Kang Sung Il
Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
J Anus Rectum Colon. 2025 Apr 25;9(2):179-191. doi: 10.23922/jarc.2024-090. eCollection 2025.
Hemorrhoids manifest with a range of symptoms and severities, prompting the development of various conservative, interventional, and surgical treatments. Selecting the most suitable treatment for each case is challenging, especially with the continuous evolution of new methods. This review aims to advance hemorrhoid treatment and research by exploring recent developments over the last five years. Conservative approaches have focused on isolating active ingredients from traditional herbal remedies to create new products and understand their mechanisms. In office-based treatments, advanced devices such as modified rubber band ligation and polymer clips with stronger binding forces have been introduced. Polidocanol in foam form has shown promise in sclerotherapy, while infrared coagulation is being replaced by alternative energy-based methods. Additionally, endoscopic office treatments and embolization of hemorrhoidal vessels via angiography are increasingly used as safer options for patients with high surgical risks or bleeding issues. Stapled hemorrhoidopexy has shifted to partial resection instead of complete circular resection, and hemorrhoidal artery ligation techniques have been reported to be effective when combined with stapled hemorrhoidopexy or excisional hemorrhoidectomy in severe cases. Evidence is growing that hemorrhoidal artery ligation remains effective even without Doppler guidance. With ongoing research into various methods, there is a need for scientific comparison and evaluation of their advantages and disadvantages, standardization of indicators and treatment protocols, and cost-effectiveness considerations. Surgeons should offer well-informed options and explanations to patients, based on a comprehensive understanding of available treatments.
痔疮表现出一系列症状和严重程度，促使人们开发出各种保守、介入和手术治疗方法。为每个病例选择最合适的治疗方法具有挑战性，尤其是随着新方法的不断发展。本综述旨在通过探讨过去五年的最新进展来推进痔疮治疗和研究。保守方法侧重于从传统草药中分离活性成分以创造新产品并了解其作用机制。在门诊治疗中，已引入了先进的设备，如改良的橡皮筋结扎术和具有更强约束力的聚合物夹子。泡沫形式的聚多卡醇在硬化疗法中显示出前景，而基于替代能量的方法正在取代红外线凝固法。此外，内镜门诊治疗和通过血管造影对痔血管进行栓塞越来越多地被用作手术风险高或有出血问题患者的更安全选择。吻合器痔上黏膜环切术已转向部分切除而非完全环形切除，并且据报道，在严重病例中，痔动脉结扎技术与吻合器痔上黏膜环切术或痔切除术联合使用时有效。越来越多的证据表明，即使没有多普勒引导，痔动脉结扎术仍然有效。随着对各种方法的不断研究，需要对其优缺点进行科学比较和评估，对指标和治疗方案进行标准化，并考虑成本效益。外科医生应在全面了解现有治疗方法的基础上，为患者提供充分知情的选择和解释。
