Brühl W
Fortschr Med. 1993 Feb 10;111(4):39-42.
FUNDAMENTAL REMARKS: Successful treatment of hemorrhoids stands and falls with the correct diagnosis.
Where conservative treatment measures are justified and surgical intervention can be foregone, new studies on the sclerotherapy of hemorrhoids have led to a change in therapeutic objectives. Accordingly, in the case of enlarged symptomatic hemorrhoids an attempt should not be made primarily to reduce their size; rather, the usually caudally displaced hemorrhoidal convolutes should be fixed again above the dentate line. This is achieved by injecting the sclerosant not as previously into the center of the hemorrhoid convolute, but into the base between hemorrhoids and the adjacent muscular layer. This does not lead to destruction of the hemorrhoids with possible impairment of their function, but to the desired fixation. In this way, irrespective of the degree of the hemorrhoidal disease the danger that, on defecation, the hemorrhoids are forced into the anal channel, is avoided. If the hemorrhoids cannot be fixed in the way described, only surgical measures will lead to success.
Sclerotherapy of hemorrhoids should not be aimed at shrinking, but fixing them. Should the objective not be achieved after two or three treatment sessions, surgery should be considered.
基本要点：痔疮的成功治疗取决于正确的诊断。
在保守治疗措施合理且可避免手术干预的情况下，关于痔疮硬化疗法的新研究已导致治疗目标的改变。因此，对于有症状的肿大痔疮，不应主要试图减小其大小；相反，通常向尾侧移位的痔襞应再次固定在齿状线以上。这是通过将硬化剂不是像以前那样注入痔襞中心，而是注入痔与相邻肌肉层之间的基部来实现的。这不会导致痔疮破坏并可能损害其功能，而是实现所需的固定。通过这种方式，无论痔疮疾病的程度如何，都可避免排便时痔疮被挤入肛管的危险。如果痔疮无法按所述方式固定，只有手术措施才会成功。
痔疮硬化疗法不应旨在缩小，而应旨在固定。如果经过两到三次治疗仍未达到目标，则应考虑手术。
