Osmanov I, Ergüder E, Ahmadov J, Ersak C, Leventoğlu S, Menteş B B
Department of Surgery, Ufuk University Dr. Rıdvan Ege Hospital, Ankara, Turkey.
Proctology Unit, Ankara Memorial Hospital, Ankara, Turkey.
Tech Coloproctol. 2025 Jul 22;29(1):147. doi: 10.1007/s10151-025-03184-6.
A precise evaluation of the positional distribution of hemorrhoidal piles has not been distinctly conducted. We hypothesized that the distribution of hemorrhoidal piles follows a predictable anatomical pattern influenced by disease duration and recurrence.
Our retrospective study analyzed the demographic data, surgical records, operative photographs, previous treatments, and associated colorectal symptoms of patients who underwent invasive procedures for advanced hemorrhoidal disease (2020-2024).
Of the 171 patients (123 male; 71.9%; median age 41 ± 12.04 years, range 18-88), 35 had prior interventions (recurrent cases). The largest pile was most commonly in the left lateral quadrant (40.14%), followed by right posterior (31.97%), right anterior (23.47%), and atypical locations (4.42%). Left lateral predominance was significantly higher in primary cases than in recurrent cases (p = 0.031). Most patients had more than one pile (87.7%). Symptom duration positively correlated with pile number (Spearman's rho = 0.229, p = 0.013), but not with hemoroid grade (p = 0.977). No significant differences in pile distribution were observed in patients with defecation disorders, labor history, or concomitant anal fissure (p > 0.05). Of the 48 patients with anal fissure had significantly shorter symptom duration compared to those without fissure (p = 0.011).
The classical three-quadrant distribution is confirmed, with the left lateral pile being predominant in primary cases. The association between prolonged symptom duration and increased pile number offers novel insights, highlighting left lateral predominance in primary cases and its reduction in recurrence, enhancing clinical understanding and management.
尚未对痔核的位置分布进行精确评估。我们假设痔核的分布遵循受疾病持续时间和复发影响的可预测解剖模式。
我们的回顾性研究分析了接受晚期痔病侵入性手术（2020 - 2024年）患者的人口统计学数据、手术记录、手术照片、既往治疗情况以及相关的结直肠症状。
171例患者（123例男性；71.9%；中位年龄41±12.04岁，范围18 - 88岁）中，35例有既往干预（复发病例）。最大的痔核最常见于左侧象限（40.14%），其次是右后象限（31.97%）、右前象限（23.47%）和非典型位置（4.42%）。原发性病例中左侧优势明显高于复发病例（p = 0.031）。大多数患者有不止一个痔核（87.7%）。症状持续时间与痔核数量呈正相关（Spearman秩相关系数 = 0.229，p = 0.013），但与痔分级无关（p = 0.977）。在排便障碍、分娩史或合并肛裂的患者中，痔核分布无显著差异（p>0.05）。48例有肛裂的患者症状持续时间明显短于无肛裂的患者（p = 0.011）。
经典的三象限分布得到证实，原发性病例中左侧痔核占主导。症状持续时间延长与痔核数量增加之间的关联提供了新的见解，突出了原发性病例中左侧优势及其在复发中的减少，增强了临床理解和管理。
