Department of Colorectal Surgery, Mayday Hospital, Croydon, London CR7 7YE, UK.
Int J Colorectal Dis. 2011 Jun;26(6):685-92. doi: 10.1007/s00384-010-1121-4. Epub 2011 Jan 7.
A literature review of agents used to induce chemical sphincterotomy after hemorrhoidectomy.
Electronic databases were searched from January 1935 to August 2010.
Two randomized controlled trials compared calcium channel blockers (Ca2) with placebo. Pain appeared to be less for up to 7 days, and its side-effect profile was comparable to the control group. Four randomized controlled trials examined the role of glyceryl trinitrate (GTN). GTN may be used up to 6 weeks to aid healing. Pain may be slightly less during its use and potentially offers less pain during defecation in the first 48 h. Its side-effect profile including headache appears comparable to placebo. Three randomized controlled trials investigated botulinum toxin A (BTX). BTX may be used to aid healing after hemorrhoidectomy. Pain may be less for up to a week after surgery. Its side-effect profile including incontinence to flatus appears comparable to placebo. It would be especially useful in cases where poor patient compliance is envisaged. Only one paper was found comparing BTX with GTN. BTX may be preferred over GTN due to better pain control and fewer side effects.
BTX, Ca2, and GTN may give effective pain relief for a week after hemorrhoidectomy. Their side-effect profiles are comparable to placebo.
对痔切除术后用于诱导化学括约肌切开术的药物进行文献回顾。
从 1935 年 1 月至 2010 年 8 月，对电子数据库进行了检索。
两项随机对照试验比较了钙通道阻滞剂（Ca2）与安慰剂。疼痛在 7 天内似乎减轻，且其副作用谱与对照组相当。四项随机对照试验研究了甘油三硝酸酯（GTN）的作用。GTN 可能在 6 周内用于辅助愈合。在使用期间疼痛可能略轻，并且在最初的 48 小时内排便时可能疼痛减轻。其副作用谱包括头痛，与安慰剂相当。三项随机对照试验研究了肉毒杆菌毒素 A（BTX）。BTX 可能用于辅助痔切除术后的愈合。术后一周内疼痛可能减轻。其副作用谱包括气失禁，与安慰剂相当。在预计患者依从性差的情况下，它尤其有用。只有一篇论文比较了 BTX 与 GTN。由于更好的疼痛控制和更少的副作用，BTX 可能优于 GTN。
BTX、Ca2 和 GTN 可能在痔切除术后一周内提供有效的止痛效果。它们的副作用谱与安慰剂相当。
