Landsend Erlend, Johnson Egil, Johannessen Hans-Olaf, Carlsen Erik
Gastrokirurgisk avdeling, Ullevål universitetssykehus, Oslo.
Tidsskr Nor Laegeforen. 2003 Dec 4;123(23):3366-7.
Anal fissure is very painful; surgery is warranted when medical treatment fails.
We present a retrospective study of 34 patients (median age 42; 19-63) treated by subcutaneous lateral internal sphincterotomy (n = 27) and anal dilatation (n = 7) from 1992 to 2002, carried out by a questionnaire on pain, anal incontinence, and treatment result.
There were no complications or treatment for recurrence of anal fissure. Median pain score before surgery was 7.3 on a scale from 0 (no pain) to 10 (worst imaginable pain), median 73 months (4-124) after surgery the median score was 0 (0-5) (p = 0.00). For sphincterotomy (n = 27), the median score was 7.8 before surgery and 0 (0-5) after (p = 0.00), for anal dilatation 6 (3-10) before surgery and 2 (0-2) (p = 0.01) after. All patients had reduced pain scores after surgery but their incontinence scores remained unchanged. Two patients (7%) who had previously been dilated or irradiated developed faecal incontinence after sphincterotomy. More patients became asymptomatic after sphincterotomy (n = 18; 67%) than after anal dilatation (n = 4; 57%).
Compared to anal dilatation, sphincterotomy offers better pain relief for anal fissure. Doing a shorter sphincterotomy corresponding to length of the fissure reduces the risk of anal incontinence.
肛裂非常疼痛；药物治疗无效时需进行手术。
我们对1992年至2002年间接受皮下外侧内括约肌切开术（n = 27）和扩肛术（n = 7）治疗的34例患者（中位年龄42岁；19 - 63岁）进行了一项回顾性研究，通过问卷调查了解疼痛、肛门失禁及治疗结果。
未出现肛裂复发的并发症或再次治疗情况。手术前疼痛评分中位数为7.3（范围从0分（无疼痛）至10分（难以想象的剧痛）），手术后中位73个月（4 - 124个月）时评分中位数为0（0 - 5）（p = 0.00）。对于括约肌切开术（n = 27），手术前评分中位数为7.8，术后为0（0 - 5）（p = 0.00）；对于扩肛术，手术前为6（3 - 10），术后为2（0 - 2）（p = 0.01）。所有患者术后疼痛评分均降低，但失禁评分未变。2例（7%）曾接受扩肛或放疗的患者在括约肌切开术后出现大便失禁。括约肌切开术后无症状的患者（n = 18；67%）比扩肛术后（n = 4；57%）更多。
与扩肛术相比，括约肌切开术能更好地缓解肛裂疼痛。进行与肛裂长度相应的较短括约肌切开术可降低肛门失禁风险。
