Abd Elhady H M, Othman I H, Hablus M A, Ismail T A, Aboryia M H, Selim M F
Department of General Surgery, Tanta University, Egypt.
S Afr J Surg. 2009 Nov;47(4):112-4.
To compare surgical and chemical sphincterotomy for treatment of chronic anal fissure.
The 160 patients studied were randomly divided into four equal groups, treated by lateral internal sphincterotomy (group S), local diltiazem ointment (group D), local glyceryl trinitrate ointment (group GTN), or injection of botulinum toxin into the internal anal sphincter (group BT). Anal manometry was performed before and 3 months after treatment. Patients were followed up for 5 years.
Complete pain relief was achieved in means (+/- standard deviation) of 5.7+/-7.8 days (group S), 15.7+/-5.9 days (group D), 15.6+/-5.9 days (group GTN) and 2.7+/-3.6 days (group BT). The mean times to healing were 4.5+/-1.2 weeks (group 1), 5.1+/-1.1 weeks (group D), 5.0+/-1.1 weeks (group GTN) and 5.1+/-1.3 weeks (group BT). Mean resting and squeeze anal pressures decreased significantly after sphincterotomy. Recurrence rates were 10% in group S, 65% in group D, 57.5% in group GTN and 52.5% in group BT.
Lateral internal sphincterotomy is an easy procedure with satisfactory results, minimal complications and a low recurrence rate. Medical sphincterotomy is safe and easy, with mild complications. Its effect is reversible, and relapse is common. We recommend that medical sphincterotomy be tried before surgery or in patients who are unable or unwilling to undergo surgery.
比较手术和化学性括约肌切开术治疗慢性肛裂的效果。
将160例研究对象随机分为四组，分别接受外侧内括约肌切开术（S组）、局部应用地尔硫䓬软膏（D组）、局部应用硝酸甘油软膏（GTN组）或向肛门内括约肌注射肉毒杆菌毒素（BT组）治疗。治疗前及治疗后3个月进行肛门测压。对患者进行5年随访。
完全缓解疼痛的平均时间（均值±标准差）在S组为5.7±7.8天，D组为15.7±5.9天，GTN组为15.6±5.9天，BT组为2.7±3.6天。平均愈合时间在S组为4.5±1.2周，D组为5.1±1.1周，GTN组为5.0±1.1周，BT组为5.1±1.3周。括约肌切开术后平均静息和收缩肛门压力显著降低。复发率在S组为10%，D组为65%，GTN组为57.5%，BT组为52.5%。
外侧内括约肌切开术操作简便，效果满意，并发症少，复发率低。药物性括约肌切开术安全简便，并发症轻微。其效果是可逆的，复发常见。我们建议在手术前或对不能或不愿接受手术的患者尝试药物性括约肌切开术。
