#1
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Àáñîëþòíî ñîãëàñåí ñ Âëàäèñëàâîì Âàëåðèåâè÷åì. Áåðåìåííîñòü è ðîäû ìîãóò óñóãóáèòü ãåìîððîé, à ìîãóò è ïðîéòè áåññëåäíî äëÿ íåãî. Õîòÿ åñëè óæå áûëè ýïèçîäû êðîâîòå÷åíèÿ, ÿ äóìàþ ëó÷øå ðåøèòü âîïðîñ äî áåðåìåííîñòè è íå ðèñêîâàòü êîãäà áóäåòå â ïîëîæåíèè.  íàñòîÿùåå âðåìÿ ñóùåñòâóåò äîñòàòî÷íî ñïîñîáîâ õèðóðãè÷åñêîãî ëå÷åíèÿ ãåìîððîÿ. ß îòäàþ ïðåäïî÷òåíèå íå ìàëîèíâàçèâíûì ìåòîäàì (ñêëåðîòåðàïèÿ, èíôðàêðàñíàÿ êîàãóëÿöèÿ, ëèãèðîâàíèå ëàòåêñíûìè êîëüöàìè, âîçäåéñòâèå ýêñòðåìàëüíûìè òåìïåðàòóðàìè), à áîëåå ðàäèêàëüíîìó îïåðàòèâíîìó âìåøàòåëüñòâó. Êëàññè÷åñêàÿ îòêðûòàÿ ãåìîððîèäýêòîìèÿ (îïåðàöèÿ Ìèëëèãàíà-Ìîðãàíà) äîñòàòî÷íî òðàâìàòè÷íàÿ, è ïåðâîå âðåìÿ ïîñëåîïåðàöèîííîãî ïåðèîäà ìàëîïðèÿòíî (áîëü, áîëåå äëèòåëüíåé ïåðèîä âîçâðàùåíèÿ íîðìàëüíîìó îáðàçó æèçíè). Íà ìîé âçãëÿä â íàñòîÿùåå âðåìÿ õîðîøî ñåáÿ çàðåêîìåíäîâàëà îïåðàöèÿ ïî ìåòîäó Ëîíãî, êîòîðàÿ èìååò õîðîøèå áëèæàéøèå è îòäàëåííûå ðåçóëüòàòû. Îïÿòü æå, ýòî ëèøü òîëüêî ìîå ìíåíèå. Äëÿ êàæäîãî ïàöèåíòà äîëæåí áûòü èíäèâèäóàëüíûé ïîäõîä.
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#2
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Ñòåïëåðíàÿ ãåìîððîèäýêòîìèÿ ñ ãåìîððîèäïåêñèåé ïî ìåòîäó Óàéòõåäà àïïàðàòîì Ëîíãî.
Ìíå êàçàëîñü ïåðèîä âñåîáùåãî âîñõâàëåíèÿ "ìåòîäà Ëîíãî" ïîø¸ë íà ñïàä, è ïîêàçàíèÿ ê ýòîé îïåðàöèè ðåçêî ñîêðàòèëèñü.
"Êàêèå Âàøè äîêàçàòåëüñòâà?" (ñ) õ/ô Êðàñíàÿ æàðà |
#3
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Ó ìåíÿ òàêîå æå îùóùåíèå. Êðîìå òîãî, íå çàáûâàéòå î ñòîèìîñòè îäíîðàçîâîãî èíñòðóìåíòà.
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#4
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Öèòàòà:
Öèòàòà:
Ðàáîò ïîñâÿùåííûõ ïðåèìóùåñòâàì îïåðàöèè Ëîíãî ïåðåä òðàäèöèîííîé îïåðàöèåé Ìèëëèãàíà-Ìîðãàíà èìååòñÿ áîëåå ÷åì äîñòàòî÷íî. ×òî áû íå áûòü ãîëîñëîâíûì, âîò ê ïðèìåðó ïàðî÷êà. 1: Stolfi VM, Sileri P, Micossi C, Carbonaro I, Venza M, Gentileschi P, Rossi P, Falchetti A, Gaspari A. Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy. J Gastrointest Surg. 2008 May;12(5):795-801. 2: Vasil'ev SV, Komiak KN, Nedozimovanyĭ AI. [Comparative assessment of the Longo operation and suture ligation of the terminal branches of the upper rectal artery in treatment of chronic hemorrhoids]. Vestn Khir Im I I Grek. 2007;166(3):70-2. 3: Candela G, Varriale S, Di Libero L, Manetta F, Maschio A, Giordano M, Pizza A, Sciascia V, Napolitano S, Santini L. [The gold standard in the treatment of haemorrhoidal disease. Milligan-Morgan haemorrhoidectomy vs Longo mucoprolapsectomy: comparing techniques]. Minerva Chir. 2007 Jun;62(3):151-9. 4: Martinsons A, Narbuts Z, Brunenieks I, Pavars M, Lebedkovs S, Gardovskis J. A comparison of quality of life and postoperative results from combined PPH and conventional haemorrhoidectomy in different cases of haemorrhoidal disease. Colorectal Dis. 2007 Jun;9(5):423-9. 5: Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005393. 6: Lomanto D, Katara AN. Stapled haemorrhoidopexy for prolapsed haemorrhoids: short- and long-term experience. Asian J Surg. 2007 Jan;30(1):29-33. 7: Dell'Abate P, Ferrieri G, Del Rio P, Soliani P, Sianesi M. [Longo hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy: perspective analysis]. G Chir. 2005 Nov-Dec;26(11-12):443-5. |
#5
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À ìíå êàæåòñÿ îïåðàöèåé âûáîðà ïðè ãåìîððîå äîëæíà áûòü "äåàðòåðèàëèçàöèÿ" ïîä êîíòðîëåì ÓÇ-àïïàðàòà ñ èñïîëüçîâàíèåì ýôôåêòà Äîïïëåðà (THD).
Õîòÿ "Ìèëëèãàí-Ìîðãàí" ñåáÿ íå èçæèë, è îñòà¸òñÿ êëàññèêîé. |
#6
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Ñïàñèáî.
Äàâàéòå ïîñìîòðèì ðåçþìå Êîõðàíîâñêîãî îáçîðà, óïîìÿíóòîãî Âàìè. Äóìàþ, ýòî íàèáîëåå äîñòîâåðíàÿ èíôîðìàöèÿ íà ñåãîäíÿøíèé äåíü. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005393. Stapled versus conventional surgery for hemorrhoids. Jayaraman S, Colquhoun PH, Malthaner RA. Öèòàòà:
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#7
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 ðàáîòå Long-term results after excision haemorrhoidectomy versus stapled haemorrhoidopexy for prolapsing haemorrhoids; a Belgian prospective randomized trial. PMID: 15790202 òîæå èíòåðåñíûé âûâîä: Postoperative pain is less important after PPH. This advantage disappears if any resection is associated with the stapling. At medium to long-term follow-up, PPH seems to carry a higher risk of symptomatic external haemorrhoidal disease, needing further surgery.
À âîò THD ïðèâëåêàåò åù¸ ìåíüøåé ñòîèìîñòüþ è ëó÷øåé ïåðåíîñèìîñòüþ, ïðè ñîèçìåðèìûõ ðåçóëüòàòàõ. Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. PMID: 18060529 Transanal Haemorrhoidal Artery Echodoppler Ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study. PMID: 19508513 Treatment of grade III and IV haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results. PMID: 19798507 |
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#8
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êóëóàðíî îáñóäèë ýòîò âîïðîñ ñî ñïåöèàëèñòîì èç íàøåãî Ãîðîäñêîãî öåíòðà êîëîïðîêòîëîãèè. Ëîíãà ïðàêòè÷åñêè íå âûïîëíÿþò ïî ïðè÷èíå âûñîêîé ñòîèìîñòè ðàñõîäíèêà è âîçìîæíîñòè ïîäîáðàòü àëüòåðíàòèâíûé ìåòîä/êîìáèíàöèþ ìåòîäîâ. Ê äåàðòåðèàëèçàöèè îòíîøåíèå êàê è ê äðóãèì ìåòîäàì - èìååò ñâîè ïëþñû è ìèíóñû, íå ìåòîä âûáîðà, íî ñâîþ "íèøó" çàíèìàåò. Ðàçãîâîð îêàçàëñÿ íå íà ïÿòü ìèíóò
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#9
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"Çîëîòîé ñòàíäàðò" íå çðÿ òàê íàçûâàåòñÿ, ðàçóìååòñÿ
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#10
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Îáúÿñíÿåòå ìíå, íà÷èíàþùåìó âðà÷ó, ÷åì æå òàê õîðîø ìåòîä Ëîíãî. Íàñêîëüêî ÿ ïîíèìàþ, ïîäòÿãèâàåòñÿ ñëèçèñòàÿ, ïðè ýòîì ñàìè óçëû íå óäàëÿþòñÿ. Ïðàâèëüíî? Ñëåäîâàòåëüíî, åñëè óçëû íå óäàëåíû, òî ÷òî ìåøàåò ðåöèäèâó? Ñëåäîâàòåëüíî, ýòà îïåðàöèÿ íå èçëå÷èâàåò, à äàåò êîñìåòè÷åñêèé ýôôåêò? ÿ ïðàâ?
Ê òîìó æå, ñàì àïïàðàò îäíîðàçîâûé è ñòîèò, íàâåðíîå, íå ìåíüøå 15000. Ïîëó÷àåòñÿ, ÷òî òå äåíüãè, êîòîðûìè ïàöèåíò ìîã áû îïëàòèòü òðóä âðà÷à, òðàòÿòñÿ íà ýòîò àïïàðàò è óõîäÿò â ôàðì. êîìïàíèþ. Ïîëó÷àåòñÿ, ÷òî âðà÷ â ýòîé ñèòóàöèè, ÿâëÿåòñÿ ñâÿçóþùèì çâåíîì, ìåæäó êîøåëüêîì ïàöèåíòà è êîøåëüêîì ôèðìû, ïðîèçâîäÿùèé ýòîò àïïàðàò. Ïîñêîëüêó ôèðìà èìååò íå ìàëóþ âûãîäó ñ ýòîãî ìåòîäà, îòñþäà è ïîëó÷àåòñÿ ñòîëü àêòèâíàÿ ðåêëàìà ýòîãî ìåòîäà. Ìíå âñå âèäèòñÿ èìåííî òàê. Ïîïðàâüòå åñëè ÿ íå ïðàâ. |
#11
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Öèòàòà:
Öèòàòà:
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#12
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Âîîáùå íå äîâåðÿþ âñåì ýòèì àïïàðàòàì. êòî äàñò ãàðàíèòþ ÷òî îí *ñøèë âñå íà ñîâåñòü*. Êîãäà ðàáîòàåøü ðóêàìè, çíàåøü, ÷óâñòâóåøü è âèäåøü ÷òî òû äåëàåøü, è ñåáå äîâåðÿòü ëåã÷å, ÷åì àïïàðàòó.
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#13
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drsasha Íàñêîëüêî ÿ ïîíÿë. Âû ðàáîòàåòå â õîðîøåì õèðóðãè÷åñêîì öåíòðå èì. Øàëèìîâà. Òàê?
Ñóäÿ ïî ñàéòó, öåíòð âåñüìà ñîâðåìåííûé. Êàê ÷àñòî â âàøåì öåíòðå äåëàþò îïåðàöèþ Ëîíãî? Íàñêîëüêî ÷àñòî îòäàþò ïðåäïî÷òåíèå ýòîìó ìåòîäó ó âàñ? È íà âàø âçãëÿä, ñ ÷åì ñâÿçàíî èñïîëüçîâàíèå ýòîãî ìåòîäà â âàøåé êëèíèêå ñ äîãîâîðåííîñòüþ ïðîèçâîäèòåëÿ àïïàðàòà, èëè äåéñòâèòåëüíî ñ òåì, ÷òî ìåòîä ëó÷øèé ñàì ïî ñåáå? |
#14
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Äà ÿ ðàáîòàþ â îòäåëå õèðóðãèè ïèùåâàðèòåëüíîãî òðàêòà è òðàíñïëàíòàöèè êèøå÷íèêà Íàöèîíàëüíîãî èíñòèòóòà õèðóðãèè è òðàíñïëàíòîëîãèè èì. À.À. Øàëèìîâà ÀÌÍ Óêðàèíû.  íàøåì îòäåëå âûïîëíÿþòñÿ ðàçëè÷íûå îïåðàöèè, ïåðå÷åíü ïàòîëîãèè ìîæíî íàéòè íà íàøåì ñàéòå ([Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]). Ìàòåðèàëû ñòåïëåðíîé ãåìîððîèäýêòîìèè áûëè ïðåäñòàâëåíû íà 1 ìåæäóíàðîäíîé êîíôåðåíöèè ïî òîðàêîàáäîìèíàëüíîé õèðóðãèè, êîòîðàÿ áûëà ïîñâÿùåíà ê 100-ëåòèþ ñî äíÿ ðîæäåíèÿ àêàäåìèêà Á.Â. Ïåòðîâñêîãî. Íàìè áûë ïðîâåäåí ðåòðîñïåêòèâíûé àíàëèç 125 áîëüíûõ ñ ãåìîððîåì III – IV ñ 2002 ïî 2008 ãîä. Îïåðàöèÿ Ëîíãî áûëà âûïîëíåíà ó 53 áîëüíûõ, îïåðàöèÿ Ìèëëèãàíà-Ìîðãàíà – ó 72. Äëÿ êàæäîãî áîëüíîãî áûë èíäèâèäóàëüíûé ïîäõîä, íå âñå ìîãëè êóïèòü àïïàðàò, äà è õèðóðãè ðàçíûå âûïîëíÿëè îïåðàöèè. Îäíè îòäàþò ïðåäïî÷òåíèå îïåðàöèè Ëîíãî, äðóãèå - îïåðàöèè Ìèëëèãàíà-Ìîðãàíà. Ñòåïëåðíàÿ ãåìîððîèäýêòîìèÿ ñîêðàùàåò äëèòåëüíîñòü îïåðàöèè â 2 ðàçà. Ïðîñòîòà âûïîëíåíèÿ ñòåïëåðíîé ãåìîððîèäýêòîìèè è åå âûñîêàÿ ýôôåêòèâíîñòü óëó÷øàåò êà÷åñòâî æèçíè áîëüíûõ â ðàííåì ï/î ïåðèîäå. Äëèòåëüíîñòü ïðåáûâàíèÿ â ñòàöèîíàðå áîëüíûõ ïîñëå ñòåïëåðíîé ãåìîððîèäýêòîìèè óìåíüøèëàñü â 3 ðàçà. Ñðîêè âîçâðàùåíèÿ ê íîðìàëüíîé ôèçè÷åñêîé àêòèâíîñòè ñîêðàùàþòñÿ â 3 ðàçà. Ìíåíèå ñóùåñòâóåò îäíî ñòåïëåðíàÿ ãåìîððîèäýêòîìèÿ ëó÷øàÿ àëüòåðíàòèâà ïî ñðàâíåíèþ ñ îïåðàöèåé Ìèëëèãàíà-Ìîðãàíà.
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#15
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Íå âèæó ó íàñ íèêàêèõ ðàçíîãëàñèé ïî ýòîìó âîïðîñó ß òîæå ñ÷èòàþ, ÷òî áóäü àïïàðàòû äåøåâëå - ìåòîä ïðèìåíÿëè áû øèðå.
Öèòàòà:
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |