Department of Vascular/General Surgery, Queen Elizabeth Hospital, Gateshead, United Kingdom.
Surgical Unit I, General Surgery Department, Jinnah Hospital, Lahore, Pakistan.
Asian J Surg. 2014 Jan;37(1):15-9. doi: 10.1016/j.asjsur.2013.07.004. Epub 2013 Aug 22.
Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic anal fissure is defined by a history of symptoms present for more than 2 months' duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter. Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored.
The objective of this study is to compare the difference in outcome between open partial lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure.
This was a quasi-experimental study carried out between January 16, 2007 and January 15, 2008 in the Surgical Department of Jinnah Hospital, Lahore, Pakistan. Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open partial lateral anal sphincterotomy. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment.
All the patients complained of pain. A total of 43 (71.7%) patients had pain with constipation, whereas 31 (51.7%) patients had bleeding per rectum. Upon clinically examining the anal area, tenderness was elicited in all 60 (100%) patients. Group A included 30 (11 females and 19 males) cases treated with topical 0.2% nitroglycerin ointment and Group B included 30 (11 females and 19 males) cases who underwent open partial lateral anal sphincterotomy. In Group A, only 15 patients with fissures were successfully treated (50%). By contrast, 28 (93%) patients with fissures in Group B were successfully treated, and only two (7%) remained uncured. These two patients (6.6%) in Group B suffered from incontinence due to flatus and feces as a complication of the procedure.
This quasi-experimental study demonstrates that open partial lateral internal sphincterotomy is superior to topical 0.2% nitroglycerin application in the treatment of chronic anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very low rate of early continence disturbances.
肛裂是一种常见的良性疾病。肛门直肠疾病定义为肛管黏膜从齿状线延伸至肛门缘的裂伤。慢性肛裂的定义是症状持续超过 2 个月，并伴有三个外部皮肤标志，即肥大的肛乳头、边缘内卷的溃疡和暴露内括约肌的基底。由于失禁等并发症与手术治疗相关，因此目前更倾向于化学性括约肌切开术。
本研究旨在比较开放式部分外侧肛门括约肌切开术和局部应用 0.2%硝酸甘油软膏治疗慢性肛裂的疗效差异。
这是一项准实验研究，于 2007 年 1 月 16 日至 2008 年 1 月 15 日在巴基斯坦拉合尔的 Jinnah 医院外科进行。研究纳入了 60 例临床诊断为慢性肛裂的连续患者。所有纳入的患者均符合研究纳入标准，并随机分配至两组之一。A 组接受局部 0.2%硝酸甘油软膏治疗，B 组接受开放式部分外侧肛门括约肌切开术。两组均在治疗后 1 周、2 周、4 周和 6 周进行随访。
所有患者均有疼痛症状。共有 43 例（71.7%）患者在便秘时出现疼痛，31 例（51.7%）患者出现直肠出血。对肛门区域进行临床检查时，60 例（100%）患者均有压痛。A 组包括 30 例（11 名女性和 19 名男性）接受局部 0.2%硝酸甘油软膏治疗的患者，B 组包括 30 例（11 名女性和 19 名男性）接受开放式部分外侧肛门括约肌切开术的患者。在 A 组中，仅有 15 例肛裂患者成功治愈（50%）。相比之下，B 组中 28 例（93%）肛裂患者成功治愈，仅 2 例（7%）未治愈。B 组的这两名患者（6.6%）因术后出现气体和粪便失禁而出现并发症。
本准实验研究表明，与局部应用 0.2%硝酸甘油相比，开放式部分外侧肛门内括约肌切开术在治疗慢性肛裂方面更具优势，可显著缓解症状，提高愈合率，减少副作用，且早期发生失禁的概率非常低。
