Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Colorectal Dis. 2010 Jul;12(7 Online):e163-9. doi: 10.1111/j.1463-1318.2009.02063.x. Epub 2009 Oct 13.
Chemical sphincterotomy, the use of pharmacological agents to reduce anal sphincter resting pressure, has become more and more popular in the treatment of chronic anal fissures (CAFs). It offers the possibility to avoid a lateral internal sphincterotomy and its associated risk of incontinence. In our hospital, patient with a chronic anal fissure are consecutively treated with isosorbide dinitrate 1% ointment, applied 6 times a day for 8 weeks, followed by diltiazem 2% ointment, applied 2 times a day for 8 weeks and Botulin Toxin A injections (Dysport; Ipsen, Hoofddorp, the Netherlands) in the internal anal sphincter. In a previous study (1), we describe high healing rates with this regime. Objective The objective of this study is to evaluate the effect of the combination of fissurectomy and Botulin Toxin A in the treatment of CAFs.
Twenty-one patients (10 male patients, median age 48 years) with persistent symptoms of chronic anal fissures after following the above mentioned treatment, were enrolled in this study. Fissurectomy was combined with Botulinum Toxin A (80 U of Dysport) under regional anaesthesia in day care. Results After 12 weeks 19/21 CAFs (90%) had healed. Median follow-up was 16 (9-30) months. No recurrences were seen.
Fissurectomy in combination with Botulinum Toxin A injection in the internal anal sphincter is an effective treatment for medically resistant CAFs.
化学性括约肌切开术，即使用药理制剂降低肛门括约肌静息压，在慢性肛裂（CAF）的治疗中越来越受欢迎。它提供了避免外侧内括约肌切开术及其相关失禁风险的可能性。在我院，慢性肛裂患者连续接受 1%硝酸异山梨酯软膏治疗，每天应用 6 次，持续 8 周，继以 2%地尔硫䓬软膏，每天应用 2 次，持续 8 周，以及在内括约肌中注射肉毒毒素 A（Dysport；Ipsen，荷兰 Hoofddorp）。在之前的一项研究中（1），我们描述了该方案的高愈合率。目的：本研究的目的是评估肛裂切除术联合肉毒毒素 A 治疗 CAF 的效果。
21 例（男 10 例，中位年龄 48 岁）在接受上述治疗后仍有慢性肛裂持续症状的患者纳入本研究。在日间手术中，在局部麻醉下联合使用肉毒毒素 A（80U Dysport）进行肛裂切除术。
12 周后，19/21 例（90%）CAF 愈合。中位随访时间为 16（9-30）个月。未观察到复发。
肛裂切除术联合内括约肌肉毒毒素 A 注射是治疗药物抵抗性 CAF 的有效方法。
