局部注射结合肛窦切开引流术治疗陈旧性肛裂临床观察

Local Injection Combined with Incision ＆ Drainage of Anus Sinus in the Treatment of Chronic Fissure

为克服内括约肌切断术治疗慢性肛裂后发生不同程度肛门失禁、疗程较长和术后并发症多等缺点，采用0．1％亚甲蓝局部注射结合肛窦切开引流术治疗陈旧性肛裂60例，并与闭式侧方部分内括约肌切断术60例比较。观察肛窦内口两切缘、肛窦切开引流、哨兵痔切除以及术后疼痛、出血、尿潴留等并发症、手术后遗症、切口愈合、手术前后肛管静息压、肛门形态和功能等情况。结果显示，两组疗效相近，但术后并发症、后遗症发生率治疗组低于对照组。结果表明，手术治疗陈旧性肛裂不必切断肛门括约肌，以亚甲蓝注射加肛窦切开引流对陈旧性肛裂的疗效显著。该术式提高了疗效，明显地降低了术后并发症、后遗症的发生率，缩短了治疗时间，有效地保护了肛门功能形态的完整性。

For the objective of overcoming the shortcoming of anal incontinence in various degree, long course of treatment and many postoperative complications after cutting off internal sphincter. The therapy of 1% methylene blue for local injection combined with incision ＆ drainage of anus sinus was adopted in the treatment of 60 patients with chronic fissure（as treatment group）,which was compared with 60 patients subjected to closed lateral incision of internal sphincter（controlled group） in such aspects as both edges of inner-opening of anus sinus, incision ＆ drainage of anus sinus, resection of sentinal hemorrhoids, complications such as postoperative pain, bleeding, urine retention, so on, postoperative sequel, wound healing,pre-and post-operative anal rest pressure,and form and function of anus. Results showed that the curative effects of both groups were similar, but in the incidences of postoperative complications and sequel the treatment group was superior to the controlled group. These outcome indicate that in the operation for chronic fissure amputation of internal sphincter is not necessary, while the therapy of local injection of methylene blue combined wiht incision ＆ drainage of anus sinus could obtain significant therapeutic effects,which this procedure can enhance efficacy, reduce the inciences of postoperative complications and sequle, shorten treatment course,and protect the function and form integrity.