Hemoroid - hemorrhoids - hemorrhoids

He maʻi laha loa ka hemorrhoids, akā ʻaʻohe mea e kamaʻilio e pili ana.

He aha ka hemorrhoids? 

Hemorrhoids - hemorrhoids - he mau nodular dilations o nā kīʻaha koko i loko o ka rectum, i hoʻolako ʻia e ke aʻa waena me ke koko kiʻekiʻe. ʻAʻole ʻo ka hemorrhoids nā moku anal maʻamau, kahi e hoʻopaʻa ai i ka hoʻoponopono ʻana i ka pehu. ʻO ka hemorrhoids nā moku ʻāʻī kahiko, hiki ke alakaʻi i ka prolapse o ka ʻōpū a alakaʻi i ka leakage a me ka huna ʻana o ka mucus. ʻO ka hopena, ʻo ka hemorrhoids ke kumu i nā hōʻailona e like me ka oozing, ka ʻili o ka ʻili, ke kuni ʻana, ka ʻili a me ke koko i kekahi manawa. Ma ka ʻōlelo ʻenehana, ua kapa ʻia nā hemorrhoids waho he "perianal veins". ʻO ka thrombosis perianal a i ʻole ka thrombosis vein anal kahi puʻupuʻu ʻeha i loko o ka ʻāʻī e koi koke i ka lāʻau lapaʻau.

Nā kumu o ka hemorrhoids

ʻAʻole maopopo loa ke kumu o ka hemorrhoids. ʻO ke kumu nui ke ʻano o ka noho ʻana a me ka lawa ʻole o ka lawe ʻana i ka fiber. ʻO nā meaʻai fiber kiʻekiʻe e like me ka granola, ka salakeke, ka oatmeal, a me ka bran palaoa kekahi ʻāpana o ka meaʻai olakino, akā ʻaʻole nā ​​kānaka a pau e hahai iā lākou. Hiki i nā genetic predispositions ke pāʻani i kahi hana i ka ulu ʻana o nā hemorrhoids.

Hemorrhoids - ma mua a ma hope o nā kiʻi

E aʻo hou ma o nā kiʻi a me nā kiʻi ma mua-hope e pili ana hemorrhoids,  nā aʻa perianal, ma mua a ma hope o nā kiʻi o ka hemorrhoids laser surgery (LHPC)  a ka mālama ʻana i ka hemorrhoid laser, like loa me ʻO ka lāʻau laser perianal vein a ʻO ka lāʻau laser perianal thrombosis ma ka HeumarktClinic ma Cologne me Dr. Haffner.  

Nā hōʻailona o ka hemorrhoids?

Hiki i nā hemorrhoids i kēlā me kēia ʻano ke hoʻoulu pinepine i ke koko a me ka ʻili ma ka ʻāpana anal. Loaʻa pinepine nā pilikia me ka neʻe ʻana o ka ʻōpū. ʻO ka poʻe maʻi me ka hemorrhoids e hele pinepine i ka lua i ka lālani a ʻaʻole hiki ke hoʻokaʻawale i nā mea āpau i ka manawa hoʻokahi. ʻO ka constipation, ke kaumaha a me ka ʻeha kekahi mau hōʻailona maʻamau. Hiki ke hoʻopili ʻia ka ʻōpala, akā ʻokoʻa kēia me ka incontinence fecal. Me ka hemorrhoids, ʻaʻole hiki mai ka fecal incontinence maoli no ka mea ʻaʻole i pale wale ka sphincter hohonu i ka hemorrhoid mai ka prolapse, akā pale pū kekahi i ka fecal incontinence. Eia naʻe, ʻaʻole hiki i kēia pale muscular i hāʻawi ʻia e nā ʻiʻo o ka papahele pelvic hohonu ke pale i ka pilikia o ka hoʻomau maikaʻi ma ka ʻaoʻao anal. ʻO ka lawa ʻole o ka anal i loko o ka puka anal a laila alakaʻi i nā hōʻailona hemorrhoid maʻamau e like me ka oozing, ka ʻili, ka wela a me ka hamo. ʻO ka "perianal veins," i ʻike ʻia he "varicose veins of the rectum" a i ʻole nā ​​hemorrhoids waho, he pilikia no ka mea hiki ke alakaʻi i ka thrombosis perianal, thrombosis vein anal, a i ʻole nā ​​waimaka liʻiliʻi e kahe ana ke koko a ʻeha a ma muli o ka Hemorrhoid lalo. paʻakikī ka maʻi e hoʻōla.

ke koko mai ka rectum

Wahi a nā alakaʻi S3, ʻo ka hōʻike maʻamau o ka hemorrhoids ʻo ke kahe koko mai ka rectum. Wahi a nā alakaʻi, ʻaʻole i hahai ka pinepine a me ka paʻakikī o ke koko i ke ʻano o nā hemorrhoids i ʻōlelo ʻia ma luna. Hiki ke kahe koko mai ka rectum me nā hemorrhoids li'ili'i a ho'āla pono i nā poʻe maʻi i ka wā mua o ka maʻi hemorrhoid. No ka mea, ʻaʻohe mea makemake e noho me ke koko mai ka ʻāʻī, lapaʻau, e.g. B. me ka ʻoki ʻana i ka laser, ua hōʻike mua ʻia no nā hemorrhoids liʻiliʻi inā he koko a i ʻole nā ​​hōʻailona ʻē aʻe. He ʻulaʻula ʻulaʻula maʻamau ka hemorrhages mai ka arterial vascular conglomerates i lilo i hemorrhoids. Hiki ke li'ili'i ke koko, akā hiki ke kaumaha loa a hā'ule. No ka mea hiki i ke kino o ke kanaka ke pani mau i ka rectum mahalo i nā ʻiʻo sphincter ikaika, ʻohi mua ke koko i ka ampulla o ka rectum. A laila hiki ke hāʻawi ʻia i nā mea nui e like me ka ʻulaʻula ʻeleʻele stool. Hiki ke koko ʻulaʻula ʻeleʻele nā ​​veins perianal e kahe ana mai kahi waimaka anal. He mea nui e ʻike ʻo ka hōʻailona mua o ka maʻi maʻi ʻaʻai a me ka rectal e kahe mau ana ke koko. No laila, i ka hihia o ke koko mai ka rectum, pono koke e kipa aku i kahi proctologist ma Cologne a pēlā e loaʻa ai ka maʻi wikiwiki loa me ka ʻole o ka hoʻomākaukau ʻana i ka manawa. ʻO nā mea a pau e pono ai, ʻo ka hoʻokuʻu ʻia ʻana o ka stool ma ka home ma mua o ka hoʻokolokolo a me ka hoʻomaʻemaʻe maʻemaʻe.

Perianal eczema - ʻeha perianal

Ua kapa ʻia kahi ʻili hoʻonāukiuki mau a me nā mea ʻawaʻawa ma ka anus. Hoʻomaopopo ka proctologist mālama i ka ʻili ʻulaʻula keʻokeʻo e hōʻike ana i nā ʻeha liʻiliʻi a ʻoi aku ka nui a me nā māwae. Ua pehu ka ʻili perianal, e hōʻike ana i ka piʻi ʻana o ka wrinkling a me nā mea hoʻohui ʻili i kapa ʻia he ʻili ʻili. Hiki ke hana ʻia ka maʻi e ke kauka ʻohana ma o ka nānā ʻana me ka ʻole o ka hoʻokolokolo hou ʻana: ʻike ke kauka mālama i kahi ʻili keʻokeʻo-ʻulaʻula a uhi ʻia, ʻeha a wrinkled ma kahi o 2-6 cm a puni ka rectum. I ka hohola ʻana i ke auwai anal, ʻike ʻia ka huʻi ʻana o ka pehu, ka ʻūhū, ka makū, a i ʻole kekahi manawa. Hoʻohana kekahi mau maʻi i ka cream i nā manawa a pau. Inā he maʻi me ka ʻailatem Inā hele mai ka rectum i ka proctologist, ua hōʻike mua kēia i ka hemorrhoids holomua.

ʻO ka ʻūhā anal, ʻūhū a me ka ʻā ʻana ma ka ʻāʻī

ʻO nā hōʻailona o ka hemorrhoids, e like me ka ʻili, ka wela, ka ʻeha a me ka ʻeha ʻana i ka ʻāʻī, e ala mai ma muli o ka lawa ʻole o ka anal kahi i hiki ʻole ai i ka rectum ke pani piha a maloʻo. Hoʻopilikia kēia i ka ʻili, e like me ka maʻi maʻi nui, kahi e hoʻonāukiuki nui ai ka ihu i ka ʻili olakino a maloʻo ma mua. ʻOiai ʻaʻole i paʻa loa ka rectum ma muli o ka hemorrhoids, ua lawa ia i kahi liʻiliʻi liʻiliʻi mai ka anal canal, i uhi ʻia me ka mucous membrane, e komo mau i ka ʻili maloʻo mua a hamo. Hoʻouka ʻia ka ʻili maloʻo a maikaʻi i ka puka anal, ʻeha, ʻeha a pehu, kahi e alakaʻi ai i ka ʻili a me ke ahi. No laila, ʻaʻole pono e loaʻa ka "stool incontinence" e ʻike i ka ʻeha a me ka wela i ka ʻāʻī. ʻOiai inā hiki i ka rectum ke paʻa i ka ʻāʻī, hiki ke pani pono ke kenimika hope o ka puka anal inā ʻaʻole hiki ke pani piha ʻia ma muli o ka hemorrhoids prolapsed. ʻO kēia ke kumu e pakele ai ka mucus a me ka maʻemaʻe mai ka mucous membrane maʻamau, kahi e alakaʻi ai i ka ʻili o ka ʻili maʻamau o waho, ʻaʻole hiki ke ʻae i ka mucus i ka wā lōʻihi.

hanana o ka hemorrhoids

ʻO ka hoʻonohonoho ʻana o Goligher i nā hemorrhoids i kuhi hewa ʻole ʻo ka hemorrhoids ke kumu hoʻokahi wale nō pilikia, ʻo ka prolapse. Hāʻawi kēia hana kahiko i ka manaʻo e pili wale ana ke koʻikoʻi o ka maʻi hemorrhoid a me nā hōʻailona pili i ke kiʻekiʻe o ka hemorrhoid prolapse kūloko. ʻAʻole i noʻonoʻo ʻia nā hemorrhoids waho, ka thrombosis o nā hemorrhoids o waho, ka lawa ʻole o ka anal, nā maʻi hoʻomau maikaʻi, ke koko, ka makū a me ka ʻili a me ka ʻili eczema. ʻO ke alakaʻi alakaʻi S3 ma Kelemānia ua hoʻohana i kēia hoʻolālā kahiko a hōʻike i nā hōʻailona hōʻailona e pili ana i kēia hana ʻana o ka hemorrhoids. ʻO ka hana ʻana o Goligher o nā hemorrhoids e noʻonoʻo wale ana i ka hiki ʻana o nā hemorrhoids kūloko. I loko o nā keʻena proctological, akā naʻe, hōʻike pinepine nā mea maʻi me ka hui pū ʻana o nā hemorrhoids i loko a me waho a me nā hōʻailona ʻili, hiki ke manaʻo ʻia he puʻupuʻu ma ka anus a keʻakeʻa i ka hoʻomaʻemaʻe anal a me ka hemo. Ke loaʻa ka thrombosis o nā hemorrhoids o waho a i ʻole ka huhū mau o nā ʻili ʻili ma ka piko o ka prolapse, makemake pinepine nā mea maʻi i kahi wehe haʻahaʻa a me ka ʻeha ʻole, me ka nānā ʻole inā he pae II a III paha ka hemorrhoids kūloko. Ma kahi o 90-95% o nā poʻe maʻi e ʻimi i ke kōkua ma muli o kahi puʻupuʻu palpable i loko o ka rectum e hōʻike ana ma ke ʻano he thrombosed perianal vein. Ma kahi o 10% wale nō o nā poʻe maʻi e ʻimi i ke kōkua no ka hemorrhoids prolapsed i kekahi manawa pono e hoʻokuʻu ʻia me ka manamana lima. ʻO nā hōʻailona ʻili e like me nā puʻupuʻu ma ka anus kahi kumu maʻamau no ke kipa ʻana i ka proctologist, a makemake ka hapa nui o nā maʻi i ka lapaʻau ʻana me ka ʻoki ʻole, e.g. B. ma ka hana laser.

haehae anal

Hiki i nā waimaka anal ke loaʻa ma muli o ke kīkoʻo koʻikoʻi a i ʻole, me ka ʻole o ka ʻeha o waho, mai ka ʻili a me ka mucosa i palupalu a ʻā. Hiki ke ʻike ʻia nā waimaka ma ka puka anal e like me nā waimaka anal maʻamau a me nā waimaka liʻiliʻi a me nā ʻeha a puni ka ʻāʻī. ʻO ka ʻili i hoʻā ʻia, nā māwae a me nā ʻeha he ʻeha loa i ka manawa a me ka hoʻopā iki. Ma muli o ka hōʻiliʻili ʻana o ke koko i loko o ka hemorrhoids a me nā veins perianal, hoʻomāhuahua ka mucous membrane e like me ka baluna. A laila, nahaha ka mucous membrane puʻupuʻu e like me ka baluna i ka wā e ʻakaʻaka ai ka waihona. ʻO ka ʻili perianal inflamed a eczematous ʻoi aku ka liʻiliʻi ma mua o ka ʻili olakino. No laila, hiki i ka hemorrhoids ke hana i ka waimaka anal ma muli o ka pōʻino o ka ʻili a me ka ʻili a me ka mucosa ʻili lahilahi. Ma ka HeumarktClinic Proktologie ma Cologne, ʻaʻohe hana traumatizing e hoʻonāwaliwali ai i ka ʻiʻo sphincter a, e like me nā pepa ʻike proctology i ʻōlelo ʻia ma Kelemania, hiki ke lilo i ʻāpana o ka papahana ʻokiʻoki no nā proctologists maikaʻi loa ma Cologne. No ka mea, ʻaʻole he maʻi ka waimaka anal i kona pono ponoʻī, akā he hopena o ka hemorrhoids, pono e mālama ʻia ma ke ʻano o ka maʻi hemorrhoid lalo. A me ka ʻoki ʻole, nā pahi a me nā ʻoki, akā me ka radiation laser i ka HeumarktClinic proctology ma Cologne. ʻO ka mea nui, ʻaʻole ʻōlelo ʻia ka ʻoki ʻana a i ʻole ka ʻoki ʻana i ka ʻiʻo sphincter i ka pepa ʻike a me ka ʻoki ʻana i ka waimaka.

Eha ma ka anus a me ka rectum

ʻAʻole ʻeha ka hemorrhoids iā lākou iho! Hele pinepine mai ka poʻe maʻi i kā mākou kūkākūkā proctology pilikino ma Cologne i kahaha i ka wā e haʻi aku ai ka proctologist iā lākou ua prolapsed hemorrhoids, ka mea e hoʻoulu ai i ka makū, ka ʻāʻī, ka ʻāʻī a me ke ahi a koi koke i ka mālama invasive. Ma muli o ka ʻeha ʻole o ka hemorrhoids, ua ʻae pinepine ʻia lākou, ʻoiai inā ua hāʻule lākou i ka wā o ka neʻe ʻana o ka ʻōpū a i kekahi manawa pono e hoʻihoʻi ʻia. Ua maʻa ka poʻe maʻi i ke ʻano o ko lākou ʻāʻī ponoʻī, ʻoiai ke loli mālie nei ke ʻano i nā makahiki he nui a hiki ke uku ʻia e nā ʻiʻo sphincter ikaika. He mea kupanaha i ka proctologist ka nui o nā maʻi i ʻike ʻole i ka eczema a me ka mumū o ka ʻili perianal. ʻAʻole manaʻo ka nui o ka poʻe i ka maʻi i kekahi manawa akā hele me ka "ʻaila hemorrhoid maikaʻi". ʻAʻole ʻike kekahi poʻe i ka laha ʻana o ka mumū i ka iwi huelo a i mua paha o ka scrotum i nā kāne a i ka wehe ʻana o ka wahine. ʻAʻole ʻike ka nui o ka poʻe i ko lākou hilinaʻi ʻana i ka ʻaila hemorrhoid ma ke ʻano he maʻi a manaʻo lākou ʻo ka ʻili wale nō ka mea e ʻoki liʻiliʻi.

ʻili ʻili

ʻO nā ʻili ʻili he mau ʻili ʻili a i ʻole flaps ma ka puka anal waho, ma kahi o ka anus. ʻAʻole like me nā mea hoʻopili mucous membrane a i ʻole polyps i loko o ka ʻōpū a i ʻole canal anal, ʻo nā ʻili ʻili he ʻili ʻili. Hiki ke hoʻokumu ʻia nā hōʻailona ʻili e kekahi mau kumu, me ka prolapse mucosal, microthrombosis o nā veins perianal, a i ʻole ka hui pū ʻana o nā mea ʻelua. ʻO ka huhū o ka ʻili ma muli o ka maʻemaʻe a me ka hoʻopau ʻana i ka hoʻomau maikaʻi ʻana e kōkua pū i ka hoʻokumu ʻana i nā ʻili ʻili. Hiki i nā ʻili ʻili ke pilikia i nā poʻe he nui, ʻoi aku ka maikaʻi no nā kumu nani, ʻoiai inā ʻaʻole ia e hōʻeha. Inā hele mai ka mea maʻi i ke keʻena proctology ma Cologne ma muli o ka ʻeha nui, 90% o ka poʻe i hoʻopilikia ʻia ua loaʻa i ka waimaka anal ʻeha nui. E like me ka mea i haʻi mua ʻia, ʻaʻole hiki mai ka waimaka me ke kumu ʻole, akā ke kumu ʻia e nā veins perianal haehae i hoʻokumu ʻia e ka haʻalulu kiʻekiʻe a i ʻole ka pōʻino, ka ʻili anal inflamed i ka lawa ʻole a me nā hemorrhoids. ʻO ka ʻeha koke a me ka hiki ʻana mai o kahi nodule hemorrhoidal palpable ma ka rectum e hōʻike ana i ka thrombosis o nā hemorrhoids a i ʻole nā ​​veins perianal.

ʻO ka spasm anal a me ka maʻi hoʻomau

ʻO ka spasm anal a Lord he hōʻailona maʻamau o ka hemorrhoids i mālama ʻia me kahi dilator anal i ka wā o ka mea hana. ʻOiai i kēia mau lā, hoʻohana mau ʻia nā anal dilators i ka wā e paʻa ai ka rectum a ma kekahi ʻaoʻao e hōʻeha ai i ka ʻeha nui, i kekahi manawa i kapa ʻia ʻo "proctalgia fugax", a ma kekahi ʻaoʻao e alakaʻi ai i ka hoʻopau ʻana i ka hoʻokaʻawale ʻana. I ka pōkole, ʻaʻole hiki ke wehe pono ka rectum a no laila ʻaʻole hiki ke hoʻokaʻawale loa. E nīnau paha kekahi no ke aha i manaʻo ʻia ai ka spasm anal a me ka leaka anal he mau hiʻohiʻona o ka hemorrhoids. Nawaliwali a lawa ʻole paha nā ʻiʻo rectal? Penei ka wehewehe ana: Ma ka proctology ma Cologne, aole makou e olelo no ka sphincter, aka, no ka sphincters. Hiki ke hoʻokaʻawale ʻia nā sphincters i ʻelua mau pūʻulu ʻiʻo nui i loaʻa nā hana like ʻole a me nā hana e pili ana i ka hoʻomau.

A/ Hoʻomau maikaʻi: kuleana = ʻāwīwī pāpaʻa (shincter waho, sphincter kūloko)

I loko o nā hemorrhoids, hiki ke hōʻike ʻia ka nāwaliwali o nā ʻiʻo anal superficial e ka manometry anal. ʻO ke kumu o kēia aia ma ka hāʻule ʻana o nā hemorrhoids i loko o ka anal canal, ʻo ia ka hopena o ka waiho ʻana o ka anal canal i wehe ʻia a ʻaʻole hiki i nā ʻiʻo ke paʻa i ke kaomi o ka hemorrhoids. Ke alakaʻi nei kēia i kahi haunaele o ka hoʻomau maikaʻi ʻana, i hōʻike ʻia e ka makū, lubrication a me ka ʻili. Inā wehe ʻia nā hemorrhoids me ka laser, HAL, RAR, a me nā mea ʻē aʻe me ka ʻoki ʻole ʻana, hiki ke pani maikaʻi ʻia ka rim anal a hiki ke hoʻōki i ka makū a me ka ʻili. I kekahi manawa, koi ʻia kahi hoʻomaʻamaʻa endo-anal biofeedback hou o nā ʻiʻo anal, i hana ʻia ma o ka hoʻomaʻamaʻa papahele pelvic a i ʻole me ke kōkua o kahi mea hoʻoulu.

B/ Ka hoʻomau ʻana: kuleana = nā sphincters hohonu (m. puborectalis, levator ani)

Hoʻopaʻa ʻia nā sphincters hohonu e pani ʻia ka ʻaoʻao o luna o ka rectum me ka noʻonoʻo i ka wā o ka hemorrhoid. Wahi a ka Haku, ʻo ka ʻūhā mau a me ka spasm o nā sphincters hohonu me ka haunaele i ka defecation ma muli o ka paʻa ʻana o ka wehe ʻana o ka anal kekahi o nā hōʻailona maʻamau o ka hemorrhoids holomua, ʻoiai inā hiki ke hoʻihoʻi ʻia ka hemorrhoids me ka manamana lima a ʻaʻole paha. ʻO ka lāʻau lapaʻau no nā hemorrhoids kiʻekiʻe me ka spasm anal, no laila, ʻo ka hohola ʻana i nā ʻiʻo hohonu (levator a me puborectalis) a me ka wehe ʻana i nā hemorrhoids ma ke ʻano o ka hana hemorrhoid. Inā ʻaʻole kēia e hoʻomaikaʻi i ka wā lōʻihi, hāʻawi ka HeumarktClinic Proktologie ma Cologne i kahi hoʻokele kūikawā, alakaʻi ʻia i ka ultrasound, i kuhikuhi ʻia o kahi mea hoʻomaha muscular i loko o nā ʻiʻo o ka papahele pelvic hohonu e hoʻomaha ai i ka spasm no ka liʻiliʻi o 6 mau mahina a hiki ke hoʻokuʻu maʻamau. .

lawa ole anal

ʻO ka lawaʻole o ka anal, ʻo ia hoʻi kahi maʻi o ka hoʻomau maikaʻi. Wahi a ke alakaʻi alakaʻi S3 o nā hui ʻoihana Kelemania no ka proctology a me ka colon-proctology, ʻo ka hemorrhoids prolapsed alakaʻi i ka moist a i kekahi manawa ʻo ka fecal secretion, kahi hiki ke ʻike mua ʻia he oozing, akā ma hope e like me ka stool smearing a hiki i ka hopena ke alakaʻi i ka lepo lepo. ʻO ka makū mau e hoʻonāukiuki mau i ka ʻili perianal. ʻAʻole hiki ke hoʻomaopopo ʻia ʻaʻole i hāʻawi ʻia ka hoʻomaʻemaʻe anal maloʻo a ʻaʻole lubricating a ʻaʻole i ʻike ka poʻe he nui i nā ʻāpana o ka ʻeke ma ko lākou lole komo he hōʻailona he mea hewa i ka rectum. ʻO ka huaʻōlelo "anal insufficiency" - fine continence disorder - he huaʻōlelo haole ia i ka lehulehu, ʻo ia hoʻi "ʻaʻole pili iaʻu" no ka mea "hiki iaʻu ke hoʻomalu i koʻu waihona".

Perianal thrombosis - anal thrombosis

ʻO ka thrombosis perianal, a i ʻole ka thrombosis vein anal, hiki i ka wā e paʻa ai ke koko paʻa i loko o nā aʻa i hoʻopalahalaha ʻia ma ka lihi o ka ʻāpana anal. Hoʻokumu ʻia kahi puʻupuʻu ʻeha ma ka lihi o ka anus. He mea ʻeha ka noho ʻana a me ka ʻai ʻana. Nahaha pinepine nā thromboses perianal a hiki ke kahe ke koko. ʻO ka ʻeha, ka puʻupuʻu palpable a me ke koko e hoʻolalelale i nā poʻe maʻi e ʻimi i ka lāʻau lapaʻau wikiwiki. He mea nui ia e ʻike i ka thrombosis ma ka ʻaoʻao anal he hōʻailona ʻike wale ʻia o nā hemorrhoids kūloko. Ma nā ʻāina ʻōlelo Pelekania, ʻokoʻa ka ʻokoʻa ma waena o nā hemorrhoids waho a me loko, e hōʻike ana i ʻelua ʻāpana o ka maʻi hemorrhoidal. Me ka ʻole o ka hemorrhoids i loko, ʻaʻole i hana ʻia nā hemorrhoids waho a ʻaʻohe thrombosis o nā veins perianal ma ka ʻāpana anal. I kekahi manawa hiki mai ka thrombosis o nā hemorrhoids o loko a me waho, hiki ke ʻeha loa a koi i ka mālama proctological wikiwiki.

He aha ka mea e hana ai me ka hemorrhoids 

Inā loaʻa iā ʻoe nā hōʻailona e like me ka ʻāʻī ʻana, ka ʻā ʻana, ka hamo ʻana a i ʻole ke kahe ʻana o ke koko ma ka ʻāpana anal, pono ʻoe e kipa i kahi loea i ka proctology ma Cologne e nānā i kāu rectum a e hoʻokō ʻia nā diagnostics kumu a me ka nānā ʻana i ka maʻi kanesa. Ma hope o ka hoʻokolokolo ʻana, hiki iā ʻoe ke loaʻa i nā ʻōlelo aʻo e pili ana i nā ʻano lapaʻau like ʻole, me nā ʻano conservative e like me ka rubber band ligation, sclerotherapy, freezing, a me nā ʻano hana e like me ke ala HAL, THD, RAR method, submucosal ligation a me ligature excision. I kā mākou hoʻomaʻamaʻa no ka proctology ma Cologne hoʻomaka mākou i ka wehewehe ʻana i nā lāʻau lapaʻau me ka laser therapy no ka mea ua maopopo mākou ʻo ka laser ke ala maikaʻi loa. Me ke kōkua o ka ʻenehana laser, hiki ke hoʻokō ʻia kahi mālama pani ʻole ʻole o ka hemorrhoids me ka ʻole o nā ʻoki ʻoki nui.

ʻO ka LHPC - Laser Hemorrhoids Plastic Surgery

Ua hoʻomaka mākou i ka ʻokiʻoki ʻana i ka hemorrhoid laser ma kahi o ʻekolu mau makahiki i hala ma hope o kā Dr. (H) Ua hoʻopau ʻo Haffner i kahi papa hana ʻoki laser ma Bio-Litec. I ka mua, ua hana mākou i ke ʻano e like me nā ʻōlelo aʻoaʻo ma ka pūnaewele LHP o Bio-Litec. I ka wā o ka mālama ʻana, akā naʻe, ua maopopo ka hiki ke hoʻohana ʻia ka kukuna laser ma kahi ʻano ʻokoʻa i mea e loaʻa ai nā hopena maikaʻi aʻe. Ua hoʻololi mākou i ke ʻano a me nā mea hana e like me ia. Ua kūkulu ʻia ke ala hou ma lalo o ka inoa inoa ʻo Laser Hemorrhoids Plastic Surgery (LHPC). Ua hoʻomohala ʻia ke kumu o ka LHPC ma o ka noiʻi hoʻokolohua holoholona me ka hui pū me ka Experimental Surgical Institute o ke Kulanui o Semmelweis. ʻO kēia ke ʻano o ke ʻano laser hou o ka ʻoki ʻana i ka hemorrhoid e like me LHPC, Laser Hemorrhoids Plastic Surgery ma Cologne, i lilo i mea lapaʻau maʻamau no nā ʻano āpau a me nā pae o ka hemorrhoids i kā mākou hana.

Nā pōmaikaʻi o ka LHPC:

- ʻAʻohe ʻoki - ʻaʻohe maʻi hoʻōla ʻeha - ʻaʻohe ʻeha
- Hoʻoikaika ma mua o ka hoʻonāwaliwali i ka sphincter
- Hoʻomaikaʻi i ka defecation i hoʻohālikelike ʻia ma mua
- ʻOi aku ka maikaʻi o ka hoʻomau ʻana ma mua
- Ke komo koke ʻana i ka nohona

Ma mua o ke koho ʻia ʻana no ka LHPC, e hana ʻia kahi hoʻokolokolo mua me ka ultrasound, kahi e hōʻike ʻia ai ka pūnaewele holoʻokoʻa o nā ʻaʻa a me nā veins a wehewehe ʻia kāu mau hōʻailona kikoʻī. Hana ʻia ka ʻoki ʻana i ka hemorrhoid laser ma kahi maʻi maʻi ma lalo o ka anesthesia pōkole pōkole a i ʻole ka hiamoe pō. ʻO ka anesthesia kūloko me ka hoʻohana ʻana i ka ʻenehana tumescent ua lawa wale ia no nā hemorrhoids liʻiliʻi.

LHP laser hemorrhoidoplasty

Hoʻokumu ʻia ka LHP Laser Haemorrhoidoplasty**** mua ma ke ālai ʻana i nā aʻa e hoʻolako ana i nā hemorrhoids me ka manaʻolana e hopena kēia i ka hemorrhoids. ʻekahi haʻawina lāʻau lapaʻau i ka LHP ma USA ma ʻO ClinicalTrials.gov  ma ka helu NCT03322527 DE PARADES Vincent, MD ma 2018 ua hana ʻia, akā ʻaʻohe hopena i loaʻa i kēia manawa. Eia naʻe, ua paʻi ʻia nā puke ʻē aʻe ma ka LHP me nā hopena maikaʻi. ʻO ke alakaʻi alakaʻi German S3, e like me ka mea i ʻōlelo ʻia i loko o ka puke pai lāʻau lapaʻau, ke paipai nei i ka ʻoki kuʻuna a me nā ʻokiʻoki no ka mālama ʻana i nā hemorrhoids kiʻekiʻe, no ka mea, he kakaikahi wale nō nā paʻi a me nā haʻawina hoʻopaʻa ʻia e pili ana i nā ʻano hawewe lekiō a me ka lekiō, ʻoiai nā paʻi a me nā mea kākau e hōʻike i nā hopena maikaʻi. 

HAL, THD a me RAR

ʻO HAL, THD a me RAR nā ʻano lapaʻau proctological e pili ana i nā ʻenehana humuhumu kūikawā. ʻO ka manaʻo kumu o nā ʻano hana a pau e hōʻemi i ka hemorrhoids ma ka ʻoki ʻana i ke koko. Ma ke kaʻina hana HAL, loaʻa kahi aʻalolo hoʻokahi me kahi ʻimi ultrasound Doppler a hoʻopaʻa ʻia me kahi ligature. Me ke ʻano THD, ua hoʻopaʻa ʻia nā aʻa koʻikoʻi a pau o ka hemorrhoids i kahi hili pōʻai ma ka ʻāʻī. ʻO ka pahuhopu o ke ʻano THD, e like me ka inoa i hōʻike ʻia, ʻo ia ka desterrialize i nā hemorrhoids ma ka hoʻopaʻa ʻana i nā kīʻaha koko nui. Me ke ʻano RAR, hoʻopau mua ʻia nā hemorrhoids e like me ke ʻano HAL. Eia naʻe, ma hope o ka hoʻopaʻa ʻana i ke aʻa nui, hoʻomau ke kaʻina hana ma ka hoʻopaʻa ʻana i ka nui hemorrhoidal me nā ligature hou a hoʻopaʻa i ka mucosa. Hoʻopili maʻamau ka RAR ligation a me ka hoʻopaʻa ʻana i ʻehā mau kaula nui o ka hemorrhoids. Ma ka HeumarktClinic Proktologie ma Cologne, ua hoʻohana ʻia kēia mau ʻenehana suture āpau me nā makahiki he nui o ka ʻike a me ka kūleʻa. Ua hōʻike ko mākou ʻike i ka hoʻohui ʻana i kēia mau ʻano me ka laser irradiation o ka hemorrhoidal mass ʻoi aku ka maikaʻi. I ka hōʻuluʻulu ʻana, hiki ke ʻōlelo ʻia ʻo HAL-RAR-THD i hui pū ʻia me ka laser ʻo ia ka ʻoi aku ka maikaʻi a me ka maʻalahi o ka mālama ʻana i ka proctology. ʻAʻohe ʻoki i hana ʻia, e hōʻemi ana i ka pilikia o nā pilikia.

ʻO ka sclerotherapy, ligation me nā kaula hao a me ka hau

ʻo ia nā ʻano lapaʻau maʻi maʻi maʻi maʻamau i hoʻohana pinepine ʻia no ka hemorrhoids i ka proctology, e nā kāne a me nā wahine proctologists ma Cologne. He maʻalahi kēia mau lāʻau lapaʻau a maʻamau ʻaʻole ʻeha. I ka wā o ka sclerotherapy, hoʻokomo ʻia kahi mea sclerosing agent i loko o ka ʻiʻo o ka hemorrhoid, e hoʻemi ai. Eia nō naʻe, ʻaʻole ʻoluʻolu kēia ʻano hana no nā hemorrhoids ʻoi aku ka nui a hiki ke hoʻi hou. Hoʻokahi wale nō wahi o ka hemorrhoid ka hoʻopaʻa ʻana i ka pahu Rubber, akā ʻoi aku ka maikaʻi o kēia. Hoʻohana ʻia kahi hui o kēia mau ʻano i ka proctology ma ka HeumarktClinic ma Cologne e hoʻomaikaʻi i ka kūleʻa a hoʻēmi i nā hopena ʻaoʻao. Hoʻokahi wale nō puʻupuʻu i hoʻopaʻa ʻia a hoʻokomo wale ʻia ka mea sclerosing agent i loko o ka ʻāpana i hoʻopaʻa ʻia i mea e pale aku ai i nā hopena ʻaoʻao e like me ka ʻili ʻana a i ʻole ka ʻoʻoleʻa o ka paia ʻōpū olakino. Hoʻopili ʻia ka puʻupuʻu i mālama ʻia me ka lāʻau anu. Me kēia hui ʻana, ʻaʻohe ʻeha o ka poʻe maʻi i ka HeumarktClinic Proktologie ma Cologne i ka wā a ma hope o ka mālama ʻana a me nā hopena ʻaoʻao liʻiliʻi wale nō e like me ka liʻiliʻi a me ka loaʻa ʻole o ke koko postoperative. ʻAʻole i loaʻa iā mākou nā pilikia e like me ka abscesses a i ʻole fistula e nā proctologists ʻē aʻe ma hope o kēia mau lapaʻau.

He aha ka hamo maikaʻi no ka hemorrhoids

ʻO ka hamo maikaʻi loa no ka hemorrhoids e like me nā hōʻailona pilikino a me ke kūlana o ka ʻāpana anal. Pono ka ʻaila hemorrhoid maikaʻi e hōʻoluʻolu i ka ʻeha, hoʻomaha a hoʻomaha. Loaʻa paha i nā mea kūlohelohe e hoʻomaikaʻi i ka elasticity o ka ʻili anal a hoʻoikaika i ka ho'ōla ʻana i ka ʻeha. ʻO ka ʻaila poni maikaʻi e hana ʻia ma ke ʻano he lubricant i ka wā o ka neʻe ʻana o ka ʻōpū me ka ʻole o ka pili ʻana i ke kapa komo. He mea nui ka ʻaila ʻaʻole e hoʻoulu i nā hopena allergy a kū ʻole.

Hāʻawi pinepine ka mea hana i kahi applicator hiki ke hoʻohana ʻia e hoʻokomo mālie i ka ʻaila i loko o ke kahawai anal. ʻO ka koho ma waena o ka gel, suppositories a i ʻole ʻaila e pili ana i nā hōʻailona o kēlā me kēia kanaka, e like me ka ʻeha, ke kahe ʻana o ke koko, ka ʻāʻī a i ʻole ke ahi, a me ke ʻano o ka ʻāpana anal. ʻAʻohe ʻaila poni maikaʻi loa no kēlā me kēia ʻano a me nā pae o ka hemorrhoids. Pono e ʻimi i ka ʻōlelo aʻoaʻo a me ka nānā ʻana mai kahi proctologist. He kūpono wale ka ʻaila no ka hoʻomaha ʻana i nā hōʻailona a ʻaʻole hiki ke hoʻōla i ka hemorrhoids. ʻO ia ke kumu i hoʻokumu ʻia ai ka ʻōlelo hoʻolaha hoʻolaha "ʻO Laser ka ʻaila hemorrhoid maikaʻi loa", no ka mea hiki i ka lāʻau laser ke hōʻemi pono i ka hemorrhoids a no laila e hoʻēmi i nā hōʻailona maʻamau.

I ka hōʻuluʻulu ʻana, kōkua ka ʻaila, akā hoʻōla nā lāʻau laser.

I ka manawa hea e hōʻike ʻia ai ke ʻoki hemorrhoid? 

ʻO ka hoʻonohonoho ʻana o nā hemorrhoids e like me Goligher mai 1980, i hoʻohana mua ʻia e hoʻoholo ai i ka hōʻailona no ke ʻoki ʻana, ua pau. ʻAʻole noʻonoʻo kēia hoʻohālikelike i nā hōʻailona āpau a me nā pae o ka paʻakikī o ka maʻi hemorrhoidal. Manaʻo ʻia e hana wale ʻia ke ʻoki ʻana ma nā pae kiʻekiʻe III a i ʻole IV kahi e puka ai ka hemorrhoid a pono e hoʻokuʻu ʻia me ka manamana lima. Ua kūpono kēia hoʻokaʻawale koʻikoʻi i ka wā ma mua i ka wā i hana ʻia ai nā hana koʻikoʻi me nā pahi a ʻoi aku ka pilikia o ka anesthetics.

I kēia mau lā, ʻoi aku ka maʻalahi a me ka maikaʻi o nā ala e like me ka hoʻomaʻamaʻa laser. Ma ka HeumarktClinic Proktologie ma Cologne, ke nānā aku nei i ka ʻeha a me nā hōʻailona o ka mea maʻi. ʻO ka manaʻo o ka therapy e hoʻomaha i nā hōʻailona, ​​​​me ka nānā ʻole i ka pae o ka hemorrhoids. ʻAʻole pili ka hana kahiko o Goligher me nā hōʻailona a me ke kiʻekiʻe o ka ʻeha o nā maʻi. ʻO nā hoʻohālikelike hou a me nā mea lapaʻau ʻē aʻe e noʻonoʻo i nā hōʻailona like ʻole e like me ke koko, prolapse, thrombosis a me nā pilikia ʻili (ka ʻili, ka wela, ka oozing, eczema) a me ka thrombosis o nā veins perianal waho. 

No ka mea, ʻaʻole i uhi nā alakaʻi kahiko a me ka hoʻokaʻawale ʻana o ka maʻi hemorrhoid i nā hōʻailona i loaʻa i nā kānaka, pono e hana ʻia nā hoʻohālikelike hou o ka maʻi hemorrhoid (4,5,6,7). ʻAʻole pili ka hoʻokaʻawale ʻana o ka hemorrhoid hou i ka mālama ʻana i nā hemorrhoids kūloko, akā i ka mālama ʻana i nā hemorrhoids "waho" a me nā hōʻailona maʻamau. Hoʻopili ʻia ke koko i ka wā ma mua, no ka laʻana, i ka helu "PNR bleed" i ke ʻano o ka paʻakikī (7). Me ka BRST staging e like me Sobrado (4), ua noʻonoʻo ʻia nā ʻano lapaʻau hou a me nā hōʻailona koʻikoʻi o ka hemorrhoids holomua no ka hoʻoholo ʻana i nā hōʻailona o ka ʻokiʻoki, penei: ke koko (B), prolapse (P), ka ʻili (S) complications a me ka thrombosis nā hopena (T) o nā hemorrhoids waho.

Hiki i ka lāʻau lapaʻau ke mālama pono i nā hemorrhoids kūloko a me waho a pale i nā pilikia. ʻO ka manawa kēia e nānā ai ka proctology i nā papa inoa hou a me nā ʻano hana maʻalahi e like me ka hoʻohana ʻana i nā lasers.

Hōʻike no ka ʻoki ʻana i ke ola o kēlā me kēia lā

he koko, he nui nā prolapses a i ʻole ke ʻoki ʻana o ka ʻāʻī. ʻO ka lawa ʻole o ka anal, ka hamo ʻana o ka ʻū, ka uē ʻana, ke ahi, ka eczema perianal, ka ʻeha, ka waimaka anal a i ʻole ka thrombosis kekahi hopena o ka hemorrhoids. Ua hōʻuluʻulu ʻia kēia mau hopena koʻikoʻi ma ke ʻano he "haemorrhoids holomua" a he hōʻailona loa ia no ka ʻoki ʻana. Eia nō naʻe, ʻo ka pahuhopu o ka hana i kēia lā he mea liʻiliʻi loa. Inā hiki ke wehe ʻia nā hemorrhoids me ka liʻiliʻi loa, me ka ʻole o ka pilikia nui me ka hoʻohana ʻana i ka laser a i ʻole nā ​​ala ʻē aʻe, a laila ʻaʻole pono nā ʻano hana mua.

ʻO kahi ʻē aʻe e pono ai

ʻO ka sclerotherapy a i ʻole ka hoʻopaʻa ʻana i ka lāʻau lapaʻau o nā hemorrhoids

e noʻonoʻo ʻia, akā naʻe, ʻaʻole hiki i ko lākou hopena ke hiki i ka maikaʻi o ke kaʻina hemorrhoid a no laila ʻaʻole lawa no ka hoʻōla paʻa ʻana o ka maʻi hemorrhoidal holomua. Wahi a ka moʻolelo, loaʻa nā hopena koʻikoʻi i nā ʻano hana non-surgical.

ʻO ka hemorrhoids a me ka thrombosis i ka wā hāpai

ʻO ke kumu o ka hemorrhoids i loko, aia ma lalo o ke koʻikoʻi kiʻekiʻe i ka wā hāpai. ʻO ka prolapse a me ka thrombosis ka hopena. ʻO ka lāʻau lapaʻau no ka thrombosis i ka hāpai ʻana he kanaka hoʻokahi a hilinaʻi i ka mea nāna e mālama i ka wahine hāpai, ka ʻike o ka proctologist a me ka nui o nā lā i koe a hiki i ka lā kūpono. ʻAʻole ʻae ʻia nā anesthetics a ʻaʻole hiki ke hāʻawi ʻia nā lāʻau lapaʻau narkotic. Pehea e wehe ʻia ai kahi thrombosis ʻeha nui? I ka pane ʻana i kēia nīnau paʻakikī, hiki iā mākou ke kaʻana like i kā mākou ʻano lapaʻau a me kā mākou ʻike: ʻo ka thrombosis ka mea maʻamau i ka ʻeha nui i ka wā hāpai a he mea pilikia loa a ʻeha hoʻi i ka hānau ʻana. No laila ke ho'āʻo nei mākou e kōkua i ka wahine hāpai me ka hana haʻahaʻa a liʻiliʻi. Pono kēia i ka hiki ke hoʻohana i ka ʻeha kūloko kūloko me ka ʻole o ka anesthetics. ʻO ka lua, ʻaʻohe koko, ʻaʻohe koko lua a me ka ʻeha liʻiliʻi ma hope o ka hana. No kēia kumu, hāʻawi mākou i ka wehe ʻana o ka thrombosis hāpai i ka laser mai kahi ʻoki liʻiliʻi, ʻo ia ka mea e hōʻeha ai i ka ʻeha postoperative liʻiliʻi, kahi i hōʻike ʻia e hiki ke ʻae ʻia. ʻAʻole hiki ke pilikia. Eia naʻe, ke aʻo nei mākou e kūʻē i nā hana hemorrhoid nui; pono e hana ia mau mea ma hope o ka hānau ʻana.

He aha kāu e hana ai inā loaʻa iā ʻoe nā hemorrhoids waho?

ʻO ka hemorrhoids waho he hemorrhoids ʻO nā veins ma waho o ka anus ʻO ka hopena, ʻo ia ke kumu i kapa ʻia ai nā hemorrhoids waho i nā veins piano. Hiki i kēia mau hemorrhoids Ke koko, māwae a maneo a ma luna o nā mea a pau pinepine perianal thrombosis / anal vein thrombosis kumu. ʻAʻole hiki ke hoʻopau a hoʻopaʻa ʻia nā hemorrhoids waho no ka mea ke alakaʻi nei lākou i ka hoʻopiʻi koʻikoʻi - thrombosis. Hiki ke hoʻokaʻawale ʻia nā hemorrhoids waho, e pili ana i nā kukuna liʻiliʻi o nā hemorrhoids waho / perianal veins. Eia naʻe, ʻeha loa kēia. ʻO ka maikaʻi, piha a me ka hoʻopau mau ʻana o nā veins perianal - nā hemorrhoids waho - hana ʻia me ka laser ma ka HeumarktClinic. Hoʻokumu ka HeumarktClinic i ka wehe ʻana i ka laser o nā hemorrhoids waho a me loko me ka ʻoki ʻole a i ʻole ka ʻeha nui. I ka hihia o ka thrombosis o nā hemorrhoids waho / perianal veins, ʻoi aku ka maikaʻi o ke ala laser inā makemake ʻoe e wehe loa i nā veins perianal. Eia nō naʻe, hiki i nā thromboses liʻiliʻi ke hoʻonā wale akā hiki ke hoʻi hou inā ʻaʻole wehe ʻia nā veins perianal / hemorrhoids waho. Hoʻopili ʻia ka poʻe i hoʻopilikia ʻia i ko lākou ola ʻana e ka thrombosis perianal hou mai nā veins perianal i wehe ʻole ʻia.

Uku o na Lapaau Hemoroid

Hoʻopau ʻia nā hoʻokolohua āpau a me nā lāʻau lapaʻau ma ka keʻena proctology o ka HeumarktClinic ma Cologne e like me ka papa hana uku. ʻO ka mea pōʻino, ʻaʻohe helu wehewehe kikoʻī no ka ʻoki ʻana i ka hemorrhoid laser ma ka papa o nā uku. No laila, hoʻohana ka hoʻomaʻamaʻa i ka helu 2886 me kāna mau uku, e kū nei no nā lawelawe like me ka laser therapy no nā ʻōpū koko like ʻole i ka papa manawa uku a, e like me ka ʻōlelo a ka German Medical Association no ka laser irradiation o nā veins koko, pololei. ʻEhia ka nui o kēia mea i uhi ʻia e ka ʻinikua olakino i kēlā me kēia hihia. E loaʻa iā ʻoe kahi kuhi kumukūʻai mai iā mākou no ka ʻoki ʻana i ka hemorrhoid laser, hiki iā ʻoe ke kūkākūkā me kāu hui ʻinikua a loaʻa i kahi hoʻopaʻa kumukūʻai. Uku ʻia ka bila GOÄ e ka poʻe i hoʻopaʻa ʻia ponoʻī iā lākou iho; i ka hihia o ka poʻe i hoʻopaʻa pilikino, ʻo ka hapa nui o kēia i uku ʻia e ka ʻinikua olakino pilikino.

E ʻike hou aʻe a e hana i kahi manawa no ke kūkākūkā ma ke kelepona ma: 0221 257 2976 aiʻole e Hoʻopaʻa hoʻopaʻa inoa ma ka pūnaewele - ma waho o nā hola keʻena. Hoʻokaʻaʻike ma ka leka uila ma aneʻi.

Palapala:

1. Goligher JC. ʻO ka hemorrhoids a i ʻole nā ​​puʻu. Ma: Goligher JC, Duthie HL, Nixon HH, nā mea hoʻoponopono. ʻO ka ʻoki ʻana o ka anus, rectum a me ke kolonā.4th ed. Lādana: Baillière Tindall; 1980. p. 96. [Google Scholar]

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3. Gerjy R, Lindhoff-Larson A, Nystrom PO. Hoʻopili maikaʻi ʻia ka pae o ka prolapse a me nā hōʻailona o ka hemorrhoids: ka hopena o kahi algorithm hoʻohālikelike i nā maʻi 270. Dis. 2008;10:694-700. [Hoʻokuʻuʻia] [Google Scholar]

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8 Murie JA, Sim AJ, Mackenzie I: ʻO ke koʻikoʻi o ka ʻeha, pruritus a me ka lepo e like me nā hōʻailona o ka hemorrhoids a me kā lākou pane ʻana i ka hemorrhoidectomy a i ʻole ka hoʻopaʻa ʻana i ka lāʻau. Br J Surg 1981; 68(4): 247-9.

 

 

Manaʻo ʻōlelo:

* HAL ala= ʻO ka hoʻopaʻa ʻana i ke ʻano hemorrhoid e like me Morinaga 

**ʻano THD= ʻO ka Ligation Transanal Haemorrhoidal Arteries - hoʻonui ʻia ke ʻano Morinaga

*** ʻano RAR =Clinical.Trials.gov Ka hoʻāʻo kino #  NCT01301209, 

****LHP  = Laser Hemorrhoidoplasty : https://clinicaltrials.gov/ct2/show/NCT03322527 Haʻawina e DE PARADES Vincent, MD no ka pae 2 a me 3 hemorrhoids 

*****LHPC = Laser Hemorrhoids Plastic Surgery – Na Dr. (H) Ua hoʻohana ʻo Haffner (Cologne) i nā kaʻina hana skeletal laser i hoʻololi ʻia i nā pae āpau o ka hemorrhoids. Loaʻa nā hoʻokolohua holoholona a me nā ʻikepili lapaʻau. Hoʻohana ʻia me nā hopena maikaʻi ma mua o 500 mau ʻoki hemorrhoid me ka haʻahaʻa complication rate, outpatient, me ka ʻeha ʻole.