Неприятные, а зачастую и очень болезненные ощущения преследуют людей, страдающих от геморроя.
Иногда без оперативного вмешательства не обойтись, поэтому важно знать некоторые особенности этого процесса, чтобы суметь подготовиться к процедуре как можно лучше.
Что предлагает современная медицина?
Основные виды хирургических вмешательств, активно применяющиеся в современной медицинской практике, принято делить на несколько групп.
Основные критерии – цели и техника их выполнения:
- удаление геморроидальных вен с одновременным перевязыванием их сосудистых ножек:
- сшивание части геморроидального узла со слизистой оболочкой (вмешательство относится к пластической хирургии);
- удаление геморроя лазером;
- фотокоагуляция при помощи инфракрасного излучения;
- операции по Миллигану-Моргану и по Лонго.
Пластическая операция является способом не только избавиться от боли и неприятных ощущений, но и в значительной степени снизить период реабилитации, но само лечение потребует большего времени, так как необходимо приходить на консультации к врачам до полного излечения.
Также существуют несколько менее распространенных методик, которые применяются, например, в случае осложнения течения болезни и/или в запущенных случаях:
- По Склифосовскому – процедура предусматривает перевязывание основания узла, используя прочную медицинскую нить.
- По Мартынову – метод также предлагает перевязать узел, чтобы не допустить притока крови к узлу, но также производится иссечение.
- Прием Уайтхеда применяется, если наблюдается осложнение течения болезни или оно наступило после проведенных мероприятий по избавлению от геморроя. Его суть заключается в следующем — по периметру производится надрез в месте проявления проблемы, далее пораженный участок толстой кишки извлекается наружу и отсекается, после чего края аккуратно пришиваются к надрезу.
Прежде чем назначить операцию, врач произведет полное обследование, необходимо будет сдать анализы, только после этого будет выявлен тип вмешательства, который позволит избавиться от заболевания.
Показания к оперативному лечению
Операции и специальные манипуляции, связанные с удалением или косметологической коррекцией геморроидальных узлов назначаются в следующих случаях:
- ухудшение состояния – переход течения болезни из легкой стадии в среднюю и тяжелую после проведения курса лечения препаратами в течение 2-3 месяцев;
- постоянное воспаление узлов (после каждой дефекации);
- болезнь сопровождается не только неприятными ощущениями, но и кровотечением;
- обнаружен тромбоз в зоне геморроидальных узлов;
- наличие других заболеваний или патологий прямой кишки;
- выявлен парапроктит в хронической форме;
- имеются полипы.
Геморроидэктомия — старый и болезненный метод
Этот вид оперативного вмешательства применяется на поздних стадиях лечения болезни или когда наблюдаются явно выраженные осложнения.
Кроме обычного скальпеля в процессе работы хирург использует современное оборудование, в основе действия которого лежит ультразвук.
Этот подход позволил значительно уменьшить травматичность и время самой операции.
Она выполняется под общим наркозом или спинальным обезболиванием около 60 минут. Оставленные после вмешательства ранки затягиваются быстро, не доставляют дискомфорта.
Операция по Миллигану-Моргану
Производится эта операция по удалению геморроя, как показано на видео:
Геморроидэктомия по Миллиган-Моргану производится как при внутреннем, так и при внешнем расположении геморроидальных узлов.
Особенность процедуры – ее можно проводить на 3—4 стадиях течения болезни, когда наблюдается увеличение узлов в размерах.
Основная суть операции – удаление узла и пришивание сосудистой ножки. После обеззараживания места, где будет производиться вмешательства, специалист производит осмотр, используя специальные средства увеличения.
Важно: врачи стараются сохранить кожно – слизистые перемычки. Длительность проведения процедуры составляет около 35-40 минут.
Места, оставленные после удаления узлов, могут зашиваться, но также их оставляют открытыми, чтобы процесс заживления прошел естественно.
Завершающий этап этой операции – тампонирование, которое продолжается несколько дней. Естественные процессы организма, такие как отхождение газов, производятся при помощи специальной мягкой медицинской трубки, которая вставляется в самом конце процедуры.
Операция по Миллигану-Моргану
В свою очередь, для операции Миллигана-Моргана имеется целый ряд противопоказаний:
- инфекционный процесс в организме;
- хронические болезни (их обострения);
- онкология;
- болезнь Крона;
- беременность и лактация.
Кроме того, к операции не допускаются пациенты, у которых выявлен ВИЧ. Детский возраст не является прямым противопоказанием, но врач проводит обязательно тщательное исследование всего организма, прежде чем дать разрешение на процедуру.
Вмешательство по Лонго
Удаление геморроя методом Лонго – видео:
Этот метод в различных клиниках называется по-разному, например, трансанальная резекция или геморроидопексия.
Суть операции заключается в следующем: проводится удаление слизистой оболочки прямой кишки. Вместе с этой частью удаляется и сам узел.
Ушивание, которое необходимо после процедуры, производится титановыми скобками. В результате операции полное удаление узла не производится, уменьшению способствует меньший приток крови.
Особенностью проведения процедуры состоит в том, что во время осуществления вмешательства, используется не только знания и медицинские инструменты, но и аппаратура:
- расширитель анального канала;
- циркуляционный степплер;
- вдеватель нити.
Благодаря техническому усовершенствованию, метод проявляет себя как быстрый и надежный с минимальным процентом появления осложнений.
Преимущества методики Лонго
Любая операция производится, чтобы избавиться от причины заболевания. Методика Лонго позволяет полностью восстановить ткани и слизистые, которые имеются в анальном канале, избежать травмирования.
Также абсолютно не повреждается мышечно-нервный аппарат, который присутствует в прямой кишке. Это означает, что пациент не будет испытывать дискомфорта, болевых ощущений, а также страдать от неконтролируемой дефекации.
Немаловажен и тот факт, что восстановительный период не занимает и 5 дней, тогда как сама операция, что можно наблюдать и на видео, не длиться и 15 минут.
Очень важно помнить, выбирая этот способ избавления от геморроя, что осложнений в любой форме, он практически не вызывает.
Противопоказания к применению метода
При всех положительных сторонах операционного воздействия по методу Лонго, выделяют несколько минусов – невозможность просчитать отдаленные последствия, а также невозможность удаления узлов, находящихся снаружи.
Возможные осложнения
Конечно же, необходимо знать и о том, какие осложнения могут возникнуть после хирургического вмешательства, так как 100% гарантии их отсутствия не могут дать даже самые опытные специалисты.
Среди наиболее вероятных трудностей выделяют:
- кровотечение, в том числе и обильное;
- нагноение места воздействия;
- покраснения и воспалительные процессы;
- сильная местная боль;
- нарушение мечеиспускания – особенно часто оно проявляет себя в первый день после процедуры;
- неконтролируемая дефекация;
- недержание газов;
- сужение канала.
Именно по этой причине в первые сутки или двое врачи настоятельно рекомендуют соблюдать постельный режим.
Обязательна к соблюдению личная гигиена – лучше всего использовать для этой цели специальные антибактериальные средства.
Со второго дня разрешается питаться нежирными бульонами и кисломолочные продуктами, например, йогуртами. Каши и вареные овощи можно есть на третий день после операции.
Особый запрет накладывается на алкоголь – до 6 месяцев. Дополнительно рекомендуется прием слабительных средств, чтобы избежать травм.
В качестве вывода
Применение оперативного метода лечения позволит за короткое время избавиться от мучительных болей. Все виды воздействия производятся быстро – не более часа и требуют от человека минимум ограничений на момент восстановления, которое занимает несколько дней.
После операции пациент не испытывает в большинстве случаев никаких посторонних, мешающих ему жить, отдыхать и работать, ощущений.
Проблемы в большинстве случаев не проявляют себя снова. Возникающие иногда осложнения являются не нормой, а особенностями организма человека, потому они являются исключением из правил.
Именно поэтому не следует бояться, необходимо обращаться к врачам и проходить обследования, чтобы раз и навсегда забыть про геморрой.
Удаление венозных сплетений, что мы называем геморроем, – мера, которая требуется, когда медикаментозная терапия не результативна. Так получается, что показания к оперативному лечению не являются редкой практикой: часто уже пациентам со второй стадией болезни врач рекомендует хирургическое решение проблемы. Из этого еще не следует, что больной, впервые появившийся у врача, попадает прямиком на операционный стол. Есть малоинвазивные техники удаления геморроя, и они не столь травматичны и сложны как классическая операция.
Но факт остается фактом: если геморроидальные шишки выпадают, ситуация уже не поддается медикаментозной коррекции – требуется иссечение геморроидального узла либо альтернативные действия по его удалению. Классическая же операция проводится сегодня не так часто: на заключительных этапах болезни, сопряженных с осложнениями патологического процесса.
Когда показана операция
Когда нужна операция при геморрое, решает доктор. Для классической операции требуются серьезные показания, ведь это нарушение целостности тканей и отнюдь не простая реабилитация.
Врач настаивает на хирургическом решении при геморрое, когда:
- Кавернозные образования (узлы геморроя) выходят из ануса не только при опорожнении прямой кишки, но и при всяком напряжении;
- Пациент жалуется на частые и массивные кровотечения;
- Размеры самих шишек трактуются как крупные;
- Больной имеет физиологическую предрасположенность к тромбообразованию в геморроидальных венах;
- Боль, дискомфорт, кровотечения и жжение перечеркивают привычный режим пациента;
- Все применяемые консервативные методы оказались бессильны перед проблемой варикоза прямокишечных сосудов.
Когда операцию делать нельзя
Хирургическое лечение геморроя возможно не всегда. Есть ситуации, которые сами по себе будут противопоказанием к такой терапии. Например, классическая геморроидэктомия сопряжена с иссечением кожных покровов, слизистой, а также сосудистой оболочки. Это связано с возможными осложнениями, потому для доктора важно просчитать все потенциальные риски.
Например, очень редко операцию геморроидэктомию назначают пожилым пациентам, так как для них общий наркоз и тяжелый реабилитационный период являются чрезмерными нагрузками. Да и имеющиеся хронические патологии всячески препятствуют проведению операции.
Очень редко, если разбирать ситуацию на примерах, операцию на геморрое рекомендуют пациентам с диагностированным сахарным диабетом. Хроническая гипертензия – еще один пункт, что делает операцию нежелательным вмешательством.
Среди серьезных противопоказаний к оперированию:
- Свищи, развивающиеся в нижнем отделе прямой кишки;
- Инфекция в толстом кишечнике;
- Декомпенсированная стадия хронических недугов;
- Беременность;
- Плохая свертываемость крови;
- Генетическая подверженность кровотечениям.
Но, опять же, эти случаи не будут однозначным и постоянным противопоказанием к оперированию. Можно дождаться благоприятного периода, когда операция будет реальным выходом и все риски врач тоже учтет. Надо отметить, что малоинвазивные технологии более гибки в этом смысле: они не имеют такого большого перечня противопоказаний.
Как подготовиться к операции по удалению геморроя
Один из радикальных методов лечения геморроидального недуга – операция геморроидэктомия. Предшествует этому подготовка: во-первых, инструментальное обследование, которое точно определит локализацию узлов и их размер. Обычно проводятся аноскопия и ректророманоскопия. Во-вторых, накануне операции человеку предстоит сдать ряд стандартных анализов.
Среди таких назначений:
- ОАК. В числе функций общего анализа крови – выявление продолжительности кровотечения, а также фиксация периода свертываемости крови и тромбоцитарного показателя.
- ОАМ (мочу сдавать обязательно).
- Биохимия крови. Нужна для определения уровня глюкозы, а также показателей холестерина, мочевины и т.д.
- Установка группы крови и резус-фактора.
- Анализ крови на сифилис, гепатит и ВИЧ.
Помните, полноценная операция – не просто предварительное обследование, но и некоторые процедурные моменты. Один из них – очищение кишечника. Делают это обычно с помощью клизмы, но альтернативой может быть и прием специальных слабительных.
За пару дней до назначенной операции нужно отказаться от приема лекарств, среди действий которых – разжижение крови. Это, хочется отметить, антикоагулянты, антиагреганты, а также некоторые НПВС.
Нужна ли психологическая подготовка к операции
Это действительно хорошая, доказавшая свою эффективность практика. Для многих пациентов операция – это не просто стресс, а событие, которого они очень боятся. Психолог не просто беседует с таким больным, он может проделать с ним упражнения, помогающие расслабиться, нормализовать дыхание, снять напряжение.
Если вы чувствуете, что нервная дрожь и сильный страх появляются даже при мыслях о том, как оперируют геморрой, нужно обращаться за помощью к специалисту. Чем более вы готовы и физически, и психологически к операции, тем успешнее она пройдет.
Геморроидэктомия: как она проходит
Это классическое вмешательство по иссечению кавернозных телец. Другое название вмешательства – операция по Миллигану-Моргану. Методика эта разработана очень давно, в 1937 году. Колопроктологи в ходе времени меняли нюансы операции, в частности, ее окончание.
Сегодня ее делают двумя путями:
- Открытая геморроидэктомия. Это тот самый, первичный вариант операции. Врачи удаляют не только сам узелок, но и соседние ткани. Так, края раны доктор не ушивает, предполагается, что ткани будут заживать естественно. Врач орудует либо скальпельным ножом, либо электрокоагулятором.
- Закрытая геморроидэктомия. Ее разработали в начале 50-х прошлого столетия, и это уже операция по Фергюсону. Отличие от вышеописанного способа – ушивание раны после завершения работы. Ее иногда производят амбулаторно.
- Подслизистая геморроидэктомия. Данный способ предложил хирург Паркс. Эта операция непростая – врач удаляет только узел, оставляя его основание, при этом сама слизистая не травмируется. Такое действие переносится легче, чем два вышеобозначенных варианта.
Недостатки геморроидэктомии
Эта операция раньше была распространенной, сегодня же только 15% пациентов с геморроем, нуждающихся в хирургической коррекции, подвергаются геморроидэктомии. Во-первых, появились в практике колопроктологов малоинвазивные техники удаления геморроя, во-вторых, минусы этой операции слишком существенны.
К недостаткам геморроидэктомии можно отнести:
- Продолжительность операции;
- Необходимость общего наркоза;
- Массивная кровопотеря;
- Болевой синдром;
- Угроза осложнений;
- Долгая реабилитация.
Но, бывает, другого выхода просто нет, и больному приходится решиться на эту операцию. Врач объяснит, как удаляют геморроидальные узлы, что ожидает больного после операции, каковы риски осложнений и т.д.
Как проходит операция
Операция проходит в ряд этапов. Незадолго до хирургических действий больному бреют все операционное поле. Непреложный момент – дезинфекция ануса и прямокишечного канала.
Пациенту нужно лечь на спину в удобное кресло (проктологическое). Но иногда операцию выполняют, когда больной находится в позиции лежа на животе с немного приподнятым тазом. В данной позиции случается отток крови от шишек, что облегчает для хирурга процесс иссечения. Затем пациенту вводят анестезию. Под каким наркозом удаляют геморрой, решает врач – часто используют при таком кардинальном вмешательстве общую анестезию.
В прямую кишку доктор вводит расширитель с ректальным зеркалом – это нужно для лучшей визуализации узлов и их же доступности. Медик захватывает узел инструментом, вытягивает его наружу, и затем ножка прошивается кетгутом. Шишка иссекается электрическим коауглятором (дабы избежать кровотечения).
Финальный этап операции зависим от ее вида. Если выбираете закрытый вид геморроидэктомии, то рана зашивается, а в задний проход вводится тампон с мазью на 4-5 часов.
Постоперационный период: что ждет пациента
Всегда справедливо высказывание, что процесс выздоровления на 50% зависит от доктора, и на 50% от самого пациента. Не нужно перекладывать всю ответственность на прохождение восстановления на медиков.
От врача нужно качественно, строго по показаниям выполнить операцию, справиться со всеми интраоперационными нюансами и грамотно объяснить больному, что нужно делать дальше и как контролировать процесс заживления ран.
От пациента нужна дисциплинированность и доверие доктору. Следует отодвинуть в сторону страх, усталость, капризы и прочие моменты, которые, конечно, имеют место быть. Когда операция выполнена, активная работа переходит от доктора к самому больному. Теперь ему нужно столько, сколько это необходимо, вставлять в задний проход свечи, делать мазевые втирания, соблюдать диету.
Пациент может не ожидать, что в анальном канале меняются ощущения. Он иногда даже не понимает, действительно ли ему хочется в туалет, или это обманчивое чувство. Дефекация может быть многократной – до 6 раз в день. И к этому придется на какое-то время привыкнуть. Раны будут заживать около двух месяцев или чуть меньше. Но самые сложные для пациента дни – полторы-две недели после операции. Это действительно непросто, потому, решаясь на операцию, вы должны понимать, что восстановление – непростой период, к которому нужно быть готовым.
Классические послеоперационные рекомендации
Доктор, который будет вас оперировать, объясняет, как делается операция при геморрое, а также подробно рассказывает о восстановительном периоде. Рекомендации будут индивидуальны, но есть некоторые общие моменты.
Стандартная схема постоперационного восстановления подразумевает:
- Отказ от пищи в первый день после хирургических манипуляций. Это делается для исключения эвакуации кала в первые послеоперационные сутки – эвакуация кала способствует травме раневой поверхности либо шва.
- Строгую диету. Питаться нужно правильно и систематично. Если в первые дни больному следует есть жидкую пишу, то никаких послаблений в таком пищевом графике быть не может. Это не просто диетическое питание, это именно строгая диета.
- Обильный питьевой
режим. Конкретный объем выпиваемой ежедневно жидкости тоже определит врач. Это хорошее и действенное предупреждение запоров путем размягчения каловых масс.
- Симптоматическое лечение при значительном болевом синдроме. Боль может быть, и часто именно она мучает пациента в первые дни в стационаре. Терпеть боль не стоит – принимайте лекарства, которые советуют в таких случаях врач. Обычно это суппозитории и мази с обезболивающим эффектом.
- Ускорение регенеративных механизмов. Смазывайте слизистую и кожу специальными мазями, которые стимулируют быстрое заживление тканей. Это либо Левомеколь, либо метилурациловая мазь.
Если после операции, несмотря на все старания больного, его все равно мучают запоры, доктор назначит ему специальные слабительные средства.
Могут ли возникнуть осложнения после геморроидэктомии
Не всегда все проходит гладко, и осложнения действительно могут омрачить восстановительный период.
Обычно врачи всячески предупреждают ход событий и делают все, чтобы негативный сценарий не осуществился, но стопроцентной гарантии благополучности операции не даст даже опытнейший колопроктолог.
Какие осложнения бывают чаще:
- Кровотечение – возможно из-за деформации швов, плохого прижигания сосудов.
- Задержка урины – чаще фиксируется у мужчин, они оказываются неспособными опустошить мочевой пузырь, приходится использовать катетер.
- Психогенный запор – появляется вследствие того, что больной испытывает страх перед походом в туалет.
- Сужение прямокишечного канала. Это можно объяснить ошибкой хирурга – для расширения анального канала доктор использует специальные инструменты либо рекомендует пластические операции.
- Выпадение нижнего сегмента прямокишечного канала. Если колопроктолог случайно повреждает мышцы и нервные окончания, то выведение слизистой за границы ануса нельзя исключить.
- Свищи. Это аномальные канальцы, соединяющие проход прямой кишки с близлежащими тканями.
- Гноеобразование. Воспаление и нагноение – не такое редкое осложнение постоперационного периода. Это объясняется скоплением патогенных бактерий в зоне операции. Гнойнички придется вскрывать, либо ограничивать коррекцию такого состояния антибактериальной терапией.
Но, еще раз стоит отметить, многие осложнения можно предупредить. Особенно тщательно пациент должен выполнять гигиенические предписания после операции.
Геморроидопексия: как проходит эта операция
Данный метод около двадцати пяти лет назад изобрел и запатентовал итальянский медик Антонио Лонго. Конкретно геморроидопексия активно замещает на сегодняшний день классическую операцию, т.е. геморроидэктомию. Объясняется это меньшей травматичностью операции по Лонго (так иначе называют геморроидопексию).
Суть операции в иссечении зоны слизистой канала прямой кишки круговым способом, немного выше геморройной шишки. Патологическое образование хирург подтягивает вверх, и там закрепляет путем титановых скрепок. В ходе вмешательства нарушается кровообращение кавернозного тела, потому через какое-то время оно становится меньше, а затем уходит полностью.
- Полная безболезненность. В оперируемых районах нет большого числа нервных скоплений. Локальная анестезия требуется только для введения специального расширителя.
- Операцию можно проводить даже пожилым. Геморроидопексию делают людям с серьезными хроническими недугами и пациенткам «в положении».
- Скорость манипуляций. Грамотный хирург осуществит все действия за 25 минут.
- Беспроблемное восстановление. И это действительно так: восстанавливается пациент быстро и сравнительно легко.
Но и без минусов, как стоит ожидать, не обошлось. Например, нельзя проводить геморроидопексию при наружной форме геморроя. Наконец, это недешевая операция: врачи работают одноразовым инструментарием, который достаточно дорого стоит.
Альтернативная терапия: малоинвазивные техники
Щадящие методики – это прекрасная возможность решить проблему геморроя без серьезной травматизации. Малоинвазивные техники являются, по сути, операциями «одного дня» с быстрым восстановлением, с минимальными рисками осложнений. Но не на всех стадиях, не во всех случаях возможно решение проблемы этими методами.
Среди популярных малоинвазивных методик:
- Лигирование кольцами из латекса – на ножку узелка колопроктолог накладывает колечко из экологического латекса, оно останавливает поступление крови;
- Лазерная коагуляция – на шишку негативно влияет направленное излучение, затем ткани и сосуды свертываются;
- Дезартеризация – в канал ануса вводят аппарат, перетягивающий артерию, питающую геморройное образование;
- Склеротерапия – в деформированные сосуды вводят склеивающий состав, который нарушает их работу, питающих узлы;
- Инфракрасная фотокоагуляция – геморрой подавляют инфракрасные лучи, ткани свертываются и запекаются;
- Криодеструкция – манипуляции проводят с применением жидкого азота, он замораживает и просто разрушает измененные варикозом вены.
Эти методики эффективные, но бесплатно они проводятся редко. Правда, тот минимальный комплекс негативных моментов, который их сопровождает, покрывает необходимость затрат.
Лечение всякой болезни путем операции требует от больного некоторых перемен в образе жизни. Человек должен понять, что ситуация критическая, и возможность улучшить качество жизни – это труд, и с его стороны тоже. Очень важны гигиена, питание, физическая активность, позитивный настрой, наконец.
Геморрой – заболевание вен и сосудов, расположенных в прямой кишке и анусе человека. Болезни подвержены все люди планеты, но вовремя за медицинской помощью обращаются немногие. В результате болезнь доходит до последних стадий, консервативное лечение не в силах решить проблему пациента. Назначают операцию в обязательном порядке.
Необходимость операции
Третья и четвёртая стадии болезни – прямые показания к удалению геморроя хирургическим путём. Состояние пациента тяжёлое. Если консервативные и малоинвазивные методы лечения не оправдались, болезнь стремительно прогрессирует, требуется оперативное вмешательство. Опишем причины необходимости.
- Узлы крупного размера, выпадают из просвета прямой кишки;
- Сильное кровотечение;
- Больной испытывает нестерпимую боль при ходьбе, в положении покоя;
- Ослабляются функции сфинктера прямой кишки – бесконтрольное выделение каловых масс;
- Угроза возникновения тромбоза, защемления геморроидальных узлов, образования трещин в прямой кишке;
- Велик риск развития воспалительного процесса, присоединения инфекции.
При наружном геморрое:
- Сильные отёки тканей вокруг ануса;
- Болевые ощущения сильные;
- Геморроидальные узлы большого размера мешают передвижению. В сидячем положении зафиксироваться невозможно;
- Ткани вокруг анального канала трескаются;
- Увеличивается риск тромбоза, защемления геморроидального узла;
- Повышенная вероятность развития кожных заболеваний из-за агрессивных слизистых выделений;
- Возрастает угроза присоединения инфекции и воспаления подкожной жировой клетчатки.
При комбинированном геморрое возникают симптомы, характерные для внешнего и внутреннего геморроя.
Обязательным показанием для операции становится выпадение прямой кишки при геморрое, осложнения – парапроктит и другие.
Случаи противопоказания операции
Ряд противопоказаний для проведения операции при геморрое:
- Не проводится операция на геморрой в стадии обострения заболевания кишечника;
- Не делают операцию по удалению геморроидальных узлов в случае плохой свёртываемости крови, заболеваний кровеносной системы;
- Нельзя назначать оперативное лечение геморроя в случае почечной, печёночной и лёгочной недостаточности;
- Недопустимо проведение оперативного вмешательства с использованием общего наркоза при патологиях сердечно-сосудистой системы, заболеваниях органов дыхания;
- Сахарный диабет – противопоказание для проведения операции из-за плохой свёртываемости крови;
- Противопоказана операция по удалению геморроидальных узлов при наличии у пациента злокачественных опухолей;
- Операция по удалению геморроя не проводится при ослабленном иммунитете.
Не рекомендуется хирургическое лечение беременных женщин. После родов проблема часто возвращается. Воздействие наркоза сказывается негативно на плод.
Лечение пожилых людей стараются назначать с использованием консервативных методов – после 50 лет ткани с трудом восстанавливаются. Если операции не избежать, рекомендуется тщательное обследование пациента и подготовка к операции.
Подготовка к операции
Пациента тщательного готовят к предстоящему оперативному вмешательству.
Какие подготовительные мероприятия проводятся в клинике
- Подбор подходящего метода лечения. Врач определяется с методом хирургического вмешательства в зависимости от степени тяжести заболевания, локализации геморроидальных узлов, наличия осложнений. Для этого пациента осматривают, знакомятся с анамнезом, обговаривают жалобы.
- Проведение медицинского обследования. С целью выявления возможных противопоказаний и рисков проводятся лабораторные исследования (анализы крови и мочи), электрокардиография, флюорография, пальцевое обследование прямой кишки, аноскопия, колоноскопия, УЗИ органов брюшной полости.
- Подготовка к анестезии. Врач анестезиолог фиксирует информацию о постоянном приёме лекарств пациентом, наличии аллергических реакции на медицинские препараты, делает необходимые пробы. Принимает решение – под каким наркозом будет проходить операция. Информирует больного о подготовке за день до операции – питание и питьевой режим, клизма. Следует убрать из ротовой полости съёмные протезы, снять украшения.
Как готовится к операции пациент
Подготовку к операции больной начинает за пару недель до операции.
- Соблюдается диета. Чтобы не допустить осложнений после операции, больной нормализует работу кишечника и предотвращает образование запоров. Из рациона исключаются продукты, вызывающие вздутие кишечника, диарею, запор, раздражающие желудок и кишечник продукты.
- Заранее перед операцией проводятся мероприятия по устранению воспалений в области ануса. Отёки, воспаления или язвы минимизируются лекарственными средствами.
- Перед операцией посетите стоматолога. Вылечите больные и шатающиеся зубы, так как при общем наркозе они создадут проблемы.
- Вечером перед операцией обязательны гигиенические процедуры. Вечером примите душ и сделайте очистительную клизму – кишечник в день операции содержится в пустоте.
- Питание и питьевой режим. Последний приём пищи перед операцией проводится не менее, чем за 12 часов. Утром в день операции, в случае общего наркоза нельзя пить и воду.
Методы проведения хирургического вмешательства
В зависимости от локализации геморроидальных шишек, величины, наличия кровотечения, стадии течения заболевания, назначаются способы избавления пациента от геморроя.
Первостепенная цель хирургии – удалить воспалённые геморроидальные узлы.
Известны радикальные и малоинвазивные методы хирургического лечения. Удаление геморроя путём радикального хирургического вмешательства проводится на третьей-четвёртой стадиях заболевания. Устранение поражённых участков происходит путём вырезания и иссечения.
Геморроидэктомия по Миллигану-Моргану
Радикальный метод по лечению геморроя. Лечение проводится двумя способами:
- Открытым – когда операционная рана не зашивается, а заживает самостоятельно. Операция происходит в условиях стационара.
- Закрытым – на прооперированные участки слизистой оболочки накладываются швы. Пациента оперируют в амбулаторных условиях.
Геморроидэктомия открытым способом применяется в случаях, осложнённых трещинами на прямой кишке либо развитием парапроктита. Процедура предусматривает вырезание либо иссечение воспалённых узлов и окружающей слизистой. Иногда применяется метод Пракса, когда сами узлы вырезают без слизистой оболочки.
К преимуществам метода относятся:
- Оперирование по методу Миллигана-Моргана удаляет внутренние, наружные геморроидальные узлы;
- Операция даёт результат, проблема не возвращается продолжительное время;
- Осложнения после операции возникают редко.
К недостаткам относят:
- Операционное лечение занимает несколько часов, проходит под общим наркозом;
- Болевые ощущения в течение послеоперационного периода;
- Долгосрочный период заживления и реабилитации.
Геморроидэктомия по методу Лонго
Применяется метод трансанальной резекции – метод Лонго.
Хирургическое вмешательство заключается в отсечении части слизистых оболочек прямой кишки над зубчатой линией – выше геморроидальных шишек. Узлы не иссекаются, вытягиваются вверх, подшиваются медицинскими скобками. В результате прекращения притока крови, шишки «усыхают». Впоследствии зарастают соединительной тканью, кишка приобретает естественный анатомический вид.
- Оперируют пациента с использованием местной анестезии;
- Кровопотери при операции минимальны;
- Процедура длится до 15-20 минут;
- Безболезненное течение послеоперационного периода;
- Операция даёт устойчивый результат, осложнения возникают нечасто.
- Метод Лонго применим только к лечению внутреннего геморроя.
- Операция дорогостоящая.
Лечение геморроя лазером
Если на 1-2 стадиях консервативное лечение не приносит ощутимого эффекта, требуется операция, геморрой удаляют малоинвазивными методами.
Лазерная коагуляция – действенный метод лечения геморроя. Эффективен при внутреннем и наружном геморрое.
Методика основана на применении следующих свойств лазерного пучка:
- Работа в инфракрасном диапазоне;
- Сверхточная фокусировка;
- Использование теплового излучения.
Внутренние узлы прижигаются лазерным лучом, наружные – срезаются. При лечении врач регулирует глубину и мощность воздействия луча.
Метод эффективен при лечении тромбированного геморроя, при наличии обильного кровотечения из внутренних узлов и анальных трещин. Лазерную коагуляцию назначают даже при воспалении и свищевых каналах.
- С помощью лазерной коагуляции проводится удаление геморроя любой локализации;
- Устраняются трещины, язвы и воспаления;
- Процедура высокоточная и нетравматичная для окружающих тканей;
- Лазерная коагуляция безболезненна и бескровна;
- Пациент быстро восстанавливается после такой операции;
- Удаление больших узлов на 3 и 4 стадиях течения болезни с использованием комбинированной методики.
Процедура лазерной коагуляции требует от пациента предварительной подготовки.
Отзывы
Человек решается на операцию, когда иные методы испробованы, а боли и дискомфорт делают жизнь невыносимой. Приходится решаться на радикальные меры, в подавляющем большинстве случаев пациенты избавляются от проблемы на годы – геморрой больше не мучает.
Операция проводится методом Миллигана-Моргана. Тяжёлый этап – послеоперационный период. Операция приходит безболезненно. Устраняет запущенный внутренний, внешний и комбинированный геморрой 3-4 степени. Больно в первые две-три недели реабилитации. Мужчины жалуются на нарушение мочеиспускания первое время. Решить проблему необходимо, так как в запущенных случаях другой альтернативы нет.
Метод Лонго избавляет от проблемы действенно, период восстановления непродолжительный. Внешний геморрой этим методом не лечат.
Лазерная коагуляция решает проблему со здоровьем и затрагивает эстетическую сторону. У женщин после родов и беременности внешние узлы неприглядного вида. Лазерная коагуляция призвана лечить геморрой вне зависимости от того, где локализуются узлы, но на запущенных стадиях она недостаточно результативна. Отзывы о методе лечения положительные – всё происходит безболезненно, за 15 минут. Никакого наркоза и больничной палаты. На 3-4 стадиях геморрой лучше лечить другими методами.
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