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 nā hemorrhoids nā moku ʻāʻī ʻeleʻele, hiki ke alakaʻi i ka prolapse o ka ʻōpū a ma laila 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 me ka hemorrhoids e hele pinepine i ka lua i nā manawa he nui i ka lālani a ʻaʻole hiki ke mimi i ka manawa hoʻokahi. ʻO ka constipation, ke kaumaha a me ka ʻeha kekahi mau hōʻailona maʻamau. Hiki nō hoʻi ke hoʻopaʻa ʻia, akā ʻokoʻa kēia mai ka fecal incontinence. I ka hihia o ka hemorrhoids, ʻaʻohe mea maoli ʻole o ka fecal incontinence, no ka mea, ʻaʻole ʻo ka reflexively tense deep sphincter muscle ʻaʻole wale e pale i ka hemorrhoids mai ka puka ʻana, akā pale pū nō hoʻi 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 e alakaʻi i nā hōʻailona hemorrhoid maʻamau e like me ka uē ʻana, 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 o waho he pilikia no ka mea hiki iā lākou ke alakaʻi i ka thrombosis perianal a i ʻole thrombosis vein anal a i ʻole nā ​​​​waimaka liʻiliʻi e kahe ana ke koko a ʻeha a ma muli o ka maʻi Hemorrhoid lalo. .

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, ke kuni, ka ʻeha a me ke kuʻi ʻana i ka ʻāʻī, e ala mai ma muli o ka lawa ʻole o ka anal, kahi hiki ʻole ke pani a maloʻo ka rectum. Hoʻopilikia kēia i ka ʻili, e like me ka maʻi maʻi ʻino, kahi e hoʻonāukiuki nui ai ka ihu i ka ʻili olakino a maloʻo ma mua. ʻOiai inā ʻaʻole i paʻa loa ka rectum ma muli o ka hemorrhoids, ua lawa ia no kahi mucus liʻiliʻi mai ke kahawai anal, i uhi ʻia me ka mucous membrane, e komo mau i ka ʻili maloʻo mua a hamo. Hoʻopilikia kēia, hoʻopōʻino, hoʻoulu, a pehu i ka ʻili maloʻo maikaʻi i ka puka anal, kahi e alakaʻi ai i ka ʻili a me ke ahi. No laila ʻaʻole pono ka "fecal incontinence" i mea e ʻike ai i ka ʻeha a me ka wela i ka ʻāʻī. ʻOiai inā hiki i ka ʻāʻī ke paʻa i ka ʻāʻī, ʻaʻole 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 wai mai ka mucosa maʻamau, a ʻo ia hoʻi ke kumu o ka ʻili o ka ʻili maʻamau o waho, ʻaʻole hiki ke ʻae i ka mucus no ka manawa 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! ʻO kā mākou kūkākūkā proctology pilikino ma Cologne e hele pinepine ʻia e nā poʻe maʻi e kāhāhā i ka haʻi ʻana o ka proctologist iā lākou ua hoʻomake lākou i ka hemorrhoids e hoʻoulu ai i ka makū, ka ʻāʻī, ka ʻāʻī a me ke ahi a koi koke i ka mālama invasive. No ka mea ʻaʻole ʻeha ka hemorrhoids, ʻae pinepine ʻia lākou inā ua puka lākou i ka wā o ka neʻe ʻana o ka ʻōpū a pono e hoʻihoʻi ʻia i kekahi manawa. Hoʻomaʻamaʻa ka poʻe maʻi i ke ʻano o kā lākou ʻāʻī ponoʻī, ʻoiai ke loli mālie nei ke ʻano i nā makahiki he nui a hiki ke uku nui ʻia e nā sphincters ikaika mau. He mea kupaianaha 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 ʻeha i kekahi manawa, akā nalo hou me ka "ʻaila hemorrhoid maikaʻi". ʻAʻole ʻike kekahi poʻe i ka laha ʻana o ka mumū i ka iwi huelo a i mua o ka scrotum i nā kāne, a i ʻole ka wehe ʻana o ka wahine. ʻAʻole ʻike ka nui o ka poʻe i ko lākou hoʻohui ʻana i ka cream hemorrhoid ma ke ʻano he maʻi, me ka manaʻo he maʻi wale nō ka ʻili.

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. Hoʻohana mau ʻia nā anal dilator i kēia mau lā i ka wā e paʻakikī loa ai ka ʻāʻī a hiki ke hōʻeha i ka ʻeha nui, i kekahi manawa i kapa ʻia ʻo "proctalgia fugax", a ke hoʻopau nei hoʻi i ka hoʻokuʻu ʻana. I ka pōkole, ʻaʻole hiki ke wehe pono ka rectum a no laila ʻaʻole hiki ke hoʻokaʻawale loa. E noʻonoʻo paha kekahi no ke aha i manaʻo ʻia ai ka spasm anal a me ka lawa ʻole anal i nā hiʻohiʻona o ka hemorrhoids. He nāwaliwali 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 ka hoʻohaunaele o ka hoʻomau maikaʻi. Wahi a ke alakaʻi alakaʻi S3 o nā hui loea Kelemania no ka proctology a me ka colo-proctology, ʻo ka hemorrhoids prolapsed alakaʻi i kahi maʻa a i kekahi manawa ʻo ka fecal secretion, hiki ke ʻike mua ʻia he uē, akā ma hope he lepo lepo a hiki ke alakaʻi i ke kapa lepo lepo. . ʻO ka maʻa mau e hoʻonāukiuki i ka ʻili perianal. He mea hikiʻole ke hoʻomaopopo i ka maloʻo maloʻo a me ka hoʻomaʻemaʻeʻole i ka anal hygiene,ʻaʻole ia he mea maʻamau aʻaʻole iʻike ka poʻe he nui i nā hōʻailona ma luna o ke kapa komo he hōʻailona he mea hewa i ka rectum. ʻO ka huaʻōlelo "anal insufficiency" - ka haunaele o ka hoʻomau maikaʻi - he ʻōlelo haole ia no ka lehulehu ākea, ʻo ia hoʻi "ʻaʻole pili iaʻu" no ka mea "hiki iaʻu ke hoʻomalu i koʻu stool".

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 e hiki ai ke hoʻokomo mālie i ka ʻaila i loko o ka anal canal. ʻO ka koho ma waena o ka gel, suppository a hinu paha 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 kuni ʻana, 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 puka mai ai ka huaʻōlelo hoʻolaha "ʻo ka laser ka ʻaila hemorrhoid maikaʻi loa", no ka mea, hiki i ka lāʻau laser ke hōʻemi pono i ka hemorrhoids a pēlā pū kekahi e hōʻoluʻolu 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.