Rosa G, Lolli P, Piccinelli D, Mazzola F, Zugni C, Ballarin A, Bonomo S
Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy.
Tech Coloproctol. 2005 Jul;9(2):127-31; discussion 131-2. doi: 10.1007/s10151-005-0210-9. Epub 2005 Jul 8.
Lateral internal sphincterotomy is an effective procedure for the treatment of anal fissure, but may affected anal continence. We describe a procedure aimed at tailoring the division of the sphincter according to the degree of the hypertonia and to the sphincter length in order to offer an effective and safe treatment for chronic anal fissure.
The internal sphincter was divided on the basis of anal manometry results. The average of maximum values of resting pressure determined by the stationary motility protocol was considered the reference parameter to measure hypertonia. Mild hypertone was considered to be 50-60 mmHg, moderate hypertone 60-80 mmHg, and severe hypertone >80 mmHg. In case of mild hypertone, 20% of the internal sphincter was divided; in case of moderate hypertone; 40% and 60% for severe hypertone. Calibrated lateral internal sphincterotomy is the division of the internal sphincter based on these parameters. Over 5 years, 388 patients underwent this procedure (197 men, 191 women) with a median age of 43 years (range, 18-80).
Postoperative complications consisted of abscess in 4 patients (1.0%), hemorrhage in 2 patients (0.5%), and pain in 6 patients (1.5%). Follow-up data are available for 261 patients (67.3%). Two months after surgery, 9 patients (3.4%) complained of persistent or recurring pain with or without fissure and 1 (0.4%) complained of gas incontinence. At postoperative manometry, 12 patients (4.6%) revealed persistence of anal resting pressure over 40 mmHg, 9 patients (3.4%) were still symptomatic and 97.6% were cured at a median follow-up of 8 months. An anal resting pressure lower than 30 mmHg was found in 10 patients (3.8%), only one of whom was incontinent.
Calibrated sphincterotomy may represent an effective and safe procedure for the treatment of chronic anal fissure.
外侧内括约肌切开术是治疗肛裂的有效方法，但可能影响肛门节制功能。我们描述了一种根据高张程度和括约肌长度来调整括约肌切开程度的手术方法，以便为慢性肛裂提供有效且安全的治疗。
根据肛门测压结果进行内括约肌切开。通过静态运动方案测定的静息压力最大值的平均值被视为衡量高张程度的参考参数。轻度高张定义为50 - 60 mmHg，中度高张为60 - 80 mmHg，重度高张>80 mmHg。对于轻度高张，切开20%的内括约肌；中度高张切开40%；重度高张切开60%。校准外侧内括约肌切开术就是基于这些参数进行内括约肌的切开。5年多来，388例患者接受了该手术（197例男性，191例女性），中位年龄43岁（范围18 - 80岁）。
术后并发症包括4例（1.0%）脓肿、2例（0.5%）出血和6例（1.5%）疼痛。261例患者（67.3%）有随访数据。术后2个月，9例患者（3.4%）主诉有持续性或复发性疼痛，伴或不伴有肛裂，1例患者（0.4%）主诉有气体失禁。术后测压时，12例患者（4.6%）显示肛门静息压力持续高于40 mmHg，9例患者（3.4%）仍有症状，中位随访8个月时97.6%的患者治愈。10例患者（3.8%）肛门静息压力低于30 mmHg，其中只有1例有失禁情况。
校准括约肌切开术可能是治疗慢性肛裂的一种有效且安全的手术方法。
