OBJECTIVE. Determine the frequency of clinical manifestations of hemorrhoids and constipation in people seeking advice about hemorrhoids. In the course of the treatment of patients with hemorrhoids phlebotropic evaluate the effectiveness of therapy micronized purified flavonoid fraction (MPFF). MATERIALS AND METHODS. This multicenter study, including screening and observation part, which is part of the International Research «CHORUS» (Chronic venous and hemorrhoid diseases evaluation and scientific research), conducted in nine centers in different regions of Russia, 80 doctors of Coloproctology. In the screening group included 2668 patients who had investigated the incidence of constipation, as a risk factor for hemorrhoids. Conservative treatment, the foundation of which was, Moffitt therapy, received 1952 patients with stage I-IV hemorrhoids. Evaluating the effectiveness of the treatment was evaluated on the basis of a questionnaire. RESULTS. The questionnaire shows that constipation suffered - 766 (28,8 %) patients. Violation of defecation patterns and changes in stool consistency was observed in 1155 (43,9%) and 633 (25.5 %), respectively. At the same time, 288 (11,1 %) indicated a tendency to loose stools and diarrhea. Conservative treatment, the foundation of which is phlebotropic MPFF therapy conducted in patients of observational group has shown its efficiency in all grades of hemorrhoids. During the entire observation period of conservative treatment was effective in 1489 (76,3 %) patients. Surgical treatment was performed in 463 (23 %) patients grade I-IV hemorrhoids, the main part of patients with grade III -199 (43,1 %) and grade IV hemorrhoids - 68 (64,2 %). CONCLUSION. Conservative treatment of hemorrhoid disease, which is the basis on phlebotropic MPFF therapy, is effective at all stages of hemorrhoids, but in patients with grade III and grade IV disease requires surgical treatment.
AIM: to assess objective criteria for the prolapsed of internal hemorrhoids piles and to define the degree ofexternal hemorrhoids enlargement in comparison with the Goligher classification. PATIENTS AND METHODS: the clinical and anatomical status of patients with various forms of hemorrhoids was evaluated within the multicenter observation program «REVISION». The study is based on the analysis of clinical and instrumental examination of 1020 patients with stages I-IV of hemorrhoids aged 44.1±12.7 (18-81) years. The study included 506 (49.6%) females. RESULTS: the data obtained show an irregular increase of internal and external piles, which can be expressed in digital form. In patients with stage I-II, the presence of external pileswas detected in 64.7% and 55.7% and in stage III-IV was revealed in 77.7% and 93.5%. Compliance with Goligher classification and the degree of piles enlargementin patients with stages I and II was notedin 225 (84.6%) and 236 (72.2%) cases (p<0.001). In patients with stages III and IV this compliance was detected only in 211 (66.1%) and 58 (53.7%) cases (p<0.001). CONCLUSION: the study showed that the Goligher classification is an inadequate tool for assessing the surgical status of hemorrhoids and evaluating surgical outcomes. The degree of prolapse can be classified according to the size of the internal hemorrhoid piles relative to the sector of the circumference of the anal canal and to the displacement of the pilein relationshipwith the "dentate line". The size of the external hemorrhoid piles is determined similarly in accordance with the perianal region.
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