Witte M E, Klaase J M
Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Dig Surg. 2007;24(3):197-201. doi: 10.1159/000102899. Epub 2007 May 15.
In the treatment of chronic anal fissures (CAFs), surgical sphincterotomy is more commonly being replaced by chemical sphincterotomy. After the good results of our pilot study including 32 patients, we now describe the effect of botulinum toxin A (BT-A) in a consecutive series of 100 patients with isosorbide dinitrate (ISDN) ointment-resistant CAFs.
From October 2002 until August 2005, 100 patients (52 males, 48 females) with a median age of 45 (20-79) years were treated with an injection of 40-100 IU BT-A (Dysport, Ipsen, The Netherlands) in the internal anal sphincter.
After a median follow-up of 10 (4-38) months, 77 of the 100 CAFs (77%) were cured. 20 patients were given a second injection, 1 a third and 1 a fourth injection. In 11 patients a fissure recurred (14%). In 1 patient (1%) there was temporary incontinence due to flatus.
With an early response rate of 77% and an overall success rate of 66%, BT-A injections appear to be effective in patients with ISDN ointment-resistant CAFs if initial non-responders are retreated. These results are in concordance with the results of our pilot study. It is a simple technique with little or no side effects, that does not compromise future treatments. Its place in the first-line treatment of CAFs should be investigated further.
在慢性肛裂（CAF）的治疗中，手术括约肌切开术正越来越多地被化学性括约肌切开术所取代。在我们纳入32例患者的初步研究取得良好结果后，我们现在描述肉毒杆菌毒素A（BT - A）对连续100例对硝酸异山梨酯（ISDN）软膏治疗无效的CAF患者的疗效。
从2002年10月至2005年8月，100例患者（52例男性，48例女性），中位年龄45（20 - 79）岁，接受了在内括约肌注射40 - 100 IU BT - A（Dysport，益普生，荷兰）的治疗。
中位随访10（4 - 38）个月后，100例CAF患者中有77例（77%）治愈。20例患者接受了第二次注射，1例接受了第三次注射，1例接受了第四次注射。11例患者（14%）肛裂复发。1例患者（1%）出现因排气导致的暂时性失禁。
早期有效率为77%，总体成功率为66%，如果对初始无反应者进行再次治疗，BT - A注射对ISDN软膏治疗无效的CAF患者似乎有效。这些结果与我们初步研究的结果一致。这是一种简单的技术，副作用很少或没有，且不影响未来的治疗。其在CAF一线治疗中的地位应进一步研究。
