Gaj Fabio, Biviano Ivano, Candeloro Laura, Andreuccetti Jacopo
Department of General Surgery and Organ Transplant, Umberto I Policlinic of Rome, Sapienza University, Rome (Fabio Gaj).
Department of Medicine and Medical Specialties, Umberto I Policlinic of Rome, Sapienza University of Rome (Ivano Biviano, Laura Candeloro).
Ann Gastroenterol. 2017;30(4):438-441. doi: 10.20524/aog.2017.0154. Epub 2017 May 10.
An anal fissure (AF) is a tear in the epithelial lining of the anal canal. This is a very common condition, but the choice of treatment is unclear. The use of anal dilators is effective, economic, and safe. The aim of the study was to compare the efficacy of two conservative treatments, the use of anal dilators or a finger for anal dilatation, in reducing anal pressure and resolving anal fissures.
Fifty patients with a clinical diagnosis of AF were randomly assigned to one of the treatments, self-massage of the anal sphincter (group A, 25 patients) or passive dilatation using dilators (group B, 25 patients). All patients were evaluated at baseline, at the end of treatment, and after 12 weeks and 6 months. Pain was measured using a visual analog scale.
After the treatment, 60% of patients treated with dilators and 80% of patients treated with anal self-massage using a finger showed disappearance of their anal fissures. A comparison between signs and symptoms reported by the patients in the two groups showed a statistically significant reduction in anal pain (group A, P=0.0001; group B, P=0.0001) and bleeding after defecation (group A, P=0.001, group B, P=0.001). At 6 months after treatment, a significantly greater reduction in anal pain was observed in Group A compared to Group B (P=0.02).
The use of anal self-massage with a finger appears to induce a better resolution of acute anal fissure than do anal dilators, and in a shorter time.
肛裂是肛管上皮层的撕裂。这是一种非常常见的病症，但治疗方法的选择尚不清楚。使用肛门扩张器有效、经济且安全。本研究的目的是比较两种保守治疗方法，即使用肛门扩张器或手指进行肛门扩张，在降低肛门压力和治愈肛裂方面的疗效。
50例临床诊断为肛裂的患者被随机分配至其中一种治疗方法，即肛门括约肌自我按摩（A组，25例患者）或使用扩张器进行被动扩张（B组，25例患者）。所有患者在基线、治疗结束时、12周和6个月后进行评估。使用视觉模拟量表测量疼痛程度。
治疗后，使用扩张器治疗的患者中有60%肛裂消失，使用手指进行肛门自我按摩治疗的患者中有80%肛裂消失。两组患者报告的体征和症状比较显示，肛门疼痛（A组，P = 0.0001；B组，P = 0.0001）和排便后出血（A组，P = 0.001，B组，P = 0.001）在统计学上有显著降低。治疗后6个月，与B组相比，A组肛门疼痛的减轻更为显著（P = 0.02）。
与肛门扩张器相比，使用手指进行肛门自我按摩似乎能在更短时间内更好地治愈急性肛裂。
