N., Sowade O. et al. Venous elasticity after treatment with Daflon 500 mg. Angiology. - 1997. - vol. 48 (1). - p. 45-49.Ibegbuna V., Nicolaides A.N., Sowade O. et al. Venous elasticity after treatment with Daflon 500 mg. Angiology. - 1997. - vol. 48 (1). - p. 45-49.Jiang Z.M., Cao J.D. The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Current Medical Research and Opinion. - 2006. - vol. 22 (6). - p. 1141-1147.Jiang Z.M., Cao J.D. The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Current Medical Research and Opinion. - 2006. - vol. 22 (6). - p. 1141-1147.La Torre F., Nicolai A.P. Clinical Use of Micronized Purified Flavonoid Fraction for the Treatment of Symptoms After Hemorrhoidectomy: Results of a Randomized, Controlled, Clinical Trial. Diseases of the Colon & Rectum. - 2004. - vol. 47. - p. 704-710.La Torre F., Nicolai A.P. Clinical Use of Micronized Purified Flavonoid Fraction for the Treatment of Symptoms After Hemorrhoidectomy: Results of a Randomized, Controlled, Clinical Trial. Diseases of the Colon & Rectum. - 2004. - vol. 47. - p. 704-710.Mentes B.B., Gorgul A., Tatlicioglu E. et al. Efficacy of Calcium Dobesilate in Treating Acute Attacks of Hemorrhoidal Disease. Diseases of the Colon & Rectum. - 2001. - vol. 44 (10). - p. 1489-1495.Mentes B.B., Gorgul A., Tatlicioglu E. et al. Efficacy of Calcium Dobesilate in Treating Acute Attacks of Hemorrhoidal Disease. Diseases of the Colon & Rectum. - 2001. - vol. 44 (10). - p. 1489-1495.Misra M.C., Parshad R. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. British Journal of Surgery. - 2000. - vol. 87. - p. 868-872.Misra M.C., Parshad R. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. British Journal of Surgery. - 2000. - vol. 87. - p. 868-872.Pecking A.P., Fovrier B., Wargon C. et al. Efficacy of Daflon 500 mg in the treatment of lymphedema (secondary to conventional therapy of breast cancer). Angiology. - 1997. - vol. 48 (1). - р. 93-98.Pecking A.P., Fovrier B., Wargon C. et al. Efficacy of Daflon 500 mg in the treatment of lymphedema (secondary to conventional therapy of breast cancer). Angiology. - 1997. - vol. 48 (1). - р. 93-98.Rovenskc J., Stancokovc M., Rovenskc E. et al. Treatment of rat adjuvant arthritis with flavonoid (Detralex), methotrexate, and their combination. Ann. N. Y. Acad. Sci. - 2009. - vol. 1173. - p. 798-804.Rovenskc J., Stancokovc M., Rovenskc E. et al. Treatment of rat adjuvant arthritis with flavonoid (Detralex), methotrexate, and their combination. Ann. N. Y. Acad. Sci. - 2009. - vol. 1173. - p. 798-804.Wijayanegara H., Mose J., Achmad L. et al. A Clinical Trial of Hydroxyethylrutosides in the Treatment of Haemorrhoids of Pregnancy. The Journal of International Medical Research. - 1992. - vol. 20. -p. 54-60.Wijayanegara H., Mose J., Achmad L. et al. A Clinical Trial of Hydroxyethylrutosides in the Treatment of Haemorrhoids of Pregnancy. The Journal of International Medical Research. - 1992. - vol. 20. -p. 54-60.

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