Scholz Th, Hetzer F H, Dindo D, Demartines N, Clavien P A, Hahnloser D
Department for Visceral and Transplantation Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zurich, Switzerland.
Int J Colorectal Dis. 2007 Sep;22(9):1077-81. doi: 10.1007/s00384-006-0261-z. Epub 2007 Jan 30.
Chronic anal fissures are difficult to treat. The aim of this retrospective study was to determine the outcome of combined fissurectomy and injection of botulinum toxin Type A (BT).
Between January 2001 and August 2004, 40 patients (21 women), median age 37 years (range 18 to 57), underwent fissurectomy and BT injection. Fissurectomy was performed followed by injection of 10 U of BT into the internal anal sphincter on both sides of the fissure. All patients were clinically checked 6 weeks after the operation. At 1 year, patients were sent a detailed questionnaire regarding symptoms, recurrence and further treatment for evaluation of long-term results.
RESULTS/FINDINGS: At 6 weeks, 38 patients (95%) were free of symptoms. No adverse effects were detected. The response rate of questionnaires was 93%; the median follow-up was 1 year (range 0.9 to 1.6). In the long-term, a recurrence was found in four patients. These patients were treated successfully with repeated fissurectomy and BT injections and salvage procedures, respectively. Overall, the success rate of combined fissurectomy and BT injection was 79%.
INTERPRETATION/CONCLUSION: Combined fissurectomy and Botox injection for chronic anal fissure is an excellent and safe procedure with low morbidity and a high healing rate.
慢性肛裂难以治疗。本回顾性研究的目的是确定肛裂切除术联合A型肉毒杆菌毒素（BT）注射的疗效。
2001年1月至2004年8月期间，40例患者（21例女性），中位年龄37岁（范围18至57岁），接受了肛裂切除术和BT注射。先进行肛裂切除术，然后在肛裂两侧的肛门内括约肌注射10 U的BT。所有患者在术后6周进行临床检查。在1年时，向患者发送一份关于症状、复发及进一步治疗的详细问卷，以评估长期结果。
结果/发现：6周时，38例患者（95%）无症状。未检测到不良反应。问卷回复率为93%；中位随访时间为1年（范围0.9至1.6年）。长期来看，4例患者复发。这些患者分别通过重复肛裂切除术、BT注射及挽救手术成功治疗。总体而言，肛裂切除术联合BT注射的成功率为79%。
解读/结论：肛裂切除术联合肉毒杆菌毒素注射治疗慢性肛裂是一种优良且安全的手术，发病率低，愈合率高。
