Chinese General Practice ›› 2024, Vol. 27 ›› Issue (20): 2545-2550.DOI: 10.12114/j.issn.1007-9572.2022.0704
• Review & Perspectives • Previous Articles Next Articles
Received:
2022-09-22
Revised:
2022-11-10
Published:
2024-07-15
Online:
2024-04-08
Contact:
FAN Wenbin
通讯作者:
樊文彬
作者简介:
作者贡献:
倪嘉淳负责文献收集、整理,撰写论文;倪嘉淳、蔡增进、江琼、樊文彬负责文章构思;侯长城、康健、杨向东、樊文彬负责论文的修订;樊文彬负责文章的质量控制及审校,对文章整体负责,监督管理。
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2022.0704
出血(B) | 脱垂(P) | 回纳(R) | 皮赘(S) | 血栓(T) |
---|---|---|---|---|
B0:无出血 | P0:无脱垂 | R0:可自主回纳 | S0:无皮赘 | T0:无急性血栓 |
B1:出血 | P1:脱垂数=1 | R1:需手辅助回纳 | S1:有症状的皮赘 | T1:有血栓 |
P2:脱垂数≥2 | R2:无法回纳 |
Table 1 BPRST classification
出血(B) | 脱垂(P) | 回纳(R) | 皮赘(S) | 血栓(T) |
---|---|---|---|---|
B0:无出血 | P0:无脱垂 | R0:可自主回纳 | S0:无皮赘 | T0:无急性血栓 |
B1:出血 | P1:脱垂数=1 | R1:需手辅助回纳 | S1:有症状的皮赘 | T1:有血栓 |
P2:脱垂数≥2 | R2:无法回纳 |
出血(B) | 脱垂(P) | 外痔(E) | 内痔大小(C) | 肛管括约肌张力(T) |
---|---|---|---|---|
B0:无出血 | P0:无脱垂 | E0:无外痔 | C0:单个独立的内痔,且直径<1/4肛管周径 | T0:肛管括约肌张力正常 |
B1:间断、可控的出血 | P1:可还纳的脱垂 | E1:单个或多个外痔直径之和<1/2肛管周径 | C1:单个或多个内痔直径之和<1/2肛管周径 | T1:肛管括约肌张力降低(指伴有肛门不完全失禁、肛管括约肌张力收缩功能下降或肛管压力测定显示肛管静息压降低等) |
B2:持续喷射状、严重的出血 | P2:严重脱垂 P2a:内痔脱垂不可还纳 P2b:任何内置脱垂+肛管脱垂 | E2:单个或多个外痔直径之和≥1/2肛管周径 | C2:单个或多个内痔直径之和≥1/2肛管周径 | T2:肛管括约肌张力升高(指伴有肛管内括约肌痉挛或肛裂等) |
Table 2 BPECT classification
出血(B) | 脱垂(P) | 外痔(E) | 内痔大小(C) | 肛管括约肌张力(T) |
---|---|---|---|---|
B0:无出血 | P0:无脱垂 | E0:无外痔 | C0:单个独立的内痔,且直径<1/4肛管周径 | T0:肛管括约肌张力正常 |
B1:间断、可控的出血 | P1:可还纳的脱垂 | E1:单个或多个外痔直径之和<1/2肛管周径 | C1:单个或多个内痔直径之和<1/2肛管周径 | T1:肛管括约肌张力降低(指伴有肛门不完全失禁、肛管括约肌张力收缩功能下降或肛管压力测定显示肛管静息压降低等) |
B2:持续喷射状、严重的出血 | P2:严重脱垂 P2a:内痔脱垂不可还纳 P2b:任何内置脱垂+肛管脱垂 | E2:单个或多个外痔直径之和≥1/2肛管周径 | C2:单个或多个内痔直径之和≥1/2肛管周径 | T2:肛管括约肌张力升高(指伴有肛管内括约肌痉挛或肛裂等) |
名称 | 优点 | 缺点 | 客观性 | 实用性 | 治疗关联性 | 复现性 | 评估价值 |
---|---|---|---|---|---|---|---|
印度痔病新分类法 | 对痔的数量、周长及血栓痔进行细分 | 缺乏出血及内外痔分类;缺乏循证医学证据 | ★ | ★ | ★ | ★★★ | |
BPRST分类法 | 新颖;全面 | 操作繁琐;治疗方式较笼统 | ★ | ★ | ★ | ★★★ | |
SPC | 新颖;着眼于单体痔 | 与治疗方式无关联 | ★ | ★ | ★ | ★★★ | |
脱垂痔评估流程 | 流程清晰;易于操作 | 与治疗方式无关联 | ★ | ★ | ★ | ★★★ | |
A/CTC | 量化脱垂;关注并发症及治疗方式禁忌证 | 操作繁琐;存在主观评估项 | ☆ | ★ | ★ | ★★☆ | |
Goligher分类法 | 操作简便;应用广泛 | 缺乏出血及内外痔分类;与治疗方式无关联;缺乏循证医学证据 | ★ | ★ | ★★ | ||
BPECT分期法 | 新颖;全面;细致 | 操作繁琐;缺乏循证医学证据 | ★ | ★ | ★★ | ||
PNR-bleeding分类 | 全面;细分Ⅳ度痔;量化出血症状 | 与治疗方式无关联;缺乏循证医学证据 | ★ | ★ | ★★ | ||
日本内痔结肠镜分类 | 出血评估更为客观 | 评估工具不具普适性;被指南评价为不规范;与治疗方式无关联 | ★ | ★ | ★★ | ||
内痔与混合痔"四因素"评估方案 | 细化外痔类型;评估主痔痔核占肛管环周比例 | 与治疗方式无关联;缺乏循证医学证据 | ★ | ★ | ★★ | ||
Lunniss内痔分类法 | 全面;细化无脱垂痔分类 | 操作繁琐;存在主观评估项;缺乏循证医学证据 | ☆ | ★ | ★☆ |
Table 3 Advantages,disadvantages and evaluation values of different hemorrhoidal disease classification methods
名称 | 优点 | 缺点 | 客观性 | 实用性 | 治疗关联性 | 复现性 | 评估价值 |
---|---|---|---|---|---|---|---|
印度痔病新分类法 | 对痔的数量、周长及血栓痔进行细分 | 缺乏出血及内外痔分类;缺乏循证医学证据 | ★ | ★ | ★ | ★★★ | |
BPRST分类法 | 新颖;全面 | 操作繁琐;治疗方式较笼统 | ★ | ★ | ★ | ★★★ | |
SPC | 新颖;着眼于单体痔 | 与治疗方式无关联 | ★ | ★ | ★ | ★★★ | |
脱垂痔评估流程 | 流程清晰;易于操作 | 与治疗方式无关联 | ★ | ★ | ★ | ★★★ | |
A/CTC | 量化脱垂;关注并发症及治疗方式禁忌证 | 操作繁琐;存在主观评估项 | ☆ | ★ | ★ | ★★☆ | |
Goligher分类法 | 操作简便;应用广泛 | 缺乏出血及内外痔分类;与治疗方式无关联;缺乏循证医学证据 | ★ | ★ | ★★ | ||
BPECT分期法 | 新颖;全面;细致 | 操作繁琐;缺乏循证医学证据 | ★ | ★ | ★★ | ||
PNR-bleeding分类 | 全面;细分Ⅳ度痔;量化出血症状 | 与治疗方式无关联;缺乏循证医学证据 | ★ | ★ | ★★ | ||
日本内痔结肠镜分类 | 出血评估更为客观 | 评估工具不具普适性;被指南评价为不规范;与治疗方式无关联 | ★ | ★ | ★★ | ||
内痔与混合痔"四因素"评估方案 | 细化外痔类型;评估主痔痔核占肛管环周比例 | 与治疗方式无关联;缺乏循证医学证据 | ★ | ★ | ★★ | ||
Lunniss内痔分类法 | 全面;细化无脱垂痔分类 | 操作繁琐;存在主观评估项;缺乏循证医学证据 | ☆ | ★ | ★☆ |
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