| PurposeRecent research has shown that anal fissures are caused by IAS spasm, which affect the blood supply and induced ischaemic ulcer. Because it is hard to change the hypertonia caused by the IAS spasm, the small tear of the anal skin could not heal, the fissure then developed into chronic. For the treatment of the anal fissure, the internal sphincterotomy and chemical sphincterotomy are the two main therapies of the disease. The former usually done in an operation, and because of the damage done to the muscle which may be more harmful and may lead to fecal incontinence, especially as the age grows, when the rest anus pressure comes down, the problem may became much more obvious. To avoid this problem, clinical doctors modified the operation of LIS(lateral internal sphincterotomy),"Tailored internal sphincterotomy only to make a short length of the incision on the internal sphincter which is as long as the tear of the anus skin. It is not only avoid the damage to the muscle as much as possible in thearies, but also creat a satisfactied result .Though chemical internal sphincterotomy especially using glyceryl trinitrate (GTN) and botulinum toxin(BT) have good results in anal fissure treatment,their shortcomes are obvious.The most common side effect of GTN is headache,and its treatment cause needs 6 to 8 weeks.BT is expensive and need injection.According to the condition of our contry,operation is still a direct and effect way to treat chronic anal fissure.In order to discover a new therapy to the chronic anal fissure, we have a purpose that our clinical study of modified tailored internal sphincterotomy on the treatment of chronic anal fissure, especially to study the anal function after operation.MethodsThe study is mainly a clinical study. Thirty chronical anal fissure patients who have accepted to be treated with operation and fit for the trial condition are divided into trial group and control group follow the order of operation, each of the group has 10 patients. The trial group use subcutaneous internal sphincterotomy and lateral internal sphincterotomy, and the control group use the modified tailored internal sphincterotomy. Compare the result of①the pain feeling before and a week after operation;②the persistent pain feeling after ;③healing time;④the short time healing of fissures;⑤infection rate of the wounds;⑥the recurrence after the operation for 3months⑦the change of anorectal function after operation.ResultsCompared with the three different procedures of internal sphincterotomy, we can satisfied with the short time effect according to the result of the experiment, all 30 patients have cured in 4 weeks after operation. As the statistic results showed: there is no significant differences between the three different way of treatment in the curing of pain, persistent pain feeling after bowel and the healing time of the fissures. Though the clinical result is a little better than the other, there is no evidence to confirm that tailored internal sphincterotomy has a much better effect for the bowel function, it still need a large symptom clinical study to prove the result. The infection rate in lateral internal sphincterotomy is a little higher than the other groups, but it got a low recurrence rate. Modified tailored internal sphincterotomy had a better wound healing due to its good drainage, but as only a partial internal sphincter been dissected, it contains a little recurrence rate. And this is also need to be proved by a further study.ConclusionModified tailored internal spincterotomy could make the blood flow of the internal sphincter much better effectively, and it has a lower infection rate after operation, healing fast. It could have the most minors affect on the soiling control especially in a short time after operation. And it can also reduce incontinence obviously. |
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