Manookian C M, Fleshner P, Moore B, Teng F, Cooperman H, Sokol T
Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am Surg. 1998 Oct;64(10):962-4.
Anal sphincter spasm is a common finding in patients with anal fissure disease. It is postulated that spasm impedes mucosal blood flow and impairs healing. Topical nitroglycerin (NTG), a nitric oxide donor compound, has been shown to cause relaxation of the anal sphincter and may have treatment efficacy in the management of anal fissure. The purpose of this study was to assess the usefulness of NTG for anal fissure. We performed a retrospective review of patients with anal fissure treated with various concentrations of topical NTG ointments over an 18-month period ending July 1997. Of the 81 patients studied, 44 (54%) were male. There were 42 acute and 39 chronic fissures. NTG preparations included 1 per cent isosorbide (n = 37), 0.2 per cent NTG (n = 38), and 0.5 per cent NTG (n = 6). Healing with NTG therapy occurred in 29 acute (69%) and 21 chronic fissure (54%) patients. There was no difference in the incidence of healing of acute or chronic fissure between the various NTG treatment preparation groups. When acute and chronic fissure therapy was subdivided by time of NTG treatment (immediate versus post-conservative therapy failure (PCF)), 14 (74%) of acute PCF and 5 (42%) of chronic PCF patients healed. We conclude that no single formula was superior. When patients were subdivided into a PCF group, NTG therapy demonstrated a significant salvage rate, thus avoiding surgery.
肛门括约肌痉挛是肛裂患者的常见表现。据推测，痉挛会阻碍黏膜血流并影响愈合。局部使用硝酸甘油（NTG），一种一氧化氮供体化合物，已被证明可引起肛门括约肌松弛，可能对肛裂的治疗有效。本研究的目的是评估NTG对肛裂的疗效。我们对在1997年7月结束的18个月期间接受不同浓度局部NTG软膏治疗的肛裂患者进行了回顾性研究。在研究的81例患者中，44例（54%）为男性。有42例急性肛裂和39例慢性肛裂。NTG制剂包括1%异山梨醇（n = 37）；0.2% NTG（n = 38）和0.5% NTG（n = 6）。NTG治疗使29例急性肛裂患者（69%）和21例慢性肛裂患者（54%）愈合。不同NTG治疗制剂组之间急性或慢性肛裂的愈合发生率没有差异。当急性和慢性肛裂治疗按NTG治疗时间（即刻与保守治疗失败后（PCF））细分时，14例急性PCF患者中的14例（74%）和5例慢性PCF患者中的5例（42%）愈合。我们得出结论，没有单一配方更具优势。当将患者分为PCF组时，NTG治疗显示出显著的挽救率，从而避免了手术。
