Siddique Md Ibrahim, Murshed Khandker Manzoor, Majid M A
Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh.
Bangladesh Med Res Counc Bull. 2008 Apr;34(1):12-5. doi: 10.3329/bmrcb.v34i1.1163.
The gold standard surgical treatment of chronic anal fissure is lateral internal sphincterotomy which lowers the resting anal pressure and effectively heals the majority of fissures. Local application of 0.2% glyceryl trinitrate ointment has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal without compromising the anal continence. The aim of the present study was to compare the results of surgical sphincterotomy with that of local 0.2% glyceryl trinitrate ointment in the treatment of chronic anal fissure. Seventy adult patients between the age of 18 and 50 years with chronic anal fissure were randomized in a prospective trial to receive either surgical sphincterotomy or 0.2% glyceryl trinitrate ointment locally. Patients were followed up at 2 weeks' interval for 10 weeks. Symptom relief, fissure healing and continence scores were the outcomes assessed. Six patients were excluded for protocol violations. Surgical sphincterotomy was significantly more effective in providing pain relief and was associated with significantly better fissure healing rates at 6 weeks and 10 weeks (both p < 0.001). There were substantial problems with compliance in ointment group related to slow healing and longer time needed for symptomatic relief. Minor incontinence was 6% in sphincterotomy group and none in ointment group (p > 0.05). Considering early symptomatic relief, rapid fissure healing and better patient compliance surgical sphincterotomy is the treatment of choice for chronic anal fissure.
慢性肛裂的金标准手术治疗是外侧内括约肌切开术，该手术可降低静息肛管压力，并能有效治愈大多数肛裂。局部应用0.2%硝酸甘油软膏已被用作化学性括约肌切开剂，可暂时缓解括约肌痉挛，使肛裂愈合，且不影响肛门节制功能。本研究的目的是比较手术括约肌切开术与局部应用0.2%硝酸甘油软膏治疗慢性肛裂的效果。70例年龄在18至50岁之间的慢性肛裂成年患者被纳入一项前瞻性试验，随机接受手术括约肌切开术或局部应用0.2%硝酸甘油软膏治疗。患者每隔2周随访1次，共随访10周。评估的结果包括症状缓解情况、肛裂愈合情况及节制功能评分。6例患者因违反方案被排除。手术括约肌切开术在缓解疼痛方面明显更有效，且在6周和10周时肛裂愈合率明显更高（均p<0.001）。软膏组在依从性方面存在严重问题，与愈合缓慢及症状缓解所需时间较长有关。括约肌切开术组轻度失禁发生率为6%，软膏组无轻度失禁发生（p>0.05）。考虑到早期症状缓解、肛裂快速愈合及更好的患者依从性，手术括约肌切开术是慢性肛裂的首选治疗方法。
