Department of Colorectal Surgery, St James' Hospital, Dublin, 8, Ireland.
Int J Colorectal Dis. 2020 Oct;35(10):1807-1815. doi: 10.1007/s00384-020-03699-4. Epub 2020 Jul 25.
Anal fissure is the most common cause of severe anorectal pain in adults, contributing significantly to coloproctology workloads. There are a wide variety of management options available, including topical nitrites, calcium channel blockers, botulinum toxin injection and sphincterotomy. The aim of this study was to review current options for the treatment of chronic anal fissure.
A comprehensive search identifying randomized controlled trials comparing treatment options for anal fissure published between January 2000 and February 2020 was performed. The primary outcome assessed was healing at 8 weeks post commencing treatment. Secondary outcomes included recurrence, intolerance of treatment and complications.
A total of 2822 studies were identified. After removal of duplicates and non-relevant studies, we identified nine randomized controlled trials which met pre-defined criteria. There was a total of 775 patients. At 8 weeks, healing rates were 95.13% in those treated with sphincterotomy, 66.7% in the botulinum toxin group, 63.8% in the nitrate group, 52.3% for topical diltiazem and 50% for topical minoxidil. Recurrence was highest amongst those treated with botulinum toxin injection (41.7%) and lowest for sphincterotomy (6.9%). Although the absolute number is low, there was a risk of permanent incontinence with sphincterotomy.
This review of the randomized control data demonstrates that healing was significantly higher amongst those treated with sphincterotomy versus more conservative modalities. Topical nitrites had similar outcomes to botulinum toxin injection but were poorly tolerated in comparison to other treatments. The benefit of sphincterotomy was at a cost of increased complications, notably permanent incontinence.
肛裂是成年人严重肛门直肠疼痛的最常见原因，对肛肠病学工作量有重大影响。有多种管理选择，包括局部亚硝酸酯、钙通道阻滞剂、肉毒杆菌毒素注射和括约肌切开术。本研究旨在回顾慢性肛裂的治疗选择。
进行了全面搜索，以确定 2000 年 1 月至 2020 年 2 月期间发表的比较肛裂治疗选择的随机对照试验。评估的主要结果是开始治疗后 8 周的愈合。次要结果包括复发、治疗不耐受和并发症。
共确定了 2822 项研究。去除重复项和不相关的研究后，我们确定了符合预先确定标准的九项随机对照试验。共有 775 名患者。在 8 周时，括约肌切开组的愈合率为 95.13%，肉毒毒素组为 66.7%，硝酸盐组为 63.8%，局部地尔硫卓为 52.3%，局部米诺地尔为 50%。肉毒毒素注射组的复发率最高（41.7%），括约肌切开组最低（6.9%）。尽管绝对数字较低，但括约肌切开术存在永久性失禁的风险。
对随机对照数据的回顾表明，与更保守的治疗方式相比，括约肌切开术治疗的愈合率显著更高。局部亚硝酸酯的效果与肉毒毒素注射相似，但与其他治疗方法相比，耐受性较差。括约肌切开术的益处是以增加并发症为代价的，特别是永久性失禁。
