Università Cattolica del Sacro Cuore, Roma, Italy.
Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy.
Int J Colorectal Dis. 2022 Mar;37(3):693-700. doi: 10.1007/s00384-022-04110-0. Epub 2022 Feb 11.
Anal fissure is caused by a pathological contraction of the internal anal sphincter. Lateral internal sphincterotomy remains the gold standard for the treatment of fissure. Botulinum toxin injections have been proposed to treat this condition without any risk of permanent injury of the internal sphincter. We investigate clinical and pathological variables and the effects of different dosage regimens of botulinum toxin to induce healing in patients with idiopathic anal fissure.
This is a retrospective study at a single center. The patients underwent a pre-treatment evaluation that included clinical inspection of the fissure and anorectal manometry. We collected and analyzed demographic data, pathological variables, associated pathological conditions, and treatment variables. Success was defined as healing of the fissure, and improvement of symptoms was defined as asymptomatic persistent fissure.
The findings of 1003 patients treated with botulinum toxin injections were reported. At 2 months evaluation, complete healing was evident in 780 patients (77.7%). Resting anal tone (77.1 ± 18.9 mmHg) was significantly lower from baseline (P < 0.0001) and from 1-month value (P = 0.0008). Thirty-nine not healed patients underwent lateral internal sphincterotomy, and 184 were re-treated with 50 UI of botulinum toxin. In these patients, the healing rate was 93.9% (171 patients). Dose and injection site of toxin correlates with healing rate. There were no relapses during an average of about 71 months.
Our data show that injection of botulinum toxin into the internal anal sphincter is a safe and effective alternative to surgery in patients with chronic anal fissure.
肛裂是由肛门内括约肌的病理性收缩引起的。侧方内括约肌切开术仍然是治疗肛裂的金标准。肉毒毒素注射已被提议用于治疗这种疾病，而不会对内括约肌造成任何永久性损伤。我们研究了不同剂量方案的肉毒毒素在诱导特发性肛裂患者愈合方面的临床和病理变量及效果。
这是一项单中心回顾性研究。患者接受了治疗前评估，包括肛裂的临床检查和肛肠测压。我们收集和分析了人口统计学数据、病理变量、相关病理状况和治疗变量。治愈定义为肛裂愈合，症状改善定义为无症状持续肛裂。
报告了 1003 例接受肉毒毒素注射治疗的患者的发现。在 2 个月的评估时，780 例患者（77.7%）完全愈合。静息肛门张力（77.1±18.9mmHg）明显低于基线（P<0.0001）和 1 个月时的值（P=0.0008）。39 例未愈合的患者接受了侧方内括约肌切开术，184 例患者接受了 50 UI 的肉毒毒素再次治疗。在这些患者中，愈合率为 93.9%（171 例）。毒素的剂量和注射部位与愈合率相关。在平均约 71 个月的时间内没有复发。
我们的数据表明，向肛门内括约肌注射肉毒毒素是慢性肛裂患者替代手术的一种安全有效的方法。
