Hyman Neil
Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
Dis Colon Rectum. 2004 Jan;47(1):35-8. doi: 10.1007/s10350-003-0002-0. Epub 2004 Jan 14.
Lateral internal sphincterotomy is an effective treatment for chronic anal fissures; however, the risk of "incontinence" has generated interest in pharmacologic approaches that are far less effective and may be poorly tolerated. This study was designed to objectively define the risk of incontinence with sphincterotomy using the Fecal Incontinence Severity Index and assess the implications for quality of life using the Fecal Incontinence Quality of Life Scale.
A prospective study was undertaken on all patients undergoing lateral internal sphincterotomy for a chronic anal fissure by a single surgeon at a university teaching hospital from January 1, 2000 to September 30, 2002. All patients had failed at least six weeks of nonoperative management. Patient demographics and use of nitroglycerin were noted. The Fecal Incontinence Severity Index was measured preoperatively and at a six-week postoperative visit when fissure healing and postoperative complications were assessed. The Fecal Incontinence Quality of Life Scale was administered to patients with an incontinence score>0.
Thirty-five patients (15 males) underwent sphincterotomy during the study period. Thirty-one of 35 had failed nitrates: 10 because of unacceptable side effects, and 21 because of lack of efficacy. Thirty-two patients returned for their six-week postoperative visits, and two completed their questionnaires by telephone. One patient was lost to follow-up. Mean age was 41.2 (range, 21-67) years. Thirty of 32 (94 percent) evaluable fissures had healed by six weeks, one healed by three months, and the other required V-Y anoplasty. There were two minor complications. Three patients had postoperative deterioration in their continence score. Quality of life deteriorated in only one patient.
Lateral internal sphincterotomy is a safe and effective treatment for chronic anal fissures that only occasionally impairs continence and rarely diminishes quality of life.
外侧内括约肌切开术是慢性肛裂的有效治疗方法；然而，“失禁”风险引发了人们对效果远不如手术且耐受性可能较差的药物治疗方法的兴趣。本研究旨在使用大便失禁严重程度指数客观界定括约肌切开术导致失禁的风险，并使用大便失禁生活质量量表评估对生活质量的影响。
对2000年1月1日至2002年9月30日在一所大学教学医院由一名外科医生为慢性肛裂行外侧内括约肌切开术的所有患者进行前瞻性研究。所有患者至少经过六周的非手术治疗均告失败。记录患者的人口统计学资料及硝酸甘油的使用情况。在术前及术后六周随访时测量大便失禁严重程度指数，同时评估肛裂愈合情况及术后并发症。对失禁评分>0的患者进行大便失禁生活质量量表测评。
在研究期间，35例患者（15例男性）接受了括约肌切开术。35例中有31例使用硝酸甘油治疗失败：10例是因为出现不可接受的副作用，21例是因为治疗无效。32例患者术后六周前来复诊，2例通过电话完成问卷调查。1例患者失访。平均年龄为41.2岁（范围21 - 67岁）。32例可评估的肛裂中有30例（94%）在六周时愈合，1例在三个月时愈合，另1例需要V - Y成形术。有2例轻微并发症。3例患者术后失禁评分恶化。仅1例患者生活质量下降。
外侧内括约肌切开术是慢性肛裂的一种安全有效的治疗方法，仅偶尔会损害控便能力，很少降低生活质量。
