Menteş B Bülent, Güner Melike Karen, Leventoglu Sezai, Akyürek Nusret
Department of Surgery, Gazi University Medical School, Ankara, Turkey.
Dis Colon Rectum. 2008 Jan;51(1):128-33. doi: 10.1007/s10350-007-9121-3. Epub 2007 Dec 18.
This study was designed to compare the results of controlled lateral internal sphincterotomy by using anal calibrators with those of sphincterotomy up to the fissure apex in a randomized, prospective fashion.
In the fissure apex group, sphincterotomy was extended to the level of the fissure apex, and in the spasm-controlled group, serial small sphincterotomies and anal caliber measurements followed until an anal caliber of 30 mm was obtained.
The preoperative anal caliber was 24 +/- 1.9 (range, 20-28) mm and 24.9 +/- 2.44 (range, 19-28) mm in the spasm-controlled and fissure apex groups, respectively (P = 0.127). Postoperatively, the spasm-controlled group had a mean anal caliber of 31.5 +/- 1.28 (range, 30-32) mm, and the fissure apex group had 32.5 +/- 2.33 (range, 25-37) mm (P = 0.035). In the fissure apex group, a significant negative correlation was determined between the postoperative anal caliber and time of relief of pain (r = -0.568, P = 0.001). The early (7 and 28 days) postoperative anal incontinence scores were significantly higher in the fissure apex group (P = 0.002, P < 0.0001, respectively). A significant positive correlation between the anal caliber measurements and anal incontinence scores at 28 days and 2 months also was noted in the fissure apex group (r = 0.406, P = 0.023; and r = 0.364, P = 0.044).
Controlled sphincterotomy provided a faster relief of pain, and it was associated with a lower rate of early postoperative disturbance of continence and an insignificantly lower rate of treatment failure compared with sphincterotomy up to the fissure apex.
本研究旨在以随机、前瞻性的方式比较使用肛门扩张器进行控制性外侧内括约肌切开术与直至肛裂顶端的括约肌切开术的结果。
在肛裂顶端组，括约肌切开术延伸至肛裂顶端水平；在痉挛控制组，进行一系列小的括约肌切开术并测量肛门口径，直至获得30毫米的肛门口径。
痉挛控制组和肛裂顶端组术前肛门口径分别为24±1.9（范围20 - 28）毫米和24.9±2.44（范围19 - 28）毫米（P = 0.127）。术后，痉挛控制组平均肛门口径为31.5±1.28（范围30 - 32）毫米，肛裂顶端组为32.5±2.33（范围25 - 37）毫米（P = 0.035）。在肛裂顶端组，术后肛门口径与疼痛缓解时间之间存在显著负相关（r = -0.568，P = 0.001）。肛裂顶端组术后早期（7天和28天）的肛门失禁评分显著更高（分别为P = 0.002，P < 0.0001）。在肛裂顶端组，28天和2个月时的肛门口径测量与肛门失禁评分之间也存在显著正相关（r = 0.406，P = 0.023；r = 0.364，P = 0.044）。
与直至肛裂顶端的括约肌切开术相比，控制性括约肌切开术能更快缓解疼痛，且术后早期控便障碍发生率较低，治疗失败率略低。
