The Clinical Significance of the Pathomorphological Hemorrhoid Classification Based on the Macroscopic Locations of Piles in the Anal Canal, and ClinicalInvestigation by Metric Analysis of Hemorrhoids Versus ALTA Injection

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  • III．解剖学的区画と「病態」に基づく痔核程度分類の意義とALTA療法の計量的検討

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Abstract

This study reviewed the clinical significance of published articles on the pathomorphological classification of hemorrhoids based on the macroscopic locations of piles in the anal canal (P-c) and added a new symbol describing "P-0 degree". This study also objectively, numerically, and theoretically investigated conventional clinical study methods and used a pile-volume theory and pile models as references to explain a rough estimation formula. Regarding the rough estimation formula, this study used a hypothesis and example (≥ 2.25-2.75) of the ratio of ALTA injection per hemorrhoid volume (I/V ratio) to explain the general idea of ALTA optimal dose, made a tentative proposal to determine the limitation of hemorrhoid volume on ALTA therapy, and proposed a verification method. This paper presents one case of P-IV hemorrhoids, which may be used as data obtained from ALTA therapy to expand the applicable range of ALTA therapy.<BR>This paper also introduces a slit-type proctoscopy, with which a whole picture of a pile can be observed. The author proposed a randomized controlled trial (RCT) in three groups from specified hospitals to verify the effect of ALTA therapy, accumulated data of an ALTA therapy method to compare with those of a surgical excision method in one patient with P-IV hemorrhoids, and a PCT (a method to select and compare patients). In addition, the paper discusses the phenomena and behaviors of anal prolapse, Goligher classification (G classification), and the Japanese classification of hemorrhoids.

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