Dissertations / Theses on the topic 'Hemorrhoids. Hemorrhoids Hemorrhoids'

La patología hemorroidal es una de las causas más frecuentes de consulta en coloproctología. En las fases más avanzadas de la enfermedad el tratamiento es quirúrgico y la técnica más ampliamente utilizada es la hemorroidectomía excisional. El tratamiento quirúrgico presenta una comorbilidad significativa, con el objetivo de disminuirla se han desarrollado técnicas mínimamente invasivas como el HAL-RAR (Ligadura arterial hemorroidal guiada por Doppler y reparación rectoanal). Los objetivos del estudio de la presente tesis son determinar de forma prospectiva la eficacia y seguridad del HAL-RAR a corto y medio plazo en el tratamiento de las hemorroides grado III-IV, estudiar el dolor postoperatorio y la resolución de los síntomas hemorroidales mediante el HAL-RAR comparándolo con la hemorroidectomía excisional, determinar la seguridad y eficacia del HAL-RAR en los programas de cirugía ambulatoria de las hemorroides, comparar las tasas de persistencia, recurrencia y morbilidad del HAL-RAR con la hemorroidectomía excisional, estudiar el impacto en la calidad de vida en los pacientes sometidos a HAL-RAR y la hemorroidectomía excisional y determinar la aplicabilidad en la práctica clínica de los resultados obtenidos con ambas técnicas. Para ello hemos llevado a cabo dos estudios que han sido publicados en revistas internacionales: 1. EL HAL-RAR ES UN PROCEDIMIENTO SEGURO Y EFECTIVO PARA EL TRATAMIENTO DE LAS HEMORROIDES. RESULTADOS DE UN ESTUDIO PROSPECTIVO TRAS DOS AÑOS DE SEGUIMIENTO En 2016 realizamos un estudio prospectivo en el que se incluyó a 30 pacientes intervenidos entre Junio de 2012 y Junio de 2014 con enfermedad hemorroidal grado II-IV. 29 (96.6%) pacientes se recuperaron sin observarse complicaciones postoperatorias. Un paciente presentó necrosis de uno de los paquetes hemorroidales, por lo que fue reintervenido de forma urgente realizándose una hemorroidectomía excisional (Complicación grado III-a de la clasificación de Dindo-Clavien). El paciente fue dado de alta a las 48 horas de la segunda reintervención sin presentarse otras complicaciones. Ningún paciente fue reintervenido por hemorragia postoperatoria y la mortalidad en nuestra serie fue nula. 2. ESTUDIO PROSPECTIVO Y ALEATORIZADO COMPARANDO EL HAL-RAR CON LA HEMORROIDECTOMÍA EXCISIONAL Se incluyeron todos los pacientes valorados de forma consecutiva entre Marzo de 2014 y Octubre de 2015, con patología hemorroidal grado II y IV de la clasificación de Goligher, con síntomas hemorroidales refractarios a tratamiento médico. Con éste estudio concluimos que el HAL-RAR es una técnica eficaz y segura, con buenos resultados a corto y medio plazo (26 meses) para el tratamiento de la patología hemorroidal grado III y IV. El HAL-RAR causa un dolor postoperatorio menos intenso y menos duradero que la hemorroidectomía excisional. Además el HAL-RAR consigue una resolución de los síntomas hemorroidales más temprana y con menos molestias postoperatorias, especialmente si el síntoma principal es la rectorragia. Debido al menor dolor postoperatorio y a la ausencia de complicaciones severas, el HAL-RAR puede incorporarse en los programas de cirugía ambulatoria de las hemorroides grado III y IV. El HAL-RAR presenta una tasa de persistencia, recurrencia y morbilidad postoperatoria similar a la hemorroidectomía excisional a los 15 meses de seguimiento. El HAL-RAR consigue una mejoría en todas las esferas de la calidad de vida que se mantiene tras un año de la intervención, la mejoría en la calidad de vida es similar a la que se consigue con la hemorroidectomía excisional. Los estudios realizados en nuestro centro nos han permitido modificar nuestro algoritmo terapéutico de la patología hemorroidal para incorporar el HAL-RAR como técnica de elección para la mayoría de casos de hemorroides grado III y algunos casos de hemorroides grado IV.<br>Hemorrhoidal disease is one of the most frequent causes of consultation in coloproctology. In the advanced stages of the disease, the treatment is surgical and the most widely used technique is the excisional hemorrhoidectomy. Surgical treatment presents a significant comorbidity, with the aim of reducing it, minimally invasive techniques have been developed, such as HAL-RAR (Doppler-guided hemorrhoidal arterial ligation and rectoanal repair). The objectives of the study are to prospectively determine the efficacy and safety of HAL-RAR in the short and medium term in the treatment of grade III-IV hemorrhoids, to study postoperative pain and the resolution of hemorrhoidal symptoms with HAL-RAR comparing it with the excisional hemorrhoidectomy, determine the safety and efficacy of the HAL-RAR in the ambulatory surgery programs of the hemorrhoids, compare the rates of persistence, recurrence and morbidity of the HAL-RAR with the excisional hemorrhoidectomy, study the impact on quality of life in patients undergoing HAL-RAR and excisional hemorrhoidectomy and determine the applicability in clinical practice of the results obtained with both techniques. For this we have carried out two studies that have been published in international journals: 1. HAL-RAR IS A SAFE AND EFFECTIVE PROCEDURE FOR THE TREATMENT OF HEMORRHOIDS. RESULTS OF A PROSPECTIVE STUDY AFTER TWO YEARS OF FOLLOW UP In 2016, we conducted a prospective study in which 30 patients operated on between June 2012 and June 2014 with grade II-IV hemorrhoidal disease were included. 29 (96.6%) patients recovered without observing postoperative complications. One patient presented necrosis of one of the hemorrhoidal cushions, so he was reoperated urgently, performing an excisional hemorrhoidectomy (Complication grade III-a of the Dindo-Clavien classification). The patient was discharged 48 hours after the second reoperation without presenting other complications. No patient was reoperated for postoperative hemorrhage and the mortality in our series was zero. 2. PROSPECTIVE AND RANDOMIZED STUDY COMPARING HAL-RAR WITH EXCISIONAL HEMORRHOIDECTOMY All patients consecutively assessed between March 2014 and October 2015, with grade II and IV haemorrhoidal pathology of the Goligher classification, with hemorrhoidal symptoms refractory to medical treatment, were included. With this study we conclude that the HAL-RAR is an effective and safe technique, with good results in the short and medium term (26 months) for the treatment of hemorrhoidal pathology grade III and IV. HAL-RAR causes less intense and shorter postoperative pain than excisional hemorrhoidectomy. In addition, the HAL-RAR achieves a resolution of the hemorrhoidal symptoms earlier and with less postoperative discomfort, especially if rectal bleeding is the main symptom. Due to the lower postoperative pain and the absence of severe complications, the HAL-RAR can be incorporated in the ambulatory surgery programs of grade III and IV hemorrhoids. The HAL-RAR presents a rate of persistence, recurrence and postoperative morbidity similar to excisional hemorrhoidectomy at 15 months of follow-up. The HAL-RAR achieves an improvement in all areas of quality of life that is maintained after one year of the intervention, the improvement in quality of life is similar to that achieved with the excisional hemorrhoidectomy. The studies carried out in our center have allowed us to modify our therapeutic algorithm for hemorrhoidal pathology to incorporate the HAL-RAR as the technique of choice for the majority of cases of grade III hemorrhoids and some cases of grade IV hemorrhoids.

Homoeopathy is a system of medicine used in obstetric prescribing to reduce the minor common complications of pregnancy (Cure, 1999). One such complication is haemorrhoids. Haemorrhoids are varicosities of the haemorrhoidal plexus in the rectum, and are often complicated by inflammation, thrombosis and haemorrhage (Beers & Berkow, 1999). The aim of the study was to determine the effect of homoeopathic similimum treatment on haemorrhoids in pregnant women. This was a quantitative, interventive and descriptive study spanning one month. The research method used homoeopathic similimum treatment and a participant administered questionnaire in a panel longitudinal, in-depth case study. Non-probability purposive sampling was used to select 12 primigravida or multigravida pregnant females, aged 18-35, from the 12th to 35th week of gestation, presenting with haemorrhoids, who met the inclusion criteria. The sample was obtained by advertisements placed in antenatal classes, private clinics and pharmacies; and by pamphlets handed out at Baby City shops and baby expositions to pregnant women; and referrals from health care providers. The similimum medicine was selected after an initial consultation and physical examination. The symptoms of the initial consultation were noted on a case taking form. The similimum medicine was prescribed in potency between 5CH and 200CH. Dosage was determined by the laws of similimum prescribing. Questionnaires relating to the patients symptoms were completed by the patient daily during the duration of the study. A follow up consultation and physical examination was conducted at the end of the 2nd week of treatment. As indicated by the symptoms at the follow up consultation, a new similimum was prescribed; the original similimum was continued; or it was decided to wait and watch the action of the medicine in the participant if there were signs of improvement. A final consultation and physical examination was conducted at the end of the 4th week of treatment to document the effectiveness of the treatment. The questionnaire was collected. The symptoms of both follow up consultations were noted on a follow up form. Data obtained from the questionnaires were analysed. An ordinal regression, time 1 vs. time t - 1 analysis, regression using sums and a reliability analysis were performed. The data from the individual consultations were used to write up an in depth case study. Eighty three percent (10/12) of the cases of haemorrhoids in pregnancy improved on homoeopathic similimum treatment. Homoeopathic similimum medicine had a significant effect on decreasing the severity of the pain (p < 0.00) and protrusion (p < 0.00). Besides the improvement to the haemorrhoids, there were also signs of improvement to some of the concomitant symptoms experienced by the participants. In conclusion, homoeopathic similimum treatment within a clinical setting is effective in relieving the symptoms of haemorrhoids in pregnant women. Further research needs to be conducted in order to verify these findings.<br>Dr. Candice Bodkin Dr. Elizabeth Solomon

碩士<br>國立陽明大學<br>醫務管理研究所<br>104<br>Characteristics of hemorrhoids patients in Taiwan-A descriptive analysis based on the National Health Insurance database Abstract Background: Hemorrhoids is a common disease, but itsprevalence, patient population and health seekingbehaviorwere notreported in Taiwan. The purpose of the study is to evaluate the prevalence of hemorrhoids and to explore the factors of undergoingsurgical treatment such as gender, age, and Charlson comorbidity index. Methods: We used a nationally representative dataset (Taiwan’s National Health Insurance Research Database) containing 1,000,000patients, who were randomlysampled from the years 2000,2005, and 2010, respectively.Information of diagnosis, examination, and treatment were further retrieved.The factors in relation to undergoing surgery for hemorrhoids patients were analyzed by logistic regression model. Result: 1. From 2000 to 2010,the crude prevalence of patients with symptomatic hemorrhoids increased from 1.37 to 2.01%, and the adjusted prevalence increased from 0.58 to 1.01%. The prevalence among males and females was similar. The prevalent age group for Hemorrhoids was 61–80 years (crude, 3.4%;adjusted, 1.77%). 2.From 2000 to 2010,the proportion of patients undergoing surgical treatment decreased from 39.6 to 27.4%.Among all types of medical facilities where the surgery was carried out, clinics had the highest proportion (37.23%,p<0.05).Patients without comorbidities also had higher proportion as compared with those with comorbidities. (29.57%, p < 0.05). The odds ratio (OR) for surgery was highest in those aged 41–60 years (1.431, p < 0.05, 95%CI: 1.202-1.703),presenting at clinics (2.787, p<0.05, 95% CI:2.569- 3.025) and without comorbidities (1.875, p<0.05, 95% CI:1.687-2.045). 3.From 2000 to 2010, the proportion of patients undergoing total hemorrhoidectomy decreased from 13.06 to 7.75%. The peak age for total hemorrhoidectomy was 21–40 years (9.85%, p <0.05). The proportion was highest in regional hospitals (9.59%, p < 0.05) and in patients without comorbidities (8.98%, p <0.05). The OR of performing a Surgery was highest in those aged 21–40 years (3.425, p <0.05, 95% CI: 2.190–5.356), regional hospitals (1.283, p <0.05, 95% CI:1.020–1.613), and those without comorbidities (1.334, p <0.05, 95% CI: 1.088–1.635). Conclusions: From 2000 to 2010, the prevalence of hemorrhoids increased in Taiwan, whereas the proportion of patients undergoing surgical treatments decreased. Patients with a higher comorbidity score had a lower surgical treatment rate. The highest proportion of medical facilities undergoing surgical treatment for hemorrhoids was clinics. Key word: Hemorrhoid, prevalence, treatment, hospital

碩士<br>國立中山大學<br>醫務管理研究所<br>97<br>Patients experience some degree of pain accompanying all surgical procedures. If this pain is not adequately treated, it will cause severe physiological and psychological damage. It will even affect patients'' postoperative recovery. However, if preemptive analgesia is administered before noxious stimuli arise, rather than afterwards, it is significantly more effective. The purpose of this study is to recognize that reasonable effort and time should be spent to determine a patient''s tolerance level towards pain before surgery. Then, the appropriate dosage of analgesia can be given immediately after surgery to alleviate pain. By administering effective pain relief, it will improve patient’s satisfaction with medical services. Using classic experimental design (which consists of an experimental group and a control group), this study focuses on cases of patients who had hemorrhoid surgery in a certain hospital in southern Taiwan. The experimental group and the control group consist of a total of 75 valid samples. The experimental group received customizing analgesic postoperative care, while the control group received conventional analgesic postoperative care. Patient’s satisfaction questionnaires were gathered from patients on the day they were discharged from the hospital. Instruments used in the experiment include VAS, PThM, and patient’s satisfaction questionnaires.To examine the basic characteristics of the samples in both the experimental group and the control group, two statistical methods, Chi-square test and independent T test, were adopted. For patient’s satisfaction questionnaires, Mann-Whitney-Wilcoxon test of nonparametric method was adopted to examine if obvious differences in satisfaction levels existed between the two groups. The result of the experiment shows the analgesic effect from customizing analgesic postoperative care is far better than conventional care. The patient’s satisfaction toward the doctor''s professional skill was higher as well. On the other hand, the patient’s satisfaction level toward the whole medical process had no obvious improvement. This study proves that customizing analgesic postoperative care can effectively prevent postoperative pain from occurring. However, to raise patient’s satisfaction towards the whole medical process, better professional medical skill is required as well as improved medical services.

碩士<br>中國醫藥大學<br>中西醫結合研究所碩士班<br>96<br>Objective: The purpose of this study was to assess the efficacy and safety of Sophora Flower Formula in the treatment of symptomatic hemorrhoids Methods: Under the design of a prospective, double-blind, randomized and placebo-controlled study, patients with symptomatic hemorrhoids were grouped into treatment group who received the formula when the placebo group take the capsule with starch only. The exclusion criteria were grade 4 hemorrhoids, pregnancy, radiation history, obvious impairment of liver and renal function, coexisting anal disease like ulcerative colitis, Crohns disease, anal fissure ,fistula and history of recent invasive procedure for hemorrhoids within six months. Results: There were 45 patients enrolled into this study, they were randomized by the third party. The average age in treatment group were 37.34±12.66, 18 male and 5 female. 12 patients had abnormal bowel movement. In the placebo group, age is 39.54±13.89, 15 male and 7 female. 12 patients had abnormal bowel movement. After 7 days treatment, the main symptoms among the treatment group were subsided 60.86% and improved in 26.08%. When the patients in placebo group 54.54% subsided and 18.18% had persist symptoms. The main superior effect is to maintain stop bleeding in the treatment group. On the other hand, anal pain, itching and tenesmus sensation improved equally in both group. Conclusion: According to this study, Sophora Flower Formula in the treatment of symptomatic hemorrhoids is effective, the main effect is to control and prevent recurrent hemorrhoids bleeding.

碩士<br>長庚大學<br>商管專業學院碩士學位學程在職專班醫務管理組<br>102<br>Background: Hemorrhoids are a common problem and hemorrhoiddec- tomy is a frequently performed surgical procedure for such a problem. During a surgical hemorrhoidectomy, a diverse array of complications may occur with respect to the method of anesthesia and surgical procedures. This study aims to compare the medical outcomes of different surgical procedures combined with anesthesia types. Medical outcomes include postoperative pain, urination difficulty, and admission length in hemorrhoid inpatients. Methods: A retrospective chart review was conducted to collect data from patients received any of three different hemorrhoidectomy between 2009 and 2012 in a medical center in Northern Taiwan. A total of 347 hemorrhoid inpatients were valid for this analysis. Results: 1. Patients’ personal characteristics such as sex, age, anesthesia evaluation have no significant effects on the medical outcome. 2. Types of surgical procedures have a significant effect on postoperative pain (F=4.689, p<0.01) and difficulty in urination (F=2.947, p<0.05). For traditional and Ligasure surgery, local anesthesia resulted in less pain compared to spinal anesthesia. PPH surgery with spinal anesthesia was associated with less pain than local anesthesia. For all three surgerical procedures, local anesthesia was associated with less difficulty in urination compared to spinal anesthesia. Ligasure surgery combined with local anesthesia had a shorter length of stay than other combinations of surgical procedures and types of anesthesia. Conclusion: The combination of Ligasure procedure and local anesthesia is shown to be more cost-effective and result in the most favorable medical outcomes, such as less postoperative pain and lower incidence of difficulty in urination. The results of this study can provide healthcare administrators and surgeons suggestions concerning decision-making related to better quality of care for patients received hemorrhoidectomy.

碩士<br>中原大學<br>工業工程學系<br>87<br>In order to promote medical quality and restrain the consumption of health resources, many medical organizations started to research the way to improve the quality. Clinical path has catch lots of attentions but the contribution is limited. In order to explore the medical quality, this research applies the methodologies of the customer-oriented process management to study the clinical therapy process, The purposes of this research are as follows. First, it is to establish a reference for the similar medical centers to adopt process management to construct the model of clinical practice quality. Second, it is to analyze the initial effect for the application of process management on the model of clinical therapy quality improvement. Third, it is to enhance the efficiency of medical resources. Fourth, it is to improve clinical practice quality. Finally, it is to employ the concept and the skills of industrial engineering to the medical industry by QIT（Quality Improvement Team）such as process management, problem solving procedure, statistics, etc. Finally, this research investigates the therapy process of the hemorrhoid disease by using the cross section study. First, applying multivariate analysis that examines the clinical decision making of caregiver in special time establishes a clinical therapy algorithm of hemorrhoid. Finally, using the experiment group and contract group validates the assessment of clinical therapy algorithm.