Wang Cong, Ni Jing, Xiong Yi, Chen Jinlan, Li Binting, Xu Li
The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
Graduate School, Zhejiang Chinese Medical University, Hangzhou, China.
Int J Surg. 2025 Apr 1;111(4):3020-3029. doi: 10.1097/JS9.0000000000002263.
Anal fissure (AF) is a common anorectal condition causing pain, bleeding, and other perianal discomfort. This study conducts a network meta-analysis (NMA) to compare the efficacy and side effect profiles of pharmacological treatments for AF, including diltiazem (DTZ), glyceryl trinitrate (GTN), nifedipine (ND), minoxidil (MD), and lidocaine (LC).
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review and NMA were performed. Randomized controlled trials (RCTs) comparing non-surgical treatments for AF were sourced from PubMed, Cochrane Library, Embase, and Medline. The primary outcome was AF healing, with secondary outcomes including recurrence rates, pain reduction (visual analog scale), and adverse effects. Statistical analysis utilized odds ratios and surface under the cumulative ranking values for treatment ranking.
Twenty-two RCTs involving a total of 1770 participants were included in the analysis. ND demonstrated the highest healing rate, followed by DTZ and MD. LC exhibited the lowest healing rate. DTZ had the lowest recurrence rate and was the most effective in pain reduction, whereas LC had the highest recurrence rate and was the least effective in alleviating pain. The incidence of adverse effects with MD was relatively low, second only to LC, while GTN had the highest rate of adverse effects.
ND had the highest healing rate and should be considered as a first-line non-surgical treatment for AFs. Given the elevated incidence of adverse reactions associated with nitroglycerin, its use should be avoided in order to minimize the risk of significant toxicities and side effects. Additionally, because of its outstanding analgesic properties, DTZ is recommended as the preferred option for patients with heightened sensitivity to pain, but more studies are needed to evaluate its efficacy.
肛裂（AF）是一种常见的肛肠疾病，会引起疼痛、出血及其他肛周不适。本研究进行一项网状Meta分析（NMA），以比较用于治疗肛裂的药物，包括地尔硫䓬（DTZ）、硝酸甘油（GTN）、硝苯地平（ND）、米诺地尔（MD）和利多卡因（LC）的疗效和副作用情况。
按照系统评价和Meta分析的首选报告项目指南，进行了一项系统评价和NMA。比较肛裂非手术治疗方法的随机对照试验（RCT）来自PubMed、Cochrane图书馆、Embase和Medline。主要结局是肛裂愈合，次要结局包括复发率、疼痛减轻（视觉模拟量表）和不良反应。统计分析采用比值比和累积排序值下的面积进行治疗排序。
分析纳入了22项RCT，共1770名参与者。硝苯地平显示出最高的愈合率，其次是地尔硫䓬和米诺地尔。利多卡因的愈合率最低。地尔硫䓬的复发率最低，在减轻疼痛方面最有效，而利多卡因的复发率最高，在缓解疼痛方面最无效。米诺地尔的不良反应发生率相对较低，仅次于利多卡因，而硝酸甘油的不良反应发生率最高。
硝苯地平的愈合率最高，应被视为肛裂非手术治疗的一线药物。鉴于与硝酸甘油相关的不良反应发生率较高，应避免使用以尽量减少严重毒性和副作用的风险。此外，由于其出色的镇痛特性，地尔硫䓬被推荐为对疼痛敏感患者的首选，但需要更多研究来评估其疗效。
