肉毒杆菌毒素注射与内括约肌切开术治疗慢性肛裂的比较。
Botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure.
作者信息
Massoud Baghai-Wadji, Mehrdad Vahedian, Baharak Tolooie, Alireza Zohoor
机构信息
Department of Surgery, Afzalipour Hospital, Kerman, Iran.
出版信息
Ann Saudi Med. 2005 Mar-Apr;25(2):140-2. doi: 10.5144/0256-4947.2005.140.
BACKGROUND
Anal fissure is a chronic condition characterized by painful defecation and rectal bleeding. The aim of this study was to compare injection of botulinum toxin versus surgical sphincterotomy for treatment of chronic anal fissure.
PATIENTS AND METHODS
In a quasi-experimental trial in a university hospital in Kerman, 50 patients diagnosed with chronic anal fissure received 20 units botulinum toxin (n=25) or underwent lateral internal sphincterotomy (n=25). All patients were evaluated for pain, bleeding and healing of the fissure from one to six months later by another surgeon. The data was analyzed by SPSS software with the Mann-Whitney and Fisher's exact tests.
RESULTS
One month after treatment, the rate of healing and bleeding in the operation group was better than in the toxin group (P<0.05), while pain was equal. After two months, none of the patients in either group had complications. After six months follow-up, bleeding, pain and healing were better in the operation group.
CONCLUSION
In the clinical evaluation, botulinum toxin is an effective alternative nonsurgical modality for the treatment of chronic anal fissure. We recommend botulinum toxin as the first step in treatment because of the 60% chance of cure with an easily performed treatment.
背景
肛裂是一种以排便疼痛和直肠出血为特征的慢性疾病。本研究的目的是比较注射肉毒杆菌毒素与手术括约肌切开术治疗慢性肛裂的效果。
患者与方法
在克尔曼一家大学医院进行的一项准实验性试验中，50例被诊断为慢性肛裂的患者接受了20单位肉毒杆菌毒素注射（n = 25）或接受了外侧内括约肌切开术（n = 25）。所有患者在1至6个月后由另一位外科医生对肛裂的疼痛、出血和愈合情况进行评估。数据采用SPSS软件进行曼-惠特尼检验和费舍尔精确检验分析。
结果
治疗1个月后，手术组的愈合率和出血情况优于毒素组（P<0.05），而疼痛情况相同。2个月后，两组患者均无并发症。随访6个月后，手术组的出血、疼痛和愈合情况更好。
结论
在临床评估中，肉毒杆菌毒素是治疗慢性肛裂的一种有效的非手术替代方法。由于该治疗方法操作简便且有60%的治愈几率，我们建议将肉毒杆菌毒素作为治疗的第一步。
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