Gupta Pravin J
Gupta Nursing Home, D/9, Laxminagar, Nagpur 440022, India.
Rom J Gastroenterol. 2002 Mar;11(1):25-7.
There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. About 10 different techniques are presented in brief with their efficacy and fallacy. A new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure. However, all the options should be presented to the patient with complete information about the method, cure rates, complications, and reversibility of the complications and the final choice should be left in his hands.
治疗慢性肛裂有多种选择。其中一些是非手术治疗，而另一些则是手术治疗。每种流行方法所宣称的疗效都很高，但不一致性和禁忌症同样突出。迄今为止，大多数直肠科医生都倾向于采用侧方括约肌切开术，因为它是最不广泛的外科手术，能长期缓解括约肌痉挛。简要介绍了大约10种不同的技术及其疗效和谬误。还重点介绍了一种将古老的洛德手法扩张术与放射外科相结合的新方法。发现放射外科的加入有助于使肛裂边缘恢复活力，并处理通常与慢性肛裂相关的病理情况，即哨兵痔、小内痔或肥大的肛乳头。回顾慢性肛裂的治疗趋势，最受欢迎的选择是放射外科辅助下的手法扩张术和皮下侧方肛门括约肌切开术。这两种方法都易于实施，并发症可忽略不计，除了第一种手术需要放射外科设备外，无需特殊设备。然而，所有选择都应向患者详细介绍方法、治愈率、并发症以及并发症的可逆性等信息，最终选择权应留给患者。
