肛裂治疗方式的选择

Choice of treatments for anal fissure

慢性肛裂是一种常见的肛门直肠疾病,可以引起令人不快的疼痛.对于肛裂的治疗,人们经过长期的研究,建立了许多治疗肛裂的方法.随着对肛裂病理生理的研究不断深入,手术治疗在逐渐减少,而更倾向于应用药物保守治疗.内括约肌侧切术(lateral internal sphincterotomy,LIS)被认为是治疗肛裂的"金标准",但是术后可能导致肛门失禁;化学性内括约肌切开(chemical sphincterotomy,CS)可以较快的缓解疼痛,没有手术和麻醉的危险,但是有效率不及LIS.近年来肛裂切除术联合术后CS作为一种新的治疗方式正在逐渐被人们所接受,若药物治疗失败后,其可以作为LIS的一种代替治疗方法.

Chronic anal fissure（CAF） is one of the most common and painful proctologic diseases.Its treatment has long been discussed and several different therapeutic options have been proposed.The understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment.Lateral internal sphincterotomy（LIS） is a surgical treatment that is considered the ‘gold standard’ therapy for CAF.It relieves CAF symptoms with a high rate of healing.The risk of incontinence after this procedure seems to be severe.Chemical sphincterotomy（CS） is safe,with the rapid relief of pain,no risk of surgery or anesthesia,but is a statistically less effective therapy for CAF than LIS.In recent years,fissurectomy coupled with CS has been demonstrated to be a satisfactory treatment for chronic anal fissure and an alternative to lateral sphincterotomy when conservative measures fail.