Brady Justin T, Althans Alison R, Neupane Ruel, Dosokey Eslam M G, Jabir Murad A, Reynolds Harry L, Steele Scott R, Stein Sharon L
Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Am J Surg. 2017 Oct;214(4):623-628. doi: 10.1016/j.amjsurg.2017.06.004. Epub 2017 Jul 5.
Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS.
We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction.
Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p = 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p = 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p = 0.03).
Patients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique.
由于担心长期失禁问题，外科医生在治疗肛裂时通常采用化学去神经支配术（肉毒杆菌毒素，BT）而非初始的侧方内括约肌切开术（LIS）。我们评估了接受BT或LIS治疗的患者的特征和治疗结果。
我们对2009年至2015年间接受LIS和BT治疗肛裂的患者进行了回顾性病历审查。2015年，进行了电话调查以评估治疗效果的持久性、长期失禁情况和患者满意度。
94名患者符合标准：73例行LIS，21例行BT。两组患者年龄相似（BT组49岁，LIS组52岁，p = 1.0）。干预前BT组患者的克利夫兰诊所大便失禁（CCFI）评分高于LIS组（2.1对0.4，p = 0.007），BT组完全控便的患者较少（50%对88%）。电话调查回复率为61%。BT组患者的肛裂复发率显著高于LIS组（36%对9%，p = 0.03）。
接受LIS治疗的患者复发可能性较小。LIS组和BT组患者在控便方面都有一些持久的变化，这引发了是否存在安全技术的问题。
