Servicio de Cirugía General y Aparato Digestivo, Hospital de Jove, España.
Servicio de Cirugía General y Aparato Digestivo, Hospital Valle del Nalón, España.
Rev Esp Enferm Dig. 2019 Sep;111(9):672-676. doi: 10.17235/reed.2019.6202/2019.
pharmacological treatment of a chronic anal fissure (CAF) achieves healing in half of cases and lateral internal sphincterotomy (LIS) is the definite treatment. The objective of this study was to assess the combination of fissurectomy and botulin toxin A (BTA) injection.
this was a retrospective study of 54 patients with anal sphincter hypertonia and CAF treated with an injection of BAT and fissurectomy, after an unsuccessful management with topical nitroglycerin (NGT) for eight weeks. Fissurectomy and an injection of BTA (33 or 50 units) in the internal anal sphincter was performed during the same session. The main outcome measure was the healing rate, with incontinence and the need of LIS as secondary outcomes.
two patients were excluded from the study, one due to Crohn's disease and the other was lost to follow-up. Of the 52 patients included in the study, there were 36 females (70%) and 16 (30%) males, with a mean age of 49 years (range 22-75). Fissure healing was initially achieved in 49 patients (94.2%) and LIS was required in the remaining three patients (5.8%). After initial healing, 18 patients (34.7%) developed 23 recurrences at a mean time of 27 months (5-83 months). Of these patients, healing with conservative sphincter measures was obtained in eleven cases (NGT in eight and repeat fissurectomy and BAT in three); two patients are currently under treatment with NGT and five underwent LIS.
BTA injection associated with fissurectomy is a safe and effective procedure in patients with CAF, avoiding the need of LIS in a high percentage of patients.
慢性肛裂（CAF）的药物治疗有一半可以治愈，而侧内括约肌切开术（LIS）是明确的治疗方法。本研究的目的是评估肛裂切除术联合肉毒杆菌毒素 A（BTA）注射的效果。
这是一项回顾性研究，共纳入 54 例因局部使用硝酸甘油（NGT）治疗 8 周无效而导致肛门内括约肌张力过高和 CAF 的患者，这些患者接受了 BTA 注射和肛裂切除术治疗。在同一治疗过程中，对肛裂进行切除并向肛门内括约肌注射 33 或 50 个单位的 BTA。主要观察指标是愈合率，次要观察指标为失禁和需要行 LIS。
有 2 例患者因克罗恩病和失访而被排除研究之外。在纳入的 52 例患者中，有 36 例女性（70%）和 16 例男性（30%），平均年龄为 49 岁（22-75 岁）。初始治疗后，49 例患者（94.2%）的肛裂愈合，3 例患者（5.8%）需要行 LIS。初始愈合后，18 例患者（34.7%）在平均 27 个月（5-83 个月）时出现 23 例复发。其中 11 例（8 例采用 NGT，3 例采用肛裂切除术联合 BTA）通过保守的括约肌治疗获得愈合，2 例患者目前正在接受 NGT 治疗，5 例患者接受了 LIS。
BTA 注射联合肛裂切除术是一种安全有效的治疗慢性肛裂的方法，可避免多数患者需要行 LIS。
