Hemorrhoids (in Mandarin 痔疮)

痔疮

 

痔疮通常称为肛门和直肠静脉曲张,是指肛门和直肠下段内部及周围的血管发生扩张和膨胀。直肠是大肠的末段。支撑血管的组织拉伸,导致血管扩张,血管壁变薄并出血。如果继续拉伸和受压,弱化的血管便会突出。根据痔疮所在位置,分为外痔和内痔两种类型。

 

外痔(外部)形成于肛门附近,隐藏在敏感皮肤下。除非形成血块(血栓),否则它们通常不会产生痛感。

 

血栓性外痔是指外痔中肛周皮肤下形成血块。如果血块较大,会引起明显的疼痛。可能会突然出现肛门肿块,令人疼痛难耐,并且在最初的 48 小时内进一步恶化。在接下来的几天里,疼痛通常会减轻。如果表层皮肤裂开,可能会出血。

 

内痔(内部)形成于肛门内部,粘膜之下。最常见的症状为排便时出血(无痛感)、突出。然而,如果内痔完全脱垂,会带来剧烈疼痛。这意味着痔核已完全滑出肛门,不能推回到肛门内。

 

痔疮的事实和数据

 

  • 痔疮是最常见的已知疾病之一。
  • 目前数百万美国人患有痔疮。
  • 一般人会在经受长时间的痛苦后,才寻求痔疮治疗。
  • 治疗方法的进步意味着某些类型的痔疮可采用新方法治疗,大大减少患者的疼痛。

 

病因

 

痔疮的确切病因尚不清楚。直立姿势导致人体直肠静脉承受着很大压力,这可能会引发静脉膨胀。其他致病因素包括:

 

  • 年龄
  • 慢性便秘或腹泻
  • 妊娠
  • 遗传
  • 排便过度用力
  • 由于过量使用泻药或灌肠剂导致的肠功能不良
  • 久坐马桶(例如阅读)

 

症状

 

以下任何一种情况都可能是痔疮的体征:

 

  • 便血
  • 排便时皮肤突出
  • 肛门区域瘙痒
  • 肛门区域疼痛
  • 出现敏感肿块

 

非手术治疗

 

在尝试自我治疗之前,务必让结直肠外科医生对症状进行检查。他们会进行彻底检查并提供治疗建议。通常无需手术即可缓解轻微症状。通过非手术治疗,疼痛和肿胀通常会在两到七天内减轻。硬块应在四到六周内消退。

 

治疗方法包括:

 

  • 食用高纤维食物和非处方纤维补充剂(25-35 克纤维/天),促进粪便成形,增加粪便软度和粪便量。
  • 避免过度用力可减少痔疮所受压力,并有助于防止突出。
  • 多喝水有助于防止大便硬结,并能帮助伤口愈合。
  • 每天进行数次 10 20 分钟的温水盆浴(坐浴),有助于康复过程。

 

手术治疗

 

如果血栓痔造成的痛感非常剧烈,医生可能会决定用小切口术切除痔疮和/或血块。可在医生诊室或在医院以局部麻醉的形式完成该手术。

 

橡皮带结扎法:此治疗方法对排便时突出的内痔非常有效。在痔疮上绑上橡皮带,切断其血液供应。痔疮和橡皮带会在几天内脱落。伤口通常在一到两周内愈合。可能出现轻微不适和出血。有时需要反复进行此治疗,痔疮才能彻底治愈。

 

图示

 

治疗内痔的橡皮带结扎法

 

该疗法适用于膨胀出血性内痔

橡皮带扎于痔疮的底部

结扎痔疮脱落后,底部会留下一个小的疤痕(箭状)

 

注射和凝固疗法:此方法可用于不突出的出血性痔疮。这两种方法都可无痛地使痔疮萎缩。

 

痔疮吻合器治疗术:使用特殊设备进行吻合,并将内痔上的组织切除。虽然吻合器疗法可使内部组织收缩,但不能用于外痔。此方法通常比橡皮带结扎法更痛苦,但较之痔切除术稍好。

 

痔切除术:这是一种最彻底的手术方法,可切除引起出血和突出的多余组织。该手术在麻醉下进行,使用缝合线或吻合钉完成。根据具体情况,可能需要住院并修养一段时间。与普遍看法相反,激光法较之标准手术方法并无任何优势。激光手术不仅昂贵,而且同样痛苦。

 

如出现以下情况,请考虑行痔切除术:

 

  1. 外痔中反复出现血块
  2. 结扎法对治疗内痔无效
  3. 突出的痔疮无法缩小
  4. 慢性出血

 

痔疮会导致结直肠癌吗?

 

痔疮不会增加结肠癌的患病风险,也不会导致结肠癌。但是,如果病情较重,可能会导致类似的症状。即使痔疮已完全愈合,结直肠外科医生也可能要求进行其他检查。可进行结肠镜检查,排除直肠出血的其他原因。50 岁及以上的人都应接受结肠镜检查,以筛查结直肠癌。

 

什么是结直肠外科医生?

 

结直肠外科医生是通过手术和非手术方法治疗结肠、直肠和肛门疾病的专家。他们不仅在此类疾病的治疗方面接受了完善先进的外科手术训练,还受过全面的普通外科手术训练。他们在普通外科和结直肠外科完成了住院医生实习,并通过了美国外科委员会和美国结肠和直肠外科委员会举办的强化测试,才成为具备专科医师资格的结直肠外科医生。无论是良性还是恶性的结肠、直肠和肛门疾病,他们均精通其治疗方法,且能进行常规筛查和手术治疗(如有必要)。

 

免责声明

 

美国结肠和直肠外科医师学会致力于促进对结肠、直肠和肛门疾病的科学研究,强化此类疾病的预防和管理,从而确保为患者提供高质量的医疗服务。这些手册内容广泛,并非规范性文件。目的是提供有关疾病过程的信息,而不是规定特定的治疗形式。这些手册旨在供需要了解如何管理上述疾病的所有执业医师、医护人员和患者使用。应清楚认识到,这些手册不包含所有适当的护理方法,也并未排除合理运用可获得相同治疗结果的护理方法。关于任何特定程序的适当性,必须由医生根据患者个体表现出的所有情况作出最终判断。



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