Comparative analysis of Parikartika and Anal Fissure: unraveling diagnostic, therapeutic, and surgical dimensions

Background:Agnimandya,the underlying cause of anorectal disorders,of which Parikartika is the most well-known,is brought on by lifestyles characterized by sedentary behavior,elevated stress,poor nutrition,and sleep habits.The illness known as Parikartika,with signs and symptoms like fissure-in-ano in modern sources,is characterized by kartanvat Vedana(cutting pain)over the anal region.Acute fissure-in-ano is treated with analgesics,stool softeners,and soothing creams.Treatment options for hazy chronic fissures include anal dilatation,sphincterotomy,fissurectomy,and anal advancement flap.In addition to using laxatives and substances that promote wound healing(vranaropaka),the concepts of management of Parikartika in Ayurveda are more heavily weighted towards enhancing the nature,character,and consistency of stool and stabilizing the digestive functions Parikartika is mentioned in Ayurvedic texts as a complication of many Ayurvedic procedures,such as Vamana,Virechana,and Basti,as well as a complication of some disorders,such as Arsh,Atisar,and Grahani.Aim and objective:This article aims to comprehensively review the literature,diagnostic,and therapeutic aspects of Parikartika,with its correlation to Fissure in ano,and compare the clinical outcomes of the treatment modalities with supporting references,consolidating all pertinent information on the subject.Material&method:Collection from Samhita’s,commentaries,exploring medical websites,Ayurvedic journals related to the topic of Parikartika and fissure in ano,systematic record of the collected literature and a summary of each item.Organize the collected materials,reference and citation are the material and method followed here.Discussion&conclusion:This is an extensive literature review on Parikartika in Ayurveda,exploring its contemporary association with Fissure in Ano.The research offers insights that can inform the evaluation and treatment of this condition,considering both conservative and surgical approaches,thereby enhancing clinical management strategies.

Identifying the best therapy for chronic anal fissure

Chronic anal fissure(CAF)is a painful tear or crack which occurs in the anoderm.The optimal algorithm of therapy for CAF is still debated.Lateral internal sphincterotomy(LIS)is a surgical treatment,considered as the'gold standard'therapy for CAF.It relieves CAF symptoms with a high rate of healing.Chemical sphincterotomy(CS)with nitrates,calcium blockers or botulinum toxin(BTX)is safe,with the rapid relief of pain,mild sideeffects and no risk of surgery or anesthesia,but is a statistically less effective therapy for CAF than LIS.This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy.Aspects of anal fissure etiology,epidemiology and pathophysiology are considered with their meaning for further management of CAF.A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined.Its application may influence the development of optimal therapy for CAF.BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically.Although the effectiveness of BTXvs LIS has been discussed,the essential focus of the article concerns identifying the best therapy application for anal fissure.Elements are presented which may help us to predict CAF healing.They provide rationale for the expansion of the CAF therapy algorithm.Ethical and economic factors are also considered in brief.As long as the patient is willing to accept the potential risk of fecal incontinence,we have grounds for the'gold standard'(LIS)as the first-line treatment for CAF.The author concludes that,when the diagnosis of the anal fissure is established,CS should be considered for both ethical and economic reasons.He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier,more practical stage with improved outcomes for the patient.

Innovations in chronic anal fissure treatment:A systematic review

A chronic anal fissure is a common perianal condition.This review aims to evaluate both existing and new therapies in the treatment of chronic fissures.Pharmacological therapies such as glyceryl trinitrate(GTN),Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option,but with higher recurrence rates.Lateral sphincterotomy remains the gold standard for treatment.Anal dilatation has no role in treatment.New therapies include perineal support devices,Gonyautoxin injection,fissurectomy,fissurotomy,sphincterolysis,and flap procedures.Further research is required comparing these new therapies with existing established therapies.This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy.Perineal support may offer a new dimension in improving healing rates.Lateral sphincterotomy should be offered if pharmacological therapy fails.New therapies are not suitable as first line treatments,though they can be considered if conventional treatment fails.

创面血管内皮生长因子、血管内皮生长因子受体2水平表达与Ⅱ期肛裂患者术后创面愈合时间的关系研究

目的探讨创面血管内皮生长因子(vascular endothelial growth factor,VEGF)、血管内皮生长因子受体(vascular endothelial growth factor receptor,VEGFR)-2表达与Ⅱ期肛裂术后创面愈合时间的关系。方法选取在我院进行手术治疗的Ⅱ期肛裂患者104例为研究对象。术后1周换药时采集创缘肉芽组织检测VEGF、VEGFR-2水平。统计患者术后创面愈合时间,根据患者术后创面愈合时间三分位数分3组,对比3组临床资料及创面VEGF、VEGFR-2水平。分析VEGF、VEGFR-2与术后创面愈合时间的相关性及术后创面愈合时间的影响因素。结果3组创面VEGF及VEGFR-2水平比较,差异有统计学意义(P<0.05);创面VEGF、VEGFR-2水平愈低,其创面愈合时间愈长(P<0.05);VEGF、VEGFR-2与术后创面愈合时间呈负相关(P<0.05);便秘、手术时间、开放切口、创面纵径、创面横径为术后创面愈合时间的独立危险因素,VEGF、VEGFR-2均术后创面愈合时间的独立保护因素(P<0.05)。结论创面VEGF、VEGFR-2水平与Ⅱ期肛裂术后创面愈合时间呈负相关,可通过检测两指标水平判断患者创面愈合情况,为术后治疗方案的完善提供指导。

Quality of compounded topical 2% diltiazem hydrochloride formulations for anal fissure

AIM:To investigate the quality of topical 2%diltiazem formulations extemporaneously compounded by retail pharmacies openly offering drug-compounding services.METHODS:A participating healthcare professional wrote 12 prescriptions for compounded 2%diltiazem cream,with 2 refills allowed per prescription.The 12sets of prescriptions were filled,at intervals of 1-2 wk between refills,at 12 different independent retail pharmacies that openly offer drug-compounding services in a major metropolitan region.The 36 resultant preparations,provided as jars or tubes,were shipped,as soon as each was filled,at ambient temperature to the study core laboratory for high-performance liquid chromatography(HPLC)analysis,within 10 d of receipt.For the HPLC analysis,8 different samples of the topical diltiazem,each approximately 1 g in weight,were taken from prespecified locations within each container.To initiate the HPLC analysis,each sample was transferredto a 100 mL volumetric flask,to which methanol was added.The HPLC analysis was conducted in accordance with the laboratory-validated method for diltiazem in cream,ointment,and gel formulations.The main outcome measures were potency(percentage of label claim)and content uniformity of the compounded topical 2%diltiazem formulations.RESULTS:Of the 36 prescriptions filled,30 were packaged in jars and 6 were packaged as tubes.The prescriptions were specifically for cream formulations,but6 of the 12 pharmacies compounded 2%diltiazem as an ointment;for another pharmacy,which had inadequate labeling,the dosage form was unknown.The United States Pharmacopoeia(USP)standard for potency is 90%-115%of label claim.Of the 36 preparations,5(13.89%)were suprapotent and 13(36.11%)were subpotent.The suprapotent prescriptions ranged in potency from 117.2%to 128.5%of label claim,and the subpotent prescriptions ranged in potency from34.8%to 89.8%of label claim.Fourteen(38.9%)preparations lacked content uniformity according to the USP standard of 90%-110%potency and<6%relative standard deviation.Of the 30 formulations packaged in jars,12(40%)lacked content uniformity,while of the6 formulations packaged in tubes,2(33.3%)lacked content uniformity.Nine of the 12 pharmacies(75%)failed USP potency or content-uniformity specifications for at least 1 of the 3 prescription fills.For 5 of the 12pharmacies(41.7%),the mean potency across all three prescription fills was<90%of label claim.CONCLUSION:Patients prescribed topical 2%diltiazem for treatment of anal fissure frequently receive compounded formulations that are misbranded with respect to potency and that lack content uniformity.

Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study

BACKGROUND Lateral internal sphincterotomy is still the approach of choice for the treatment of chronic anal fissure(CAF)with internal anal sphincter(IAS)hypertonia,but it is burdened by high-risk postoperative faecal incontinence(FI).Sphincter saving procedures have recently been reconsidered as treatments to overcome this risk.The most employed procedure is fissurectomy with anoplasty,eventually associated with pharmacological sphincterotomy.AIM To evaluate whether fissurectomy and anoplasty with botulinum toxin injection improves the results of fissurectomy and anoplasty alone.METHODS We conducted a case-control study involving 30 male patients affected by CAF with hypertonic IAS who underwent fissurectomy and anoplasty with V-Y cutaneous flap advancement.The patients were divided into two groups:Those in group I underwent surgery alone,and those in group II underwent surgery and a botulinum toxin injection directly into the IAS.They were followed up for at least 2 years.The goals were to achieve complete healing of the patient and to assess the FI and recurrence rate along with manometry parameters.RESULTS The intensity and duration of post-defecatory pain decreased significantly in both groups of patients starting with the first defecation,and this reduction was higher in group II.Forty days after surgery,we achieved complete wound healing in all the patients in group II but only in 80%of the patients in group I(P<0.032).We recorded 2 cases of recurrence,one in each group,and both healed with conservative therapy.We recorded one temporary and low-grade postoperative case of“de novo”FI.Manometry parameters reverted to the normal range earlier for group II patients.CONCLUSION The injection of botulinum toxin A in association with fissurectomy and anoplasty with a V-Y advancement flap improves the results of surgery alone in patients affected by CAF with IAS hypertonia.

Quality of life in patients with chronic anal fissure after topical treatment with diltiazem

AIM: To assess the physical and mental health of fissure patients before and after topical treatment with diltiazem. METHODS: Consecutive patients were enrolled prospectively into the study. Quality of life was measured with the short-forum 36 health survey (SF-36) before and after 6-wk treatment with diltiazem. Patients scored symptoms of pain, bleeding, and irritation using numeral rating scales at the initial and follow-up visits. Fissure healing was assessed and side effects were noted. RESULTS: Fissures healed in 21 of 30 (70%) patients. There were significant reductions in the scores of pain, bleeding, and irritation after 1 wk of treatment, respectively. Four patients experienced perianal itching and one patient reported headache. When measured at baseline, pain and irritation showed a negative impact on two of the eight subscales on the SF-36, respectively (bodily pain and social functioning for pain; vitality and mental health for irritation). Repeating the SF-36 showed an improvement in bodily pain (P = 0.001). Patients whose fissures healed reported an improvement in bodily pain, health-perception, vitality, and mental health (P < 0.05). CONCLUSION: Successful treatment of chronic anal fissure with topical diltiazem leads to improvement in health-related quality of life.

Hypertrophied anal papillae and fibrous anal polyps,should they be removed during anal fissure surgery?

AIM:Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. They are mostly ignored being considered as normal structures.The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus. METHODS:Two groups of patients were studied.A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm.Another group of a hundred patients who also had papillae or fibrous polyps,were treated by lateral sphincterotomy alone.They were followed up for one year. RESULTS:Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated.Group A patients showed a marked reduction with regard to pain and irritation during defecation (P=0.0011), pricking or foreign body sensation in the anus (P=0.0006) and pruritus or wetness around the anal verge (P=0.0008). CONCLUSION:Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure.This would add to effectiveness and completeness of the procedure.

Aggressive treatment of acute anal fissure with 0.5% nifedipine ointment prevents its evolution to chronicity

AIM： To investigate the efficacy of topical application of 0.5% nifedipine ointment in healing acute anal tissue and preventing its progress to chronicity. METHODS： Thirty-one patients （10 males, 21 females） with acute anal fissure from September 1999 to January 2005 were treated topically with 0.5% nifedipine ointment （t.i.d.） for 8 wk. The patients were encouraged to follow a high-fiber diet and assessed at 2, 4 and 8 wk post-treatment. The healing of fissure and any side effects were recorded. The patients were subsequently followed up in the outpatient clinic for one year and contacted by phone every three months thereafter, while they were encouraged to come back if symptoms recurred. RESULTS： Twenty-seven of the 31 patients completed the 8-wk treatment course, of them 23 （85.2%） achieved a complete remission indicated by resolution of symptoms and healing of fissure. Of the remaining four unhealed patients （14.8%）, 2 opted to undergo lateral sphincterotomy and the other 2 to continue therapy for four additional weeks, resulting in healing of fissure. All the 25 patients with complete remission had a mean follow-up of 22.9 ± 14 （range 6-52） too. Recurrence of symptoms occurred in four of these 25 patients （16%） who were successfully treated with an additional 4-wk course of 0.5% nifedipine ointment. Two of the 27 （7.4%） patients who completed the 8-wk treatment presented with moderate headache as a side effect of nifedipine. CONCLUSION： Topical 0.5% nifedipine ointment, used as an agent in chemical sphincterotomy, appears to offer a significant healing rate for acute anal fissure and might prevent its evolution to chronicity.

Anal Pathologies: What Management at the Reference Health Center of Bamako’s Commune V?

Anal pathologies are conditions affecting the anal margin and the anal canal. The aim of our study was to update data on anal diseases. Non-specific, it can reveal an emergency, a serious illness, a chronic disease or a benign condition. It was a prospective, descriptive and analytical study from April 2022 to March 2023, carried out in the hepato-gastroenterology unit of the Centre de Santé de Référence de la commune V du District de Bamako in Mali. Out of seven hundred and forty-nine (749) patients seen in consultation, 98 had anal pathology, i.e. a prevalence of 13.08%. The mean age was 40 ± 15.15 years and the sex ratio was 1.5. Hemorrhoidal disease and anal fissure were the most frequent pathologies in 66.4% and 24.4% of cases respectively. Medical treatment was initiated in 91.9% of patients with hemorrhoidal disease and 91.7% with anal fissure. Anal pathologies are common in young male patients. In our context, they are dominated by benign conditions.

Anal pruritus:Don’t look away

Anal pruritus is a common anorectal symptom that can significantly impair a patient’s quality of life,including their mental health.It can be one of the most difficult proctological conditions to treat.Patients often delay seeking medical attention,since it is an embarrassing but non-life-threatening situation.Pruritus ani can be associated with idiopathic and secondary causes,such as anorectal diseases,cancer(anal or colorectal),dermatological and sexually transmitted diseases,fungal infections and systemic diseases.If patients are referred for a colonoscopy,this can sometimes provide the first opportunity to evaluate the perianal area.Classifications of anal pruritus are based on the abnormalities of the perianal skin,one of the most commonly used being the Washington classi-fication.A proper digital anorectal examination is important,as well as an anoscopy to help to exclude anorectal diseases or suspicious masses.Endoscopists should be aware of the common etiologies,and classification of the perianal area abnormalities should be provided in the colonoscopy report.Information on treatment possibilities and follow-up can also be provided.The treatment normally consists of a triple approach:proper hygiene,elimination of irritants,and skin care and protection.Several topical therapies have been described as possible treatments,including steroids,capsaicin,tacrolimus and methylene blue intradermal injections.

CLINICAL OBSERVATION ON TREATMENT OF ANAL FISSURE BY APPLYING SPHINCTEROTOMY WITH ACUPOTOM

Objective: To observe the therapeutic effect and features of acupotomy in the treatment of anal fissure. Methods: Seventy-six cases with anal fissure were randomly divided into two groups, namely, acupotomy group in which 37 patients were treated by anal internal sphincterotomy with acupotomy, and conventional anal sphincterotomy group (conventional group, n=39) that was treated by conventional amputation of the anal sphincter. Results: After treatment, twenty-six over 37 cases in acupotomy group recovered completely and the other 9 cases were improved clinically, with the total effective rate being 94.59%. In conventional group, 27 over 39 cases recovered completely and the other 11 cases were improved clinically. The total effective rate was 97.44%. There was no significant difference in the curative rate between two groups. However, compared with those of conventional group, patients in acupotomy group had significantly less bleeding, earlier healing of fissure and less pain. Conclusion: The results suggest that acupotomy treatment of anal fissure with anal sphincterotomy is a better therapeutic technique with advantages of easier manipulation, earlier healing and milder wound, less infectious complications and pain.

肛裂洗剂治疗Ⅰ、Ⅱ期肛裂的临床疗效观察

目的探讨肛裂洗剂对Ⅰ、Ⅱ期肛裂患者的临床疗效及对肛管静息压(ASRP)的影响。方法选取2020年12月至2021年12月就诊于银川市中医医院肛肠科门诊且符合标准的120例Ⅰ、Ⅱ期肛裂患者,按随机数表法分为治疗组和对照组,每组60例。对照组用复方荆芥熏洗剂治疗,治疗组用肛裂洗剂治疗,比较两组患者在治疗前及治疗第7、14天疼痛、便血、便后疼痛缓解时间、裂口面愈合情况、症状总积分及治疗前后肛管静息压(ASRP)等指标,并观察治疗3个月后两组患者的复发次数。结果治疗组总有效率为86.7%,对照组总有效率为66.7%,治疗组高于对照组(P<0.05);患者的主要症状评分及症状总积分的时间主效应差异均有统计学意义(P均<0.05);便血、裂口愈合情况和症状总积分的组别主效应和交互效应差异均有统计学意义(P均<0.05);两组的疼痛评分及便后疼痛缓解时间评分的组别主效应和交互效应,差异均无统计学意义(P均>0.05);与对照组相比,治疗组的ASRP降低,复发次数更少(P均<0.05)。结论肛裂洗剂治疗Ⅰ、Ⅱ期肛裂的疗效明显,复发次数少,是一种可行的保守治疗方法。

锡类散熏洗剂对Ⅰ、Ⅱ期肛裂术后局部水肿、创面修复的影响及其机制研究

目的:观察锡类散熏洗剂对Ⅰ、Ⅱ期肛裂术后局部水肿、创面修复及临床疗效,并探讨其作用机制。方法:选取104例Ⅰ、Ⅱ期肛裂术后患者随机分为2组各52例,对照组予Ⅰ、Ⅱ期肛裂术后常规治疗,观察组在对照组治疗方案的基础上给予锡类散熏洗剂治疗,均连续治疗14 d。观察并比较治疗前后2组临床疗效、临床症状积分、局部水肿消退时间、创面修复时间、疼痛视觉模拟评分法(VAS)评分、免疫指标[CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)]、炎症指标[C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)、干扰素-γ(IFN-γ)],并如实记录不良反应发生情况。结果:临床疗效总有效率观察组98.08%,对照组84.62%,2组总有效率比较,差异有统计学意义(P<0.05)。治疗后,2组临床症状积分、疼痛VAS评分均下降,且观察组临床症状积分、疼痛VAS评分均低于对照组,差异均有统计学意义(P<0.05)。观察组局部水肿消退时间、创面修复时间低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组免疫指标均升高,且观察组高于对照组,差异均有统计学意义(P<0.05);治疗后,2组炎症指标均降低,且观察组低于对照组,差异均有统计学意义(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:锡类散熏洗剂可有效改善Ⅰ、Ⅱ期肛裂术后患者局部水肿情况,促进术后创面修复,缓解相关症状及局部疼痛,具有较好的安全性,其可能通过局部抗炎性作用、提升机体免疫等多环节发挥疗效。

地奥司明片对改良肛裂切除术后患者的影响

目的:探讨地奥司明片对改良肛裂切除术后患者的影响。方法:选取2019年1—11月于北京市肛肠医院肛肠科治疗的改良肛裂切除术后患者84例为研究对象,随机分为对照组和观察组,各42例。对照组采用头孢西丁钠、消毒创面等常规治疗,在此基础上,观察组采用地奥司明片治疗。比较两组临床疗效、疼痛及水肿评分、创面愈合指标、炎性因子水平。结果:观察组总有效率高于对照组,差异有统计学意义(P=0.007);观察组视觉模拟评分法、创面水肿评分低于对照组,差异有统计学意义(P<0.001);观察组术后便血次数少于对照组,肉芽组织生长时间、创面愈合时间短于对照组,差异有统计学意义(P<0.001);术后3d,两组白细胞介素-6、肿瘤坏死因子-α、γ干扰素水平低于术前,观察组低于对照组,差异有统计学意义(P<0.05)。结论:地奥司明片可减轻改良肛裂切除术后患者疼痛、水肿症状,促进创面愈合,减轻炎性反应,临床疗效显著。

喙状刀治疗Ⅱ期肛裂临床研究

目的:观察自制喙状刀治疗Ⅱ期肛裂的临床疗效。方法:将100例Ⅱ期肛裂患者随机分为治疗组(喙状刀内括约肌侧切组)和对照组(普通内括约肌侧切组)治疗,每组50例,对比观察两组疗效、术后疼痛、平均住院时间等指标。结果:两组总有效率均为100%,治疗组术后疼痛平均(2.76±1.11)分,对照组术后疼痛平均(5.75±1.57)分;治疗组创口平均愈合时间(8.67±2.82)天,对照组创口平均愈合时间(16.26±3.68)天。两组疗效无明显差异,但术后疼痛、平均住院时间比较差异有显著统计学意义(P<0.01),且治疗组优于对照组。结论:喙状刀治疗Ⅱ期肛裂临床疗效肯定,且可减轻术后疼痛,缩短住院时间。

括约肌切开术联合中药熏洗治疗Ⅱ、Ⅲ期肛裂疗效及对患者疼痛和创面愈合的影响

目的:探讨括约肌切开术联合中药熏洗治疗Ⅱ、Ⅲ期肛裂的临床疗效及对疼痛和创面愈合情况的影响。方法:选择肛裂患者92例,采用随机数字表法分为对照组和观察组各46例。对照组采用括约肌切开术治疗,观察组采用括约肌切开术联合中药熏洗治疗。比较两组治疗后创面愈合时间、愈合瘢痕面积情况,记录并比较两组术后渗液、水肿、出血及疼痛积分变化情况,并对术后1周的临床疗效情况进行观察。结果:观察组治疗后创面愈合时间早于对照组,愈合后瘢痕面积少于对照组(P<0.05);治疗后,观察组术后24、48、76 h的VAS评分积分、渗液积分、水肿积分、出血积分均明显比对照组低(P均<0.05)。观察组总有效率100.00%(46/46)明显高于对照组84.78%(39/46),感染率6.52%(3/46)明显低于对照组21.74%(10/46)(P<0.05)。结论:括约肌切开术联合中药熏洗可明显减轻Ⅱ、Ⅲ期肛裂术后疼痛程度,促进创面愈合,降低术后感染率,临床疗效较好。

颊针治疗肛裂术后疼痛疗效观察

目的:研究颊针疗法对于缓解肛裂术后患者疼痛的临床疗效。方法:选取2022年3月至2022年9月期间在本院并行肛裂手术治疗的患者70例,随机分为对照组35例和观察组35例。对照组予以双氯芬酸钾分散片口服镇痛,观察组予以颊针针刺镇痛,对比两组患者治疗前后的疼痛程度、生活质量评分、疼痛的发作频次以及术后尿潴留和便秘发生率,以观察临床疗效。结果:治疗后观察组术后疼痛VAS评分、生活质量评分、疼痛的发作频次均显著低于治疗前(P<0.05),且优于对照组(P<0.05);观察组术后尿潴留和便秘发生率显著低于对照组(P<0.05)。结论:颊针治疗对于缓解肛裂术后患者疼痛、降低疼痛的发作频次具有显著效果,并可以改善患者的生活质量、降低术后尿潴留和便秘的发生率,值得临床应用推广。

肛门内括约肌单侧部分切断术联合中药熏洗治疗肛裂的效果研究

目的探讨肛门内括约肌单侧部分切断术联合加味苦参汤中药熏洗治疗肛裂的临床效果。方法87例肛裂患者,根据治疗方式不同分为对照组(43例)和观察组(44例)。对照组单纯采用肛门内括约肌单侧部分切断术治疗,观察组采用肛门内括约肌部分切断术联合加味苦参汤中药熏洗治疗。比较两组患者的治疗效果、创面愈合情况(创面缩小率、细菌清除率、肉芽组织覆盖率以及肉芽组织生长厚度)、并发症发生情况。结果观察组患者总有效率93.18%高于对照组的76.74%,有统计学意义(P<0.05)。观察组患者创面缩小率(82.24±9.26)%、细菌清除率(85.12±9.12)%、肉芽组织覆盖率(73.12±6.45)%以及肉芽组织生长厚度(5.37±1.25)mm均高于对照组的(64.34±6.98)%、(77.95±8.44)%、(51.76±5.52)%、(3.23±0.95)mm,有统计学意义(P<0.05)。观察组患者并发症发生率4.55%低于对照组的18.60%,有统计学意义(P<0.05)。结论相比于单纯手术治疗,采用肛门内括约肌单侧部分切断术结合加味苦参汤中药熏洗治疗肛裂患者在临床效果、创面愈合情况及并发症发生率方面均有显著优势,这也提示了加味苦参汤术后熏洗肛裂具有优势,是一种值得临床推广的治疗方案。

五倍子散联合硝酸甘油软膏外用治疗Ⅰ、Ⅱ期肛裂效果及对肛门括约肌功能的影响评价

目的:观察Ⅰ、Ⅱ期肛裂患者采取五倍子散联合硝酸甘油软膏外用的治疗成效。方法:选取2016年12月-2017年12月我院收治的50例Ⅰ、Ⅱ期肛裂患者为探究对象,将这些患者按照不同治疗方式,分为观察组与对照组,各组25例。对照组采取硝酸甘油软膏外用治疗,而观察组采取五倍子散联合硝酸甘油软膏外用治疗方式,探究对比两组患者的治疗成效。结果:观察组患者的治疗总成效为96.00%,明显高于对照组的76.00%,差异具有统计学意义(P <0.05)。另外,观察组患者的肛管静息压明显低于对照组,差异有统计学意义(P <0.05);两组的肛管最大收缩压、肛管最大收缩时间等指标无明显差异,无统计学意义(P> 0.05)。结论:对Ⅰ、Ⅱ期肛裂患者采取五倍子散联合硝酸甘油软膏外用治疗方式,可有效改善患者病情,治疗成效十分明显,具有一定安全有效性,且对肛门括约肌功能没有影响,值得进一步推广采纳。