肉毒杆菌毒素治疗慢性功能性肛门直肠痛患者：一家三级转诊直肠病诊所的经验。
Botox treatment in patients with chronic functional anorectal pain: experiences of a tertiary referral proctology clinic.
机构信息
Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location VU University Medical Centre, PO Box 7057, Amsterdam, 1081 HZ, The Netherlands.
Department of Anorectal Surgery, Proctos Clinic, Bilthoven, The Netherlands.
出版信息
Tech Coloproctol. 2019 Mar;23(3):239-244. doi: 10.1007/s10151-019-01945-8. Epub 2019 Feb 16.
BACKGROUND
Anorectal pain is a symptom which may have both structural and functional causes, and can, sometimes, develop into a chronic pain syndrome. Functional causes in particular are challenging to treat when conservative treatment measures fail. Botulinum toxin A (BTX-A) can be applied to relax the anal sphincter and/or levator ani muscle to break the vicious circle of pain and contraction. In our tertiary referral proctology clinic, we evaluated the outcome of patients treated with BTX-A for chronic functional anorectal pain.
METHODS
Our electronic database was searched for patients who had BTX-A treatment for chronic functional anorectal pain from 2011 to 2016. All medical data concerning history, treatments, and clinical outcome were retrieved. The clinical outcome (resolution of pain) was scored as good, temporary, or poor.
RESULTS
A total of 113 patients [47 (42%) males; age 51years, SD 13 years, range 18-88 years] with chronic functional anorectal pain were included. The outcome of BTX-A treatment was good in 53 (47%), temporary in 23 (20%), and poor in 37 (33%). To achieve this outcome, 29 (45%) patients needed a single treatment, 11 (44%) a second treatment, and 13 (54%) ≥ 3 treatments.
CONCLUSIONS
Chronic functional anorectal pain can be treated successfully with BTX-A in 47% of patients who fail conservative management. Repeated injections may be needed to ensure complete cure in a subgroup of patients.
背景
肛门直肠痛是一种可能有结构和功能原因的症状，有时会发展成慢性疼痛综合征。当保守治疗措施失败时，特别难以治疗功能性原因。肉毒杆菌毒素 A（BTX-A）可用于放松肛门括约肌和/或提肛肌，以打破疼痛和收缩的恶性循环。在我们的三级转诊直肠病诊所，我们评估了 BTX-A 治疗慢性功能性肛门直肠痛患者的结果。
方法
我们的电子数据库搜索了 2011 年至 2016 年间接受 BTX-A 治疗慢性功能性肛门直肠痛的患者。检索了所有有关病史、治疗和临床结果的医疗数据。临床结果（疼痛缓解）评分良好、暂时或差。
结果
共纳入 113 例[47 例（42%）男性；年龄 51 岁，标准差 13 岁，范围 18-88 岁]慢性功能性肛门直肠痛患者。BTX-A 治疗的结果为良好 53 例（47%），暂时 23 例（20%），差 37 例（33%）。为了达到这个结果，29 例（45%）患者需要单次治疗，11 例（44%）需要第二次治疗，13 例（54%）需要≥3 次治疗。
结论
在保守治疗失败的患者中，47%的慢性功能性肛门直肠痛患者可以成功地用 BTX-A 治疗。在亚组患者中，可能需要重复注射以确保完全治愈。
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