Hananel N, Gordon P H
Department of Surgery, McGill University, Montreal, Quebec, Canada.
Dis Colon Rectum. 1997 Feb;40(2):229-33. doi: 10.1007/BF02054993.
This study was designed to reassess clinical manifestations of fissure-in-ano, in particular, the frequency of constipation and rate of response to medical management.
Records of 876 patients with fissure-in-ano seen between February 1975 and December 1993 were reviewed. Information gathered included age, gender, site, symptoms, bowel habits, associated anorectal problems, response, failure, and recurrence rates.
There were 439 women (51.1 percent) and 437 men (49.9 percent); mean age was 39.9 (range, 13.5-95) years. The fissure was located in the posterior mid line in 644 patients (73.5 percent), the anterior mid line in 144 patients (16.4 percent), both in 23 patients (2.6 percent), and only tenderness documented in 65 patients (7.4 percent). The fissure was located in the anterior midline in 12.6 percent of women and 7.7 percent of men. Dominant presenting symptoms included pain in 90.8 percent and bleeding in 71.4 percent of patients. Infrequent hard bowel movements (> or = 3 days) occurred in only 13.8 percent of patients. Mean follow-up was 26 (range, 0.5-215) months. A total of 44.7 percent of patients responded to nonoperative therapy, 60 percent of them in the first two months; of these, 18.6 percent developed recurrent symptoms. Of the latter group, 60 percent responded to further medical therapy, and 20 percent underwent a lateral internal sphincterotomy. Of the patients who initially did not respond to medical treatment (50.5 percent), lateral internal sphincterotomy was recommended.
Anterior fissures are much more common in both men and women than previously reported, and constipation and hard bowel movement are not universally present in patients with fissure-in-ano.
本研究旨在重新评估肛裂的临床表现，尤其是便秘的发生率以及药物治疗的反应率。
回顾了1975年2月至1993年12月期间876例肛裂患者的记录。收集的信息包括年龄、性别、部位、症状、排便习惯、相关的肛肠问题、反应、失败率和复发率。
女性439例（51.1%），男性437例（49.9%）；平均年龄39.9岁（范围13.5 - 95岁）。644例患者（73.5%）的肛裂位于后正中线，144例患者（16.4%）位于前正中线，23例患者（2.6%）前后正中线均有肛裂，65例患者（7.4%）仅有压痛记录。女性肛裂位于前正中线的比例为12.6%，男性为7.7%。主要的首发症状包括9�.8%的患者有疼痛，71.4%的患者有出血。仅有13.8%的患者排便次数少且大便干结（≥3天一次）。平均随访时间为26个月（范围0.5 - 215个月）。共有44.7%的患者对非手术治疗有反应，其中60%在最初两个月内有反应；在这些有反应的患者中，18.6%出现了复发症状。在复发的患者中，60%对进一步的药物治疗有反应，20%接受了侧方内括约肌切开术。对于最初对药物治疗无反应的患者（50.5%），建议行侧方内括约肌切开术。
男性和女性的前位肛裂比之前报道的更为常见，并且便秘和大便干结在肛裂患者中并非普遍存在。
