Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
J Pediatr Surg. 2010 Jan;45(1):241-4. doi: 10.1016/j.jpedsurg.2009.10.038.
Anal stricture is a well-known and feared consequence of anorectal surgery. Daily dilatations are often prescribed in the immediate postoperative period to avoid stricture of the anus. Nonetheless, stricture may still occur and, particularly in older children, may require multiple dilatations under anesthesia. Topical mitomycin-C has been found to be effective in the treatment of strictures at various anatomical locations. In this article, we review our experience with topical mitomycin-C as an adjunct to anal dilatation for children with anal stricture.
Cases of children with anal stricture who were treated with a single application of topical mitomycin-C as an adjunct to anal dilatation between 2000 and 2008 were analyzed retrospectively. Anal diameter was measured with Hegar dilators. Cottonoid swabs soaked in mitomycin-C were placed on the anal mucosa for 5 minutes after dilatation. Treatment success was defined by sustained improvement in anal size, decrease in symptoms, parental satisfaction, and need for additional intervention.
Ten children with anal stricture who underwent anal dilatation with application of topical mitomycin-C were identified. All children presented with severe constipation. Average increase in anal size after dilatation under sedation was 5.7 mm (+/-3.2 mm). Average improvement in anal diameter on first clinic visit after mitomycin-C application was 3.7 mm. On follow-up, only 1 child required repeated intervention for stricture after treatment with mitomycin-C. No complications were associated with the use of mitomycin-C.
All children treated with mitomycin-C showed early improvement in their anal size after dilatation under sedation. A single application of topical mitomycin-C allowed them to retain an increased anal diameter over time and avoid additional dilatations. Furthermore, the application of mitomycin-C in our population was straightforward and safe. Therefore, we advocate its use as an adjunct to anal dilatation under sedation in the treatment of severe anal stricture.
肛门狭窄是肛肠手术后一种众所周知且令人恐惧的并发症。为避免肛门狭窄，术后常需每日行肛门扩张。然而，仍可能发生狭窄，尤其是对于大龄儿童，可能需要多次在全身麻醉下进行扩张。局部应用丝裂霉素 C 已被证明对治疗各种解剖部位的狭窄有效。本文回顾了我们在儿童肛门狭窄中使用丝裂霉素 C 联合肛门扩张的经验。
回顾性分析了 2000 年至 2008 年期间，采用单次局部应用丝裂霉素 C 联合肛门扩张治疗的儿童肛门狭窄病例。使用 Hegar 扩张器测量肛门直径。扩张后，将浸有丝裂霉素 C 的棉拭子置于肛门黏膜上 5 分钟。治疗成功定义为肛门大小持续改善、症状减轻、家长满意以及无需进一步干预。
10 例儿童因肛门狭窄接受了肛门扩张联合局部应用丝裂霉素 C 治疗。所有患儿均有严重便秘。镇静下扩张后肛门平均增大 5.7mm（+/-3.2mm）。丝裂霉素 C 应用后首次就诊时肛门直径平均改善 3.7mm。随访时，1 例患儿在接受丝裂霉素 C 治疗后因狭窄再次接受治疗。丝裂霉素 C 的应用无并发症。
所有接受丝裂霉素 C 治疗的患儿在镇静下扩张后肛门大小均早期改善。单次局部应用丝裂霉素 C 可使肛门直径随时间延长而保持增大，并避免进一步扩张。此外，丝裂霉素 C 在本研究人群中的应用简单、安全。因此，我们提倡将其作为镇静下肛门扩张的辅助手段，用于治疗严重肛门狭窄。
