Buchholz B, Schwering H, Lingemann B, Stegemann B
Phlebologie. 1980 Oct-Dec;33(4):645-52.
The anal dermis, with its sensitive receptors, is an important part of the anorectal apparatus. Anal fissures and perianal phlebothrombosis can cause considerable pain. According to anatomical diagnostics, there are three clear stages in the development of an anal fissure. At the first stage, a treatment using a glass dilator gives good results. The subsequent two stages, however, require surgery. In current practice there are two types of operation: the association of a fissurectomy with dorsal sphincterotomy under local or general anaesthetic; or fissurectomy associated with an inferior lateral sphincterotomy, a technique improved by Notaras. A comparison between the two types of treatment shows that fissurectomy associated with lateral sphincterotomy constitutes the more effective method. As the rate of recidivism and complications is the same, the operation can be performed on an ambulatory basis during hours of consultation. Thrombectomy under local anaesthetic may be used for the treatment of perianal phlebothrombosis in its most critical phases. This always relieves the patient's pain, and it, too, may be performed on an ambulatory basis.
具有敏感感受器的肛管真皮是肛肠器官的重要组成部分。肛裂和肛周静脉血栓形成会引起相当大的疼痛。根据解剖诊断，肛裂的发展有三个明显阶段。在第一阶段，使用玻璃扩张器进行治疗效果良好。然而，随后的两个阶段需要手术治疗。目前的临床实践中有两种手术方式：在局部或全身麻醉下将肛裂切除术与背侧括约肌切开术联合进行；或者将肛裂切除术与外侧下括约肌切开术联合进行，这是一种由诺塔拉斯改进的技术。两种治疗方式的比较表明，肛裂切除术联合外侧括约肌切开术是更有效的方法。由于复发率和并发症发生率相同，该手术可在门诊咨询时间进行。局部麻醉下的血栓切除术可用于治疗处于最关键阶段的肛周静脉血栓形成。这总能缓解患者的疼痛，而且也可在门诊进行。
