Department of General Surgery, University "Federico II", Via Pansini 5, Naples, Italy.
Updates Surg. 2013 Sep;65(3):197-200. doi: 10.1007/s13304-013-0217-0. Epub 2013 Jun 5.
Anal fissure is a tear in the lining of the anal canal distal to the dentate line, which most commonly occurs in the posterior midline. Anal fissure was defined chronic if the patient presented with history of anal pain during defecation for at least 2 months with the observation of sphincter fibers at the base of the lesion. One hundred and forty-two consecutive patients with a chronic anal fissure with hypertonicity of internal sphincter on proctological examination were selected for this study from October 2008 to October 2010. Patients enrolled for the study were randomized to two groups by using a computer-generated list. Patients who underwent lateral internal sphincterotomy (LIS) were operated as day surgery procedures under local or epidural anesthesia. Patients randomized to conservative treatment were prescribed to use warm anal dilator with a nifedipine ointment 5 min twice daily for 4 weeks. Patients were clinically examined after 2, 4 and 8 weeks of treatment to evaluate if there was complete healing of the fissure. All patients were required to record pain after the first defecation, on 3rd and 7th postoperative day on a self-administered VAS scale in cm (0-10). Sixty-eight patients were randomly assigned to LIS, 74 to the conservative approach. Fifty-one patients of topical nifedipine group (68.9 %) and 60 patients of LIS group (88.2 %) presented an anal fissure healed at 8 weeks with a p value of 0.0077. As regards post-operative pain, 43 patients of LIS group (63.2 %) and 25 patients of topical nifedipine group (33.7 %) referred first defecation as painless. In the topical nifedipine group 43 (58.1 %) after 3 days since treatment and 35 (47.3 %) after 7 days had pain. In the LIS group 22 (32.3 %) after 3 days and 9 (13.2 %) after 7 days referred pain. There was no statistical difference between LIS and topical nifedipine group concerning side effects. Lateral internal sphincterotomy is an effective, less painful, fast recovery treatment for chronic anal fissure. Incontinence rate is overestimated and often the fear of a continence disturbance, albeit with a low incidence following surgery, may obscure the need to relieve symptoms which may be so severe as to make the patient's life intolerable.
肛裂是齿线以下肛管皮肤破裂形成棱形裂口或溃疡，是一种常见的肛管疾病。肛裂最常见的部位是肛门的后中部位。如果患者在排便时出现肛门疼痛的病史至少 2 个月，并观察到病变底部有括约肌纤维，那么就可以定义为慢性肛裂。
2008 年 10 月至 2010 年 10 月期间，我们对 142 例因肛门内括约肌张力过高而导致慢性肛裂的患者进行了研究，这些患者均经直肠检查证实。患者被随机分为两组，使用计算机生成的列表进行分组。接受侧方内括约肌切开术（LIS）的患者在局部或硬膜外麻醉下进行日间手术。随机分配到保守治疗组的患者被开具处方，使用温肛门扩张器和硝苯地平软膏，每天两次，每次 5 分钟，持续 4 周。治疗后 2、4 和 8 周，对所有患者进行临床检查，以评估肛裂是否完全愈合。所有患者都需要记录首次排便后的疼痛情况，并在术后第 3 天和第 7 天使用自我评估的 VAS 量表（0-10cm）进行记录。
68 例患者被随机分配到 LIS 组，74 例患者被分配到保守治疗组。在接受硝苯地平局部治疗的 51 例患者（68.9%）和接受 LIS 治疗的 60 例患者（88.2%）中，有 8 周后肛裂愈合，p 值为 0.0077。关于术后疼痛，LIS 组 43 例（63.2%）患者和硝苯地平组 25 例（33.7%）患者首次排便时无疼痛。在硝苯地平组中，43 例（58.1%）患者在治疗后第 3 天和 35 例（47.3%）患者在治疗后第 7 天出现疼痛。在 LIS 组中，22 例（32.3%）患者在治疗后第 3 天和 9 例（13.2%）患者在治疗后第 7 天出现疼痛。LIS 组和硝苯地平组在副作用方面无统计学差异。
侧方内括约肌切开术是治疗慢性肛裂的一种有效、疼痛较轻、恢复较快的方法。但失禁的发生率被高估了，而且手术可能会导致括约肌损伤，尽管这种情况的发生率很低，但这种担忧可能会掩盖缓解症状的必要性，而这些症状可能会严重到使患者无法忍受。
