Asefa Zelalem, Awedew Atalel Fentahun
Department of Surgery, SoM, Addis Ababa University, Addis Ababa, Ethiopia.
Sci Rep. 2023 Nov 28;13(1):20957. doi: 10.1038/s41598-023-48286-z.
Chronic anal fissure is one of the most common benign anorectal health conditions, causing significant morbidity, quality of life, and economic loss. Eight randomized controlled trials with a total population size of 1035 were eligible for analysis. Seven studies included both males and female, while one only included females. The majority of randomized controlled trials involved female dominance [54.9% (43.5-66.3)] and posterior midline location [86.1% (95% CI 81.5-90.8%)]. This meta-analysis of randomised control trials found that overall postoperative healing was 90.2%, recurrent anal fissure was 3.7%, and postoperative incontinence was 8.9% after LIS. Even though there was no statistically significant difference, closed lateral internal sphincterotomy (LIS) had higher rates of recurrent anal fissure (RR = 1.73 (95% CI 0.86-3.47, p = 0.90, I2 = 0%) and lower rates of postoperative incontinence rate (RR = 0.60 (95% CI 0.37-0.96, p = 0.76, I2-0) as compared with open LIS. We recommended that closed lateral internal sphincterotomy (LIS) is a safe and effective surgical treatment option for chronic anal fissures.
慢性肛裂是最常见的良性肛肠健康问题之一，会导致严重的发病率、生活质量下降和经济损失。共有1035名受试者的8项随机对照试验符合分析条件。7项研究纳入了男性和女性，而1项仅纳入了女性。大多数随机对照试验中女性占主导[54.9%（43.5 - 66.3）]，且肛裂多位于后正中线[86.1%（95%CI 81.5 - 90.8%）]。这项随机对照试验的荟萃分析发现，在接受侧方内括约肌切开术（LIS）后，总体术后愈合率为90.2%，肛裂复发率为3.7%，术后大便失禁率为8.9%。尽管无统计学显著差异，但与开放性LIS相比，闭合性侧方内括约肌切开术的肛裂复发率较高（RR = 1.73（95%CI 0.86 - 3.47，p = 0.90，I2 = 0%）），术后大便失禁率较低（RR = 0.60（95%CI 0.37 - 0.96，p = 0.76，I2 = 0））。我们建议，闭合性侧方内括约肌切开术（LIS）是治疗慢性肛裂的一种安全有效的手术选择。
