两种术式治疗肛裂前后肛管直肠压变化的比较

通过对两种术式治疗肛裂前后肛管直肠压的变化观察,探讨可能造成肛裂术后肛门失禁的原因,为寻找更优的手术方法提供依据。将确诊的100例肛裂患者随机分成治疗组和对照组,治疗组50例采用肛门内括约肌侧位切断术,对照组50例采用肛门内括约肌后位切断术。对两种治疗肛裂的术式手术前后肛管直肠压、疗程及术后并发症、术后疼痛、术后排便等指标进行观察统计。结果显示,治疗后两组患者症状评分均较治疗前降低,两组近期疗效、术后并发症（创13水肿、创口感染、肛门狭窄、术后排尿困难）、术后排便情况差异无统计学意义（P〉0．05）,在疗程、术后出血、术后疼痛及肛管直肠压方面治疗组优于对照组（P〈0．05）。结果表明,肛门内括约肌侧位切断术较肛门内括约肌后位切断术治疗肛裂具有创口小、愈合快、痛苦小、并发症少、安全性高等优点。     

次侧切术治疗Ⅲ期肛裂前后肛门直肠压力对比分析

目的:探讨次侧切开内括约肌治疗肛裂术前、术后肛门直肌压力的变化.方法:采用自行设计的次侧方内括约肌切开加双缘结扎术治疗Ⅲ期肛裂60例,测定手术前后肛门直肠压力,并与60例正常人肛压比较,评价新术式治疗Ⅲ期肛裂的临床疗效及其对肛门功能的影响.结果:显示术后患者肛管静息压显著降低,与术前比较有显著性差异(P＜0.01),与正常人比较无显著性差异(P＞0.05);肛管最大收缩压与术前及正常人比较无显著性差异(P＞0.05).结论:次侧方内括约肌切开加双缘结扎术能有效地解除内括约肌痉挛,从根本上消除高肛压,从而彻底治愈肛裂,而且不影响肛门功能.     

次侧方内括约肌切开加双缘结扎术治疗Ⅲ期肛裂临床观察(附150例报告)

目的观察次侧方内括约肌切开加双缘结扎术治疗Ⅲ期肛裂临床疗效及其对肛门功能的影响。方法治疗组选取Ⅲ期肛裂患者150例,均采用次侧方内括约肌切开加双缘结扎术治疗,观察创口愈合时间、随访6个月的复发率及测定手术前后肛门直肠压力,并与健康对照组比较。结果所有患者均痊愈出院,创口平均愈合时间(16±2.87)d,随访6个月无复发病例;术前肛管静息压较正常人显著升高(P0.05),肛管舒张压较前显著降低(P0.05),肛管最大收缩压及肛管自主收缩持续时间与正常人比较无明显差异(P0.05);术后肛管静息压较术前明显降低(P0.05),肛管舒张压较前明显升高(P0.05),肛管最大收缩压及肛管自主收缩持续时间与术前比较无明显差异(P0.05);术后肛管静息压、肛管舒张压、肛管最大收缩压及肛管自主收缩持续时间与正常人比较无明显差异(P0.05)。结论次侧方内括约肌切开加双缘结扎术治疗Ⅲ期肛裂疗效显著,能有效地解除内括约肌痉挛,改善肛裂溃疡面的供血不足,促进肛裂的愈合。     

次侧切术治疗期肛裂前后肛门直肠压力对比分析

目的 :探讨次侧切开内括约肌治疗肛裂术前、术后肛门直肌压力的变化。方法 :采用自行设计的次侧方内括约肌切开加双缘结扎术治疗 期肛裂 6 0例 ,测定手术前后肛门直肠压力 ,并与 6 0例正常人肛压比较 ,评价新术式治疗 期肛裂的临床疗效及其对肛门功能的影响。结果 :显示术后患者肛管静息压显著降低 ,与术前比较有显著性差异 (P <0 .0 1) ,与正常人比较无显著性差异 (P>0 .0 5 ) ;肛管最大收缩压与术前及正常人比较无显著性差异 (P>0 .0 5 )。结论 :次侧方内括约肌切开加双缘结扎术能有效地解除内括约肌痉挛 ,从根本上消除高肛压 ,从而彻底治愈肛裂 ,而且不影响肛门功能。     

肛裂切除术联合术后化学性内括约肌切开疗效观察

目的探讨肛裂切除术联合术后化学性内括约肌切开的临床疗效。方法将2013-09—2015-09间到山东省千佛山医院治疗的112例肛裂患者随机分为2组,治疗组为肛裂切除术联合术后化学性内括约肌切开术(局部涂抹硝酸异山梨酯(ISDN)软膏),对照组为单纯肛裂切除术。结果治疗组患者术后疼痛,治愈时间,肛管静息压均优于对照组,差异有统计学意义(P0.05)。结论肛裂切除术联合术后化学性内括约肌切开术,疗效显著。     

肛门内括约肌部分切开结扎术治疗陈旧性肛裂的临床研究

目的：研究肛门内括约肌部分切开结扎术治疗陈旧性肛裂的临床疗效。方法：160例陈旧性肛裂病人通过随机数字表分成两组。研究组80例采用内括约肌部分切开结扎术。对照组80例采用内括约肌后方切断术。统计两组术后各时间点创面大小、疼痛评分、出血评分、肛门功能及住院时间和切口创面愈合时间。结果：研究组和对照组有效率均100%。研究组治愈率为100%,优于对照组97.5%,差异有统计学意义（P<0.05）。研究组术后第1、3、5、7天创面面积均小于同期对照组,差异有统计学意义（P<0.05）。研究组术后第1、3、5、7天疼痛评分、出血评分、均小于同期对照组,差异有统计学意义（P<0.05）。研究组术后创面愈合后Wexner肛门功能失禁评分低于对照组,差异有统计学意义（P<0.05）。研究组住院时间以及切口创面愈合时间均短于对照组,差异有统计学意义（P<0.05）。结论：肛门内括约肌部分切开结扎术治疗陈旧性肛裂疗效确切安全,具有加速创面愈合、术后出血少、疼痛轻等优势,肛门功能保护良好。     

闭式两处括约肌切断术治疗肛裂642例临床观察

目的探索治疗肛裂的新手术方法。方法回顾性分析2004年6月至2008年6月642例患者资料,手术方式是在肛裂的两侧肛管皮下两处切断内括约肌下缘和外括约肌皮下层,切开肛管1点或11点位栉膜带,同时处理肛管其他合并症。结果术后患者无明显的疼痛感觉,Ⅲ期患者术后平均住院日9d。肛门功能良好,无肛门溢液、溢气,疗效满意,396例随访1年以上未见复发。结论本术式操作简单易掌握,疗效好,患者痛苦小,并发症少。     

扩切术和侧切术治疗陈旧性肛裂疗效比较

为探讨陈旧性肛裂术中扩创范围及切断肛门括约肌的合理性,将80例陈旧性肛裂随机分为治疗组和对照组各40例。治疗组采用扩切术,彻底扩创;对照组采用侧切术,简单扩创,两组均取肛门括约肌送病理切片检查。结果显示,80例均切断了内括约肌,其中冶疗组27例,对照组10例切断了部分外括约肌皮下部。治疗组治愈率95％,好转率5％．总有效率100％;对照组治愈率75％,好转率20％,无效5%,总有效率95％。治疗组疗效优于对照组。结果表明,以肛管能容纳4指为标准切断肛门括约肌具有合理性,肛裂扩创是一个不可忽视的环节;后侧位扩切术疗效确切．是治疗陈旧性肛裂的良好术式。     

后位内括约肌部分离断术在肛肠病中的应用

环状混合痔、肛裂、肛门狭窄等肛肠疾病手术时，大多采用后位内括约肌部分离断术，其能减轻肛缘水肿，减轻患者术后疼痛，扩张肛管。本文对采用此方法治疗的860例患者资料进行回顾分析，总结报道如下。     

两种术式治疗慢性肛裂对肛肠动力学变化的影响

本研究旨在于通过肛肠动力学检测探讨两种术式治疗慢性肛裂埘肛门功能的影响。将120例肛裂患者分别采用侧位内括约肌切断术（试验组60例）和后侧位内括约肌切断术（对照组60例）治疗．记录两组患者术前和术后直肠肛门反射（RAR）,肛管最大收缩压（AMCP）,肛管最长收缩时间（ALCT）,直肠静息压（RRP）和肛管静息压（ARP）等指标情况。结果显示,试验组和对照组术后肛管功能均得到明显改善,两组均取得良好效果,无明显的并发症;试验组ARP较对照组下降显著（P〈0．01）,两组间术前术后ALCT、RRP和AMCP差异无统计学意义（P〉0．05）;结果表明,肛裂手术后可引起一定的肛肠动力学变化,但肛门自制功能基本维持正常。     

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The maximum number of patients was encountered in the age group of 20 to 40 years with mean duration of age 34.14 years. In all three groups symptoms like pain, bleeding, constipation and sphincter spasm were present. Sentinel pile was present in 56% of the patients. Common site of fissure was found to be posterior in 94% of patients. Observations with respect to relief of pain, no bleeding and healing were recorded at 2, 6 and 12 weeks of duration. Lateral sphincterotomy remains effective but should be reserved for the patients who fail to respond to initial chemical sphincterotomy or GTN therapy. GTN is good alternative mode of therapy for patients who refuse surgery and prefer medical line of treatment.     

A Study of Fecal Incontinence in Patients with Chronic Anal Fissure: Prospective,Randomized, Controlled Trial of the Extent of Internal Anal Sphincter Division During Lateral Sphincterotomy

Background Troublesome fecal incontinence following a lateral internal sphincterotomy is often attributed to faulty surgical technique. However, it may be associated with coexisting occult sphincter defects. Whether continence is related to the extent of sphincterotomy remains debatable. The aim of the study is to identify fecal incontinence related to chronic anal fissure before and after lateral internal sphincterotomy and its relationship to the extent of internal anal sphincter division. Methods One hundred eight patients with chronic anal fissure were prospectively studied before and after lateral internal sphincterotomy. A questionnaire was completed for each patient before and after surgery with regard to any degree of fecal incontinence. Fecal incontinence severity index was assessed using the Cleveland Clinic Incontinence Score. The patients with preoperative perfect continence were randomized into two groups (46 patients in each group): Group 1 underwent traditional lateral internal sphincterotomy (up to the dentate line) and Group 2 were underwent a conservative internal anal sphincterotomy (up to the height of the fissure apex or just below it). Results Minor degrees of incontinence were present before surgery in 16 patients (14.8%). Results of the randomized trial revealed that temporary postoperative incontinence was newly developed in 6/92 of patients (6.52 %) who did not have it before surgery. Five of the six (10.86%) were in Group 1 one (2.17%) was in Group 2 (p = 0.039). Persistent incontinence occurred in two in Group 1 (4.35%). All of them were females. All have had a history of one or more vaginal deliveries. Conclusion A mild degree of fecal incontinence may be associated with chronic anal fissure at presentation rather than as a result of internal sphincterotomy. Troublesome fecal incontinence after lateral internal sphincterotomy is uncommon. Sphincterotomy up to the dentate line provided faster pain relief and faster anal fissure healing, but it was associated with a significant postoperative alteration in fecal incontinence than was sphincterotomy up to the fissure apex. Care should be exercised in female patients with a history of previous obstetric trauma, as internal anal sphincter division may further compromise sphincter function.     

控制性括约肌侧切术治疗陈旧性肛裂的临床疗效

为探讨控制性括约肌侧切术治疗陈旧性肛裂的疗效，将118例陈旧性肛裂患者随机分为两组，分别采用控制性内括约肌侧切术（治疗组）和传统的内括约肌侧切扩肛术（对照组）治疗，并对比分析两组治疗结果。结果显示，两组患者均一次性治愈，均无大便失禁发生。但治疗组和对照组分别有1例和6例肛门气体失禁。随访至今，治疗组无复发，对照组复发1例。结果表明，控制性括约肌侧切术减少了不必要的组织损伤，更好地保护了肛门功能，可～次性治愈陈旧性肛裂，且操作简单，适合基层医疗单位推广应用。     

内括约肌侧方切开术治疗肛裂30例疗效观察

为探讨白内向外内括约肌侧方切开术治疗肛裂的疗效,将60例肛裂患者随机分为两组即观察组和对照组,每组各30例。观察组采用自内向外内括约肌侧方切开术治疗,对照组采用开放式内括约肌后方切开术治疗,比较两组患者手术时间、创口愈合时间、住院时间及术后疼痛评分情况,并进行统计分析。结果显示,观察组在手术时间、创口愈合时间、住院时间及术后疼痛评分方面均优于对照组（P〈0．05或P〈0．01）。结果表明,自内向外内括约肌侧方切开术治疗肛裂安全有效,术后疼痛轻,并发症少,恢复快。     

Anal Stretch Plus Fissurectomy for Chronic Anal Fissure

Introduction : Anal fissure is a common disease. Usually chronic anal fissures are managed medically. When conservative management fails, surgical treatment should be considered. Lateral internal sphincterotomy has been advocated as the first choice invasive treatment but it has a reported rate of major fecal incontinence of 5%. In order to reduce the onset of major fecal incontinence after anal fissure surgery, it has been proposed to use the anal stretching plus fissurectomy.

Methods : From 2008 to 2011, 457 patients have been operated for chronic anal fissure.

Results : Twenty-seven patients underwent lateral internal sphincterotomy, two patients underwent posterior sphincterotomy and 428 patients underwent anal stretch plus fissurectomy. Satisfactory results have been reported in 95% of the cases. Transient incontinence rates have been of 3% after anal stretch and of 14,8% after lateral internal sphincterotomy (p < 0,05). Major and persistent incontinence rates have been reported in a case after later internal sphincterotomy (3%) but never after anal stretching (p = 0,059). Recurrence occurred in 2% of the patients after anal stretch and in 3% of the cases after lateral internal sphincterotomy (p = ns).

Conclusion : Lateral internal sphincterotomy and anal stretch have nearly a reported 95% of good results but the first have 3–5% rates of major incontinence.     

微创小针刀内括约肌切断术治疗肛裂358例

为观察采用微创小针刀内括约肌切断术治疗陈旧性肛裂的效果,对358例陈旧性肛裂患者采用眼科虹膜小针刀内括约肌切断术治疗。结果显示,358例患者均一次性治愈,疗程5～8d,无术后并发症及后遗症;随访1年,均无复发。结果表明,小针刀微创术与其他内括约肌切断术相比,具有操作简便、治疗彻底、创伤小、疗程短,无术后并发症及后遗症等优点。     

皮下潜行肛门内括约肌侧方剪切术治疗肛裂40例

为观察皮下潜行肛门内括约肌侧方剪切术治疗肛裂的效果,对80例肛裂病人随机分为试验组与对照组各40例,分别行皮下潜行肛门内括约肌侧方剪切术与经典的括约肌侧切术,试验组与对照组病人在男女构成比、平均年龄及术后并发症发生率上均无统计学意义。试验组创口愈合时间为（5．2±1．0）d,明显短于对照组（12．4±2．9）d（P〈0．001）,术后疼痛评分试验组与对照组分别为（2．35±0．74）分及（3．25±2．85）分（P〈0．001）。两组病人肛裂均治愈,肛门功能均良好。结果表明,皮下潜行肛门内括约肌侧方剪切术能缩短创口愈合时间,减轻术后疼痛。     

混合痔术后肛门水肿原因分析

为分析混合痔术后肛门水肿的原因,总结经验,做好预防,以降低术后肛门水肿发生牢。将207例混合痔术后肛门水肿患者随机分为3组,以术前是否灌肠、术中是否行肛门内括约肌切断、术后是否坐浴进行分别对比。结果显示,术前不灌肠、术中不加行肛门内括约肌切断、术后早期坐浴者肛门易水肿。结果表明,针对混合痔术后肛门水肿的原因,积极有效的预防,可明显减轻肛门水肿、疼痛,促进创面愈合。     

Assessment of Anal Sphincter Function by Sengstaken-Blakemore Tube Anal Manometry

Background Anal manometry is a useful tool for testing the effectiveness of surgical treatment. However, most techniques for anal pressure measurement are not easily available because of high cost. The aim of the present study was to introduce an easy and reproducible method for measuring anal pressures in testing the effectiveness of surgical procedures. Materials and methods We used a Sengstaken-Blakemore tube connected to a mercury manometer. After calibration of the system by inflating the distal (gastric) balloon and filling connection lines to the mercury manometer with 0.9% NaCl solution, resting and squeezing anal pressures were measured. The system was used on 50 human subjects (35 with anal fissure and 15 normal volunteers). Left lateral internal sphincterotomy had been performed in the anal fissure cases. Anal pressures were measured preoperatively and on postoperative days (POD) 2 and 20. Results Preoperative resting anal pressures in the group with anal fissure (83.4 ± 1 mmHg) were significantly higher than those in the group of normal individuals (52 ± 1.2 mmHg; p = 0.001). Resting anal pressures after the sphincterotomy (29 ± 1 mmHg) were found to be significantly lower on POD 2, and resting anal pressure measurements (47 ± 1 mmHg) on POD 20 were lower than the corresponding preoperative values. These values are closer to those of normal volunteers (p = 0.016). Conclusions Anal manometry can be performed with this easily constructible and inexpensive system. This reproducible method can be used in the assessment of the results of surgical treatment in patients with anal and perianal diseases.