asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-011asurgery-358Research ArticleПРОКТОЛОГИЯPROCTOLOGYФлеботоники в консервативном лечении геморроя: когда, кому, как?Phlebotonics for conservative treatment of haemorrhoids: when, to whom, how?https://orcid.org/0000-0002-9232-6520ШлыкД. Д.ShlykD. D.

Шлык Дарья Дмитриевна, к.м.н., доцент,

119991, Москва, ул. Большая Пироговская, д. 2, стр. 4

Darya D. Shlyk, Cand. Sci. (Med.), Assistant Professor, 

2, Bldg. 4, Bolshaya Pirogovskaya St., Moscow, 119991

shlikdarya@gmail.comhttps://orcid.org/0000-0002-6404-389XТулинаИ. А.TulinaI. A.

Тулина Инна Андреевна, к.м.н., доцент, 

119991, Москва, ул. Большая Пироговская, д. 2, стр. 4

Inna A. Tulina, Cand. Sci. (Med.), Assistant Professor, 

2, Bldg. 4, Bolshaya Pirogovskaya St., Moscow, 119991

tulina@kkmx.ruhttps://orcid.org/0000-0002-7134-6821ЦарьковП. В.TsarkovP. V.

Царьков Петр Владимирович, д.м.н., профессор,

119991, Москва, ул. Большая Пироговская, д. 2, стр. 4

Petr V. Tsarkov, Dr. Sci. (Med.), Professor, 

2, Bldg. 4, Bolshaya Pirogovskaya St., Moscow, 119991

tsarkov@kkmx.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202322052023201148155Copyright © Шлык Д.Д., Тулина И.А., Царьков П.В., 20232023Шлык Д.Д., Тулина И.А., Царьков П.В.Shlyk D.D., Tulina I.A., Tsarkov P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/358

Геморроидальная болезнь занимает 4-е место среди всех заболеваний желудочно-кишечного тракта. Распространенность геморроидальной болезни среди населения Российской Федерации составляет 130–145 пациентов на 1 000 человек, встречаясь преимущественно у пациентов 45–65 лет. В амбулаторной практике заболевание встречается с частотой 694 на 100 тыс. населения. Лечение геморроя зачастую начинается в кабинете врача-колопроктолога на амбулаторном приеме. Типичными клиническими проявлениями геморроя является комплекс симптомов: периодическое выделение крови из прямой кишки во время дефекации, выпадение геморроидальных узлов, требующих ручного пособия для их вправления. Такие симптомы, как боль и зуд встречаются значительно реже. Лечение геморроидальной болезни состоит из комплекса консервативных мероприятий, малоинвазивных и хирургических методов лечения или сочетания этих методов. В основе современных схем консервативного лечения одно из первых мест по праву занимает применение системных флеботропных препаратов, которые оказывают влияние на различные звенья патогенеза геморроидальной болезни. Флеботропные препараты представляют собой большую группу биологически активных веществ, которые получаются путем химического синтеза или переработки растительного сырья. Наиболее изучены венотоники на основе флавоноидов – диосмина и гесперидина. В клинических и экспериментальных исследованиях изучены различные эффекты диосмина и гесперидина: начиная от антиульцерогенного и противоопухолевого, заканчивая антиоксидантным и противовоспалительным. Наиболее важными действиями в отношении геморроидальной болезни являются их венотонизирующие и ангиопротективные эффекты. Данный обзор направлен на определение места использования флеботоников в амбулаторной практике при лечении пациентов с симптомами геморроидальной болезни. 

Hemorrhoidal disease (HD) is a pathological enlargement of the external and/or internal hemorrhoidal piles, which may be accompanied by the bleeding and prolapse of haemorrhoids outside the anal canal. The incidence of HD among the population of the Russian Federation is 130–145 patients per 1000 people, occurring mainly in patients 45–65 years old. Among all coloproctological diseases in Russia, haemorrhoids became the reason for visiting a coloproctologist in 35–41.9% of cases. In outpatient department, the disease occurs with a frequency of 694 per 100,000 population. The treatment of hemorrhoids often begins at the coloproctologist’s office during outpatient visits. Typical clinical presentations of hemorrhoids include a complex of symptoms: periodic rectal bleeding during defecation, prolapsed hemorrhoids requiring manual reduction. Pain and itching are much less common symptoms. The treatment of hemorrhoidal disease consists of a complex of conservative measures, minimally invasive and surgical treatments, or a combination of above methods. Systemic phlebotropic drugs that affect various pathogenesis links of hemorrhoidal disease hold one of the first rightful places at the very core of modern conservative therapy regimens. Phlebotropic drugs are a large group of biologically active substances that are products of chemical synthesis or plant processing. The venotonic drugs containing flavonoids diosmin and hesperidin are the most studied ones. Various effects of diosmin and hesperidin from anti-ulcerogenic and antitumor to antioxidant and anti-inflammatory ones have been studied in clinical and experimental studies. Its venotonic and angioprotective effects are the most important actions for the treatment of hemorrhoidal disease. This review of literature is aimed determining the place of phlebotonics in outpatient practice for the treatment of haemorrhoidal disease. 

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The authors declare that there are no conflicts of interest present.