Patti Rosalia, Almasio Piero Luigi, Arcara Matteo, Sammartano Sergio, Romano Pietro, Fede Calogero, Di Vita Gaetano
Department of Surgical and Oncologic Science, Division of General Surgery, University of Palermo, Palermo, Italy.
Dis Colon Rectum. 2006 Nov;49(11):1741-8. doi: 10.1007/s10350-006-0677-0.
The maximum resting pressure in the anal canal is greatly raised after hemorrhoidectomy. This increase is likely to be the cause of postoperative pain, which is still the most troublesome early problem after hemorrhoidectomy. This study was designed to compare, after hemorrhoidectomy, the effects of intrasphincter injection of botulinum toxin vs. application of glyceryl trinitrate ointment in improving wound healing and reducing postoperative pain at rest or during defecation.
Thirty patients with hemorrhoids of third and fourth degree were included in the study and randomized in two groups. Anorectal manometry was performed preoperatively and 5 and 40 days after hemorrhoidectomy. One group received one injection containing 20 IU of botulinum toxin, whereas the other an application of 300 mg of 0.2 percent glyceryl trinitrate ointment three times daily for 30 days.
Five days after hemorrhoidectomy, maximum resting pressure was significantly reduced compared with baseline values in both groups (85 +/- 15 vs. 68 +/- 11 mmHg for the group treated with botulinum toxin, 87 +/- 11 vs. 78 +/- 11 mmHg for the group treated with glyceryl trinitrate ointment). Overall analysis of postoperative pain at rest showed a significant reduction in the botulinum toxin group vs. glyceryl trinitrate group, whereas pain during defecation and time of healing were similar. Adverse effects, such as headaches, were observed only in the glyceryl trinitrate group. Forty days after hemorrhoidectomy in the glyceryl trinitrate group, maximum resting pressure values were similar to preoperative ones, whereas the values were still reduced in the botulinum toxin group.
A single intrasphincter injection of botulinum toxin was more effective and safer than repeated applications of glyceryl trinitrate in reducing early postoperative pain at rest but not during defecation.
痔切除术后肛管最大静息压大幅升高。这种升高可能是术后疼痛的原因，而术后疼痛仍是痔切除术后最棘手的早期问题。本研究旨在比较痔切除术后，括约肌内注射肉毒杆菌毒素与应用硝酸甘油软膏在促进伤口愈合及减轻静息或排便时术后疼痛方面的效果。
30例Ⅲ、Ⅳ度痔患者纳入研究并随机分为两组。术前及痔切除术后5天和40天进行肛肠测压。一组接受一次含20 IU肉毒杆菌毒素的注射，另一组每天3次应用300 mg 0.2%硝酸甘油软膏，共30天。
痔切除术后5天，两组最大静息压均较基线值显著降低（肉毒杆菌毒素治疗组：85±15 vs. 68±11 mmHg；硝酸甘油软膏治疗组：87±11 vs. 78±11 mmHg）。静息时术后疼痛的总体分析显示，肉毒杆菌毒素组较硝酸甘油组显著减轻，而排便时疼痛及愈合时间相似。仅在硝酸甘油组观察到不良反应，如头痛。痔切除术后40天，硝酸甘油组最大静息压值与术前相似，而肉毒杆菌毒素组仍降低。
单次括约肌内注射肉毒杆菌毒素在减轻术后早期静息时疼痛（而非排便时疼痛）方面比重复应用硝酸甘油更有效且更安全。
