CC BY
24ADVANTAGES AND FEATURES OF MODERN METHODS OF TREATMENT OF HEMORRHOIDS
Moroz P.
Bukovynian State Medical University " Assistant of the Department of Surgery №1, Phd.
Kurchik R.
Bukovynian State Medical University student of the medical faculty №2 Kotelban A.
Bukovynian State Medical University Associate Professor of Department of Pediatric Dentistry, Phd.
Abstract
The prevalence of hemorrhoids in the structure of coloproctological diseases is 34-41%. Despite the improvement of conservative methods of treatment of hemorrhoids, the main method of treatment of this pathology, which gives hope for a radical cure of the patient, is surgery. Surgical treatment is performed in about 30% of patients with chronic hemorrhoids. There are many methods of surgical treatment, which leads to severe pain and discomfort for the patient, increases the cost of treatment and prolongs the period of temporary disability. Among the postoperative complications are: bleeding, severe pain, dysuria, local edema and inflammation.
Keywords: Proctology, Hemorrhoids, Milligan-Morgan operation, electric welding, electrocoagulation.
Hemorrhoids are one of the most common diseases of the rectum. According to some authors [2], the prevalence of hemorrhoids is 130-150 cases per 1000 adults. The high prevalence of hemorrhoids, which is becoming an epidemic in industrialized countries, the defeat of a large number of people of working age, the long period of disability - the reasons why hemorrhoids are unresolved medical and socio-economic problems of mankind. In recent years, many new hemorrhoid treatments have emerged that compete with traditional surgery and each other.
Compared to traditional surgery, biological welding is a less painful and risky procedure. The body receives less stress, so the healing process is much faster.
The main advantages of the method of biological welding of tissues in proctology are: reduction of the rehabilitation period, there is no need for a painful process of suturing; safe minimally invasive intervention; reducing the risk of infections; reduction of blood loss of the patient to 50%; elimination of the risk of tissue necrosis; elimination of the risk of suppuration; reducing the duration of the operation by 20%.
Performing electrosurgical hemorrhoidectomy using modern LigaSure technique, due to the small spread of the damaged area and the absence of sutures in the vaginal area, leads to a reduction in pain, no bleeding and swelling of tissues, accelerated wound healing, shortening the duration of treatment and time.
The mechanism of action on tissues is the melting of collagen and elastin. The strength of the "brewed zone", consisting of partially denatured protein, is comparable to the strength of the stitched fabric.
The use of high-frequency currents for hemorrhoidectomy with a high-frequency electrocoagulator. The technique of performing surgical interventions does not differ from the classic hemorrhoidectomy according to Milligan-Morgan, it is different to use additional tools for it. The main tool is a bipolar clamp, which is used for both cutting and coagulation of tissues. In this device, the "cutting" mode for crossing the
perianal skin and the "overlapping" mode for crossing the rectal mucosa were used [4].
The use of high-frequency currents creates good conditions for open hemorrhoidectomy without suturing wounds, which in turn reduces tissue tension and reduces pain in the postoperative period. The use of high-frequency electrocoagulant in some cases leads to the formation of a zone of coagulation necrosis of the postoperative wound, which increases the risk of postoperative bleeding and creates unfavorable conditions for rapid postoperative healing [4].
There are publications in the literature on the use of an ultrasonic harmonic scalpel, the principle of its operation is based on the oscillation of the working nozzle, which leads to the destruction of hydrogen compounds in the protein structures of collagen and their bonding. The formed coagulate reliably obturates the lumen of blood vessels up to 5 mm in diameter, while the depth of thermal exposure is limited to 1.5 mm [5]. When performing this operation, the principle of GE according to Milligan-Morgan is preserved: after opening the anoderm and mucous membrane of the anal canal around the external and internal hemorrhoids with an ultrasonic scalpel using (alternately) coagulation and cutting mode is excision of cavernous tissue. The vascular leg of the hemorrhoid is not sutured, but intersects in the coagulation mode. The formed wound surfaces are sutured or conducted openly depending on the accepted tactics [6].
Ultrasound dissection and coagulation have improved the results of surgical treatment of patients with stage III - IV hemorrhoids. Absence of foreign bodies (ligatures, etc.) in the area of operation, low trauma and reliable hemostasis are the main advantages of ultrasonic hemorrhoidectomy over traditional methods of surgical treatment [7].
Thus, there are a large number of different techniques for the treatment of hemorrhoids, including typical hemorrhoidectomy is used very often, but numerous studies indicate a high level of postoperative complications, which requires the introduction of new
techniques for chronic hemorrhoids. Biological soft tissue welding technology, coagulation and the use of ultrasound are widely used in many areas of surgery.
Every year, technologies are improved, new elec-trosurgical instruments are created, which will be aimed at reducing the rehabilitation period of patients, reducing pain after surgery and other postoperative complications, as well as reducing the time of surgery and will be cost-effective. Coloproctologists are developing new techniques to improve the results of radical operations, with the improvement of functional results in the postoperative period. Surgeons are trying to improve the techniques they use now, or implement the latest, because the issue of hemorrhoidectomy for many years remains relevant and there is no "gold standard" in the treatment of chronic hemorrhoids.
References
1. Денисенко В. Л. Лигирование геморроидальных артерий под контролем ультразвуковой допплерометрии / В. Л. Денисенко [и др.] // Достижения фундаментальной, клинической медицины и фармации: материалы 65-й науч. сес. сотр. ун-та, 24-25 марта 2010 г. - Витебск: ВГМУ, 2010. - С. 2526.
2. «Клиническая колопроктология» под ред. Г. И. Воробьева. — М.: Медицинское информационное агентство, 2006. — 431 с.
3. Березницький Я. С. Результати хiрургiчного лшування пащентш на хрошчний геморой за допо-могою електрокоагуляци бюлопчних тканин / Я. С. Березницький, В. П. Сулима // Науковий вюник Уж-городського ушверситету. Сер. : Медицина. - 2014.
- Вип. 2. - С. 34-36.
4. Богуш А.£. «Порiвняльна характеристика сучасних модифжацш операцп Мшиган--Моргана в лтувант ускладненого геморою» / А. £. Богуш, П. В. Соломчак // Галицький лжарський вюник. - 2016.
- Т. 23, число 3(1). - С. 15-17.
5. Haveran L.A., Sturrock P.R., Sun M.Y., McDade J., Singla S., Paterson C.A. et al. Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative toconventional hemorrhoidectomy. Int J Colorectal Dis. 2007;22:801-806.
6. Соломчак П. В. Ошгашзащя комплексного лшування хворих на хротчний геморой. Дисерта-щя, 1вано-Франшвськ, 2020. С. 32-33.
7. Щвенко О. I. Електрохiрургiчна i ультразву-кова дисекщя та коагулящя при операциях на шлу-нково-кишковому тракп (експериментально- клшь чне дослiдження). Автореферат, Харшв, 2009; 27 с.
ВТОРИЧНАЯ ПРОФИЛАКТИКА ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК: РЕНОПРОТЕКТИВНЫЙ ПОТЕНЦИАЛ БЛОКАТОРА РЕЦЕПТОРОВ АНГИОТЕНЗИНА II -
ТЕЛМИСАРТАНА
Муркамилов И. Т.
Кандидат медицинских наук, и. о. доцента, Кыргызская государственная медицинская академия им. И.К. Ахунбаева,
г. Бишкек, Кыргызстан ОЯСЮ:0000-0001-8513-9279 Фомин В.В.
Доктор медицинских наук, профессор, член-корреспондент РАН, ФГАОУ ВО Первый МГМУ им. И.М. Сеченова (Сеченовский Университет),
г. Москва, Россия ОЯСЮ: 0000-0002-2682-4417 Кудайбергенова И.О. Доктор медицинских наук, профессор, Кыргызская государственная медицинская академия им. И.К. Ахунбаева,
г. Бишкек, Кыргызстан 0ЯСЮ:0000-0003-3007-8127 Счастливенко А.И.
Кандидат медицинских наук, доцент, Витебский государственный ордена Дружбы народов медицинский университет, г. Витебск, Беларусь ОЯСЮ: 0000-0002-0779-0776 Юсупов Ф.А. Доктор медицинских наук, профессор, Медицинский факультет ОшГУ, г. Ош, Кыргызстан ОЯСЮ: 0000-0003-0632-6653
