III. The Classification and Treatment of Fissures According to the Etiological Mechanisms
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Fissures, initiated by the trauma of defecation, are fixed in the anal canal by intraanal factors which make them resistant to the spontaneous healing. Fissures were classified according to the etiological mechanism into 5 types as stenotic, prolapsed, mixed, fragile and syndromatic ones. By the clinical utilization of the classification for the past 7 years has enabled the precise recognition of the status and suitable treatment of every fissure.<BR>Stenotic type of fissures is made as the result of vicious circle of pain, spasm and stenosis of the anus. Many of them are accompanied with an infected anal crypt. The treatment are manual dilatation, lateral internal sphincterotomy, cryosurgery and operative internal sphincterotomy with sliding skin graft.<BR>Prolapsed type is made by forced laceration anoderm by such a prolapsing mass as hemorrhoids and anal polyp. It is characterized as a fissure without stenosis. The treatment is shrinkage or removal of the mass with sclerosing agent, hemoligator or excision and ligation. The dilatation of the anus must never be tried on this type of fissures.<BR>Mixed type is made from the above mention 2 factors. Accordingly the treatment is directed for the dissolution of the 2 fators.<BR>Fragile type arises from fragile anoderm such as dermatitis, eczema and congenital fragility. The treatment is directed for the conservative treatment of dermatitis. Operation of sliding skin graft is applied for chronic cases.<BR>Syndroinatic type appears as one of the accompanied findings of ulcerative colitis, Crohn's disease and tuberculosis of the intestine. They are sometimes multiple and aggravated by diarrhea. The treatment is mainly directed for the intestinal lesions. However, when indicated, appropriate conservative or operative treatment is done for anal lesions.<BR>In summary, appropriate treatment of fissures is attained by the presice classification. One of the instances is that not a few reports of incidence of incontinence after dilatation or internal sphincterotomy are possibly as the result of wrong selection of prolapsed type for the dilating methods.
- 日本大腸肛門病学会の論文
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- III. The Classification and Treatment of Fissures According to the Etiological Mechanisms