D'Orazio Beatrice, Famà Fausto, Cudia Bianca, Martorana Guido, Corbo Giovanni, Terranova Gloria, Bonventre Sebastiano, Di Vita Gaetano
Ann Ital Chir. 2022;93(1):108-112. Epub 2020 Dec 21.
Etiopathogenesis of Chronic Anal Anterior Fissure (CAAF) remains poorly understood. Some anatomical, clinical and functional features suggest that pathophysiology may be linked to a reduced anal canal pressure. LIS appear illogical as a treatment for CAAF and the employ of techniques aiming to save the integrity of the sphincterial system appears more sensible. The aim of this study was to evaluate 5 years results of fissurectomy and anoplasty with cutaneous V-Y advancement flap in patients affected by CAAF without IAS hypertonia.
We enrolled 20 women, affected by idiopathic and non-recurrent CAAF without hypertonic IAS. All patients were followed up for 5 years after surgery with evaluation of anal continence, short and long term post-operative complications, recurrence rate.
At 5 years follow up we did not record any new case of anal incontinence and the pre-existing ones havent worsened. We observed 2 recurrences, which occurred within 2 years after surgery and healed after medical therapy. The manometric values were similar than those recorded prior to surgery.
Our study suggests that the procedure performed allows us to preserve anal continence and avoid worsening of its pre-existing alteration.
Anal canal, Anoplasty, Fissure, Fissurectomy, Proctology, Sphincterotomy.
慢性肛裂（CAAF）的病因发病机制仍未完全明了。一些解剖学、临床和功能特征表明，其病理生理学可能与肛管压力降低有关。作为CAAF的一种治疗方法，内括约肌侧切术似乎不合理，而采用旨在保留括约肌系统完整性的技术似乎更明智。本研究的目的是评估在无内括约肌亢进的CAAF患者中，采用皮肤V-Y推进皮瓣进行肛裂切除术和肛门成形术的5年结果。
我们纳入了20名患有特发性、非复发性CAAF且无内括约肌亢进的女性患者。所有患者术后随访5年，评估肛门节制功能、术后短期和长期并发症以及复发率。
在5年的随访中，我们未记录到任何新的肛门失禁病例，且术前已存在的肛门失禁情况也未恶化。我们观察到2例复发，均发生在术后2年内，经药物治疗后愈合。测压值与手术前记录的相似。
我们的研究表明，所实施的手术方法能够使我们保留肛门节制功能，并避免其术前已存在的功能改变恶化。
肛管；肛门成形术；肛裂；肛裂切除术；直肠病学；括约肌切开术
