Bernstein W C
Dis Colon Rectum. 1983 Dec;26(12):829-34. doi: 10.1007/BF02554764.
New concepts of the pathophysiology of hemorrhoids have been defined during the past eight or more years, yet medical education at the undergraduate and graduate levels has not kept pace with the newer concepts. The traditional concepts are being perpetuated in all medical dictionaries and in most textbooks of surgery, medicine, anatomy, and pathology. Hemorrhoids are not varicosities, but rather are vascular cushions composed of arterioles, venules, and arteriolar-venular communications which slide down, become congested and enlarged, and bleed. The pathogenesis begins in the fibromuscular supporting layer in the submucosa, above the vascular cushions. The bright red bleeding, which accompanies hemorrhoidal disease, is arteriolar in origin. Portal hypertension has been shown not to be the cause of hemorrhoids. The use of rubber bands, sclerosing solutions, cryosurgery, or the infra-red beam in the early stages of hemorrhoidal disease can take care of prolapse and bleeding and can prevent the development of third and fourth degree hemorrhoids.
在过去八年或更长时间里，痔疮病理生理学的新概念已被明确，但本科和研究生阶段的医学教育却未能跟上这些新观念的步伐。所有医学词典以及大多数外科学、医学、解剖学和病理学教材中仍在沿用传统观念。痔疮并非静脉曲张，而是由小动脉、小静脉以及动静脉交通支组成的血管垫，这些血管垫会下滑、充血、肿大并出血。发病机制始于黏膜下层血管垫上方的纤维肌肉支持层。痔疮疾病伴随的鲜红色出血源自小动脉。现已证明门静脉高压并非痔疮的病因。在痔疮疾病早期使用橡皮筋结扎、硬化剂、冷冻手术或红外线光束，能够处理脱垂和出血问题，并可预防三度和四度痔疮的发展。
