Elbetti C, Giani I, Novelli E, Fucini C, Martellucci Jacopo
UO Chirurgia Generale Oncologica, Usl4 Prato, Prato, Italy.
SD Chirurgia Proctologica e Perineale, Aou Pisana, Pisa, Italy.
Updates Surg. 2015 Dec;67(4):421-6. doi: 10.1007/s13304-015-0333-0. Epub 2015 Nov 7.
The purpose of the paper is to compare Goligher Classification with the Single Pile Hemorrhoid Classification (SPHC) to show the possible bias and limits of Goligher's use and the possible advantage with the employment of the new classification. SPHC considers the number of pathological piles(N), the characteristics of each internal pile and the characteristics of each external pile, reporting the presence of a fibrous inelastic redundant pile(F), the presence of the subversion of dentate line or the congestion of the external pile(E) and the presence of not tolerated skin tags(S). From September 2010 to December 2012, 197 consecutive patients were analysed according to both classifications. Considering pathological piles, I and II Goligher patients showed a complete agreement between pathological pile and grade, III Goligher patients had 80.5 % of pathological piles of III grade while IV Goligher patients had only 44.3 % of IV grade pathological piles (p < 0.001). Regarding the distribution of the other anatomical variables: F, E, S described in SPHC, the results showed that F was present in 18.3 % while ES was present in 46.2 %. Goligher's Classification has showed to be an inadequate tool to overview surgical outcome or to compare surgical procedure, particularly for high grades, while SPHC showed to be a feasible instrument both to describe and to compare patients affected by hemorrhoid disease.
本文的目的是比较戈利格尔分类法与单柱痔分类法（SPHC），以展示戈利格尔分类法使用中可能存在的偏差和局限性，以及采用新分类法可能具有的优势。SPHC考虑病理性痔核的数量（N）、每个内痔的特征和每个外痔的特征，记录纤维性无弹性冗余痔（F）的存在、齿状线颠覆或外痔充血（E）的存在以及不耐受皮赘（S）的存在。从2010年9月至2012年12月，根据这两种分类法对197例连续患者进行了分析。考虑病理性痔核，戈利格尔I级和II级患者的病理性痔核与分级完全一致，戈利格尔III级患者有80.5%的III级病理性痔核，而戈利格尔IV级患者只有44.3%的IV级病理性痔核（p<0.001）。关于SPHC中描述的其他解剖变量F、E、S的分布，结果显示F的存在率为18.3%，而ES的存在率为46.2%。戈利格尔分类法已被证明是一种不足以概述手术结果或比较手术程序的工具，特别是对于高分级情况，而SPHC显示是一种既可行又能描述和比较痔病患者的工具。
