Brisinda G, Cadeddu F, Brandara F, Marniga G, Maria G
Department of Surgery, Catholic University Hospital Agostino Gemelli, Istituto di Clinica Chirurgica Generale, Policlinico Universitario Agostino Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy.
Br J Surg. 2007 Feb;94(2):162-7. doi: 10.1002/bjs.5514.
In recent years treatment of chronic anal fissure has shifted from surgical to medical. This study compared the ability of two non-surgical treatments-botulinum toxin injections and nitroglycerin ointment-to induce healing in patients with idiopathic anal fissure.
One hundred adults were assigned randomly to receive treatment with either type A botulinum toxin (30 units Botox or 90 units Dysport) injected into the internal anal sphincter or 0.2 per cent nitroglycerin ointment applied three times daily for 8 weeks.
After 2 months, the fissures were healed in 46 (92 per cent) of 50 patients in the botulinum toxin group and in 35 (70 per cent) of 50 in the nitroglycerin group (P=0.009). Three patients in the botulinum toxin group and 17 in the nitroglycerin group reported adverse effects (P<0.001). Those treated with botulinum toxin had mild incontinence to flatus that lasted 3 weeks after treatment but disappeared spontaneously, whereas nitroglycerin treatment was associated with transient, moderate-to-severe headaches. Nineteen patients who did not have a response to the assigned treatment crossed over to the other therapy.
Although treatment with either topical nitroglycerin or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure, botulinum toxin is the more effective option.
近年来，慢性肛裂的治疗已从手术治疗转向药物治疗。本研究比较了两种非手术治疗方法——肉毒杆菌毒素注射和硝酸甘油软膏——对特发性肛裂患者的愈合诱导能力。
100名成年人被随机分配接受以下治疗之一：向肛门内括约肌注射A型肉毒杆菌毒素（30单位保妥适或90单位得保松），或每日三次涂抹0.2%硝酸甘油软膏，持续8周。
2个月后，肉毒杆菌毒素组50名患者中有46名（92%）肛裂愈合，硝酸甘油组50名患者中有35名（70%）肛裂愈合（P = 0.009）。肉毒杆菌毒素组有3名患者，硝酸甘油组有17名患者报告了不良反应（P < 0.001）。接受肉毒杆菌毒素治疗的患者有轻度排气失禁，治疗后持续3周但自行消失，而硝酸甘油治疗则伴有短暂的中重度头痛。19名对指定治疗无反应的患者转而接受另一种治疗。
虽然局部使用硝酸甘油或肉毒杆菌毒素治疗作为慢性肛裂患者手术的替代方法是有效的，但肉毒杆菌毒素是更有效的选择。
