Thornton M J, Kennedy M L, King D W
Department of Colorectal Surgery, St. George Hospital and University of New South Wales, Kogarah, New South Wales, Australia.
Dis Colon Rectum. 2005 Jul;48(7):1424-31. doi: 10.1007/s10350-005-0025-9.
The efficacy and pharmacokinetics of botulinum toxin for chronic anal fissure continues to be debated. Addressing both issues we prospectively assessed the manometric impact of botulinum toxin on internal anal sphincter pressure, correlating this impact with chronic anal fissure healing.
Sixty patients with chronic fissures were assessed. Fifty-seven patients had a total of 20 units of botulinum toxin injected into the intersphincteric groove at four o'clock and eight o'clock. Patients were prospectively assessed with a linear analog pain score, bleeding score, clinical fissure score, modified St. Mark's continence score, and anorectal manometry. Each parameter was reassessed two weeks following treatment and again at three months.
Fifty-six patients (30 female), median age 43 (range, 17-80) years, were followed for a median of five (range, 3-15) months with fissure healing assessed 12 weeks after treatment. Physical healing and symptom control were dependent on the baseline maximum anal resting pressure and baseline fissure score (P = 0.003, P = 0.009, respectively). Although maximum anal resting pressure fell by 17 (mean, range, 0-71) percent, pressure reduction did not correlate with clinical outcome (P > 0.2). Seventeen patients reported a mean 17 percent increase in continence score. There was no correlation between deterioration in continence and baseline or subsequent reduction in maximum anal resting pressure.
Patients with Grade 1 lower-pressure fissures are more likely to heal following treatment with 20 units of botulinum toxin. Healing does not appear to be dependent on a reduction in maximum anal resting pressure.
肉毒杆菌毒素治疗慢性肛裂的疗效和药代动力学仍存在争议。针对这两个问题，我们前瞻性地评估了肉毒杆菌毒素对肛管内括约肌压力的测压影响，并将这种影响与慢性肛裂愈合情况相关联。
对60例慢性肛裂患者进行评估。57例患者在四点和八点的括约肌间沟处共注射20单位肉毒杆菌毒素。对患者进行前瞻性评估，采用线性模拟疼痛评分、出血评分、临床肛裂评分、改良圣马克控便评分和肛肠测压。治疗两周后和三个月后再次对每个参数进行重新评估。
56例患者（30例女性），中位年龄43岁（范围17 - 80岁），中位随访时间为5个月（范围3 - 15个月），在治疗12周后评估肛裂愈合情况。身体愈合和症状控制取决于基线最大肛管静息压力和基线肛裂评分（分别为P = 0.003，P = 0.009）。尽管最大肛管静息压力下降了17%（平均，范围0 - 71%），但压力降低与临床结果无关（P > 0.2）。17例患者报告控便评分平均增加了17%。控便能力恶化与基线或随后最大肛管静息压力降低之间没有相关性。
1级低压性肛裂患者在接受20单位肉毒杆菌毒素治疗后更有可能愈合。愈合似乎不依赖于最大肛管静息压力的降低。
