肉毒杆菌毒素注射与内括约肌侧切术治疗慢性肛裂的非随机对照试验
Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: a non-randomized controlled trial.
作者信息
Giral Adnan, Memisoglu Kemal, Gültekin Yücel, Imeryüz Neşe, Kalayci Cem, Ulusoy Nefise B, Tözün Nurdan
机构信息
School of Medicine, Department of Gastroenterology, University of Marmara, Istanbul, Turkey.
出版信息
BMC Gastroenterol. 2004 Mar 22;4:7. doi: 10.1186/1471-230X-4-7.
BACKGROUND
Although lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure.
METHODS
Patients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months.
RESULTS
Twenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 +/- 22 mmHg to 86 +/- 15 mmHg in the surgery group (p < 0.05) and from 101 +/- 23 mmHg to 83 +/- 24 mmHg in the botulinum toxin group (p < 0.05). The mean maximal squeeze pressures were reduced from 70 +/- 27 mmHg to 61 +/- 32 mmHg (p > 0.05) in the surgery group, and from 117 +/- 62 mmHg to 76 +/- 34 (p < 0.01) in the botulinum toxin group. The fissures were healed in 70 percent of patients in the botulinum group and 82 percent in the surgery group (p > 0.05). There were no relapses during the 14 months of follow up.
CONCLUSION
Lateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure.
背景
尽管外侧内括约肌切开术是慢性肛裂的金标准治疗方法，但括约肌内注射肉毒杆菌毒素似乎是一种可靠的新选择。这项非随机研究的目的是比较外侧内括约肌切开术和肉毒杆菌毒素注射治疗对慢性肛裂患者的疗效以及肛门括约肌压力降低情况。
方法
慢性肛裂患者根据自身选择接受肉毒杆菌毒素注射或外侧内括约肌切开术治疗。治疗前及治疗后2周通过肛门测压法测量最大静息压力和最大收缩压力。对患者进行14个月的肛裂复发随访。
结果
连续纳入21例患有后位慢性肛裂的门诊患者。11例患者接受手术治疗，10例患者接受肉毒杆菌毒素注射治疗。治疗前，两组的肛门压力相似。治疗后，手术组的最大静息压力从104±22 mmHg降至86±15 mmHg（p<0.05），肉毒杆菌毒素组从101±23 mmHg降至83±24 mmHg（p<0.05）。手术组的平均最大收缩压力从70±27 mmHg降至61±32 mmHg（p>0.05），肉毒杆菌毒素组从117±62 mmHg降至76±34 mmHg（p<0.01）。肉毒杆菌毒素组70%的患者肛裂愈合，手术组为82%（p>0.05）。在14个月的随访期间无复发。
结论
外侧内括约肌切开术和肉毒杆菌毒素注射治疗在慢性肛裂的治疗中似乎同样有效。
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