Zeitoun Jean-David, Blanchard Pierre, Fathallah Nadia, Benfredj Paul, Lemarchand Nicolas, de Parades Vincent
Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses - Croix-Saint-Simon, Paris, France.
Gastroentérologie et Nutrition, Hôpital Saint-Antoine, Paris, France.
Ann Coloproctol. 2018 Apr;34(2):83-87. doi: 10.3393/ac.2017.06.12. Epub 2018 Apr 30.
The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment.
All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence.
Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7-36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score.
A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.
慢性肛裂患者的手术治疗标准仍存在争议。我们旨在评估特发性肛裂的自然病程以及肛裂切除术作为一种手术治疗方法的长期疗效。
主要纳入在三级中心就诊于一位专家医生的所有连续患者。在标准药物治疗4至6周后出现难治性症状的病例中建议进行肛裂切除术。只有特发性且未感染的肛裂患者被纳入该第二个亚样本以接受手术。对所有接受手术的患者进行常规术后管理。主要结局指标为成功率（定义为伤口愈合和疼痛缓解的综合情况）以及术后肛门节制功能。
最初招募了349例患者。最终有50例患者因特发性且未感染的肛裂接受了手术。其中，47例（94%）在初次随访结束时治愈，47例中的44例（93.6%）在长期随访中可被确认为持续治愈。完全愈合的平均时间为10.3周（范围为5.7 - 36.4周）。所有患者在42周时均无疼痛。术后的节制功能评分与术前评分在统计学上无差异。
对于特发性未感染肛裂患者，肛裂切除术虽常导致完全愈合延迟，但能迅速缓解疼痛且成功率高。此外，它似乎对肛门节制功能没有不良影响。
