高剂量环形内括约肌化学去神经术（HDCC）治疗复杂慢性肛裂。

Management of complicated chronic anal fissures with high-dose circumferential chemodenervation (HDCC) of the internal anal sphincter.

机构信息

Division of Gastroenterology, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

出版信息

Int J Surg. 2015 Dec;24(Pt A):24-6. doi: 10.1016/j.ijsu.2015.10.026. Epub 2015 Oct 21.

DOI:10.1016/j.ijsu.2015.10.026

PMID:26499249

Abstract

BACKGROUND

Botulinum toxin injection into the internal anal sphincter (IAS) is gaining popularity as a second line therapy for chronic anal fissures after patients fail medical therapy. The dosage of Botulinum toxin reported in the literature ranged from 20 to 50 IU. Complicated chronic anal fissure is defined as persistent fissure concurrent with other perianal pathology. We report a new approach involving high-dose circumferential chemodenervation (HDCC) of 100 IU in treating these complicated chronic anal fissures.

AIM

The aim of this study was to evaluate the fissure healing, complication, and recurrence rates with HDCC.

METHODS

Complicated anal fissure was defined as fissure with other perianal pathologies including skin tag, hypertrophied papilla, fistula, symptomatic hemorrhoids, anal condylomata, and abscess. Between 2008 and 2012, 62 consecutive patients (28 Blacks, 33 Whites, 1 Hispanic) with complete follow-up data were included in this single arm study. These patients underwent HDCC-IAS with addition interventions by a single colorectal surgeon. Follow up data were obtained by chart review and office follow up.

RESULTS

Of the 62 patients, the overall success rate was greater than 70% at 3 months follow-up. A few patients developed transient flatus or fecal incontinence, but shortly resolved. There was no major complication following HDCC-IAS.

CONCLUSIONS

Combination therapy involving HDCC-IAS and local anorectal surgery for associated condition is both safe and effective for fissure healing.

摘要

背景

在患者经药物治疗失败后，将肉毒毒素注射至肛门内括约肌（IAS）作为慢性肛裂的二线治疗方法越来越受到关注。文献中报道的肉毒毒素剂量范围为 20 至 50IU。复杂慢性肛裂定义为持续性肛裂伴其他肛周病变。我们报告了一种新的方法，涉及使用 100IU 的高剂量环形化学切断术（HDCC）治疗这些复杂的慢性肛裂。

目的

本研究旨在评估 HDCC 治疗肛裂愈合、并发症和复发的情况。

方法

复杂的肛裂定义为伴有其他肛周病变的肛裂，包括皮赘、肥大乳头、瘘管、症状性痔疮、肛门湿疣和脓肿。2008 年至 2012 年期间，共有 62 例（28 例黑人、33 例白人、1 例西班牙裔）具有完整随访数据的连续患者纳入本单臂研究。这些患者由单一结直肠外科医生进行了 HDCC-IAS 加其他干预治疗。通过病历回顾和门诊随访获取随访数据。