Department of Colorectal Surgery, Frenchay Hospital, Bristol, UK.
Int J Colorectal Dis. 2010 May;25(5):645-8. doi: 10.1007/s00384-010-0881-1. Epub 2010 Feb 23.
It was suggested that anal advancement flap be used to treat patients with chronic anal fissures that have failed medical management and have a low-pressure sphincter complex. We wished to assess anal advancement flap as a treatment for all chronic anal fissures.
All patients with chronic anal fissures regardless of their previous management underwent V-Y advancement flap. Patient demographics, symptom duration, previous treatments, short-term postoperative outcome and long-term follow-up were recorded.
Fifty-four consecutive patients, median age 39 years (22-66), underwent a V-Y advancement flap over a 7-year period; 34 were men. Duration of symptoms ranged from 2 to 36 months with a median of 8 months. Forty-two patients (78%) had failed a previous therapy: glyceryl trinitrate (GTN) (25), GTN and diltiazem (16) and lateral sphincterotomy (one). Wound dehiscence occurred in three patients of which only one required a surgical intervention. On follow-up at 6 months, all but one patient had a healed wound and was asymptomatic.
We have shown excellent rates of healing of chronic anal fissures treated with a V-Y advancement flap regardless of sphincter pressures, previous treatment and symptom chronicity. These results show the technique can be applied to all chronic fissures with success and used as a primary therapy.
有人建议使用肛门推进皮瓣治疗经药物治疗失败且伴有低压肛门括约复合体的慢性肛裂患者。我们希望评估肛门推进皮瓣作为治疗所有慢性肛裂的方法。
所有慢性肛裂患者，无论其先前的治疗情况如何，均行 V-Y 推进皮瓣术。记录患者的人口统计学资料、症状持续时间、先前的治疗、短期术后结果和长期随访情况。
54 例连续患者，中位年龄 39 岁（22-66 岁），7 年内行 V-Y 推进皮瓣术；34 例为男性。症状持续时间从 2 到 36 个月不等，中位数为 8 个月。42 例（78%）先前治疗失败：硝酸甘油（GTN）（25 例）、GTN 和地尔硫卓（16 例）和侧方括约肌切开术（1 例）。3 例患者出现伤口裂开，其中仅 1 例需要手术干预。6 个月随访时，除 1 例外，所有患者的伤口均愈合且无症状。
我们发现，无论括约肌压力、先前的治疗和症状持续时间如何，V-Y 推进皮瓣治疗慢性肛裂的愈合率均很高。这些结果表明，该技术可成功应用于所有慢性肛裂，并作为主要治疗方法。
