内括约肌侧方位与后正方位切断术治疗慢性肛裂的效果观察

Clinical curative effects of internal sphincterotomy in the posterior midline and lateral position in treatment of patients with chronic anal fissure

目的探讨内括约肌侧方位与后正方位切断术治疗慢性肛裂的效果。方法将2009年12月至2012年10．月在我院住院的150例Ⅱ、Ⅲ期慢性肛裂患者随机分为观察组（80例）与对照组（70例），分别采用内括约肌侧方位与后正方位切断术，比较两组患者的疗效、愈合时间、并发症及复发情况。结果观察组患者痊愈76例，好转6例，无效2例。对照组患者痊愈49例，好转12例，无效9例。两组疗效比较差异有统计学意义（P=0．025）。观察组和对照组伤口愈合时间分别为（9．9±0．8）、（17．1±0．9）d，两组比较差异有统计学意义（P=0．048）。观察组患者肛门渗液发生率2．5％（2／80）低于对照组24．3％（17／70）（P=0．032）。观察组患者复发发生率5．0％（4／80）低于对照组24．3％（17／70）（P=0．046）。观察组患者术后疼痛、排尿障碍、伤口水肿程度均低于对照组，两组比较差异均有统计学意义（P值分别为0．025、0．025、0．049）。结论侧方位内括约肌切断术治疗慢性肛裂患者痛苦小，修复快，并发症少，临床疗效较好，值得临床推广。

Objective To investigate the curative effects of partial internal sphincterotomy in the posterior midline and lateral position in treatment of chronic anal fissure. Methods One hundred and fifty cases chronic anal fissure patients with stage Ⅱ or Ⅲ were randomly divided into observation group （ 80 cases ） and control group（70 cases）, who were hospitalized in the Shunyi District Hospital of Beijing from Dec. 2009 to Oct. 2012. The patients of two group were treatment by internal sphincterotomy either in the posterior midline or lateral position respectively. The efficacy, healing time, complications and recurrence of the two groups were recorded and compared. Results There were 76 cases with cure, 6 cases with improvement and 2 with ineffective effect in the observer group. There were 49 cases with cure, 12 cased with improvement and 9 cases with ineffective effect in control group. The difference of the efficacy was statistically significant （ P = 0. 025 ）. Wound healing time of observation group and control group were （9. 9 ~0. 8） d and （ 17.1 ~0. 9） d,and the difference was significant （ P = 0. 048 ）. The incidence of anal exudates in observer group was lower than the control group（2. 5% （2/80） vs. 24. 3% （17/70） ;P = 0. 032）. The incidence of recurrence in observer group was 5.0% （4/80） , lower than the Control group （24. 3 % （ 17/70 ） , P = 0. 046 ）. The degree of the postoperative pain,voiding dysfunction and wound edema in observer group were lower than the other group （P = 0. 025, 0. 025,0. 049）. Conclusion The effect of internal sphincterotomy in the lateral position in treatment of chronic anal fissure is better with quickly repair,fewer complications.