Clinical Comparative Study In Two Kinds Of Operations For Anal Fissure

Background and ObjectiveAnal fissure is ischemic ulcer which is formed after anal tube skin is lacerated under dentate line. Its direction is paralleled with the longitudinal axis of anal tube. Anal fissure, fusiform-shaped or oval-shaped and 0.5—1.0 cm long, which usually causes sharp pain of crissum and is one of the commonest crissum diseases that does harm to human health and troubles people's lives in our country and in many other countries. In the past, it's the problem many patients don't want to reveal because it doesn't threaten life and the sick part is hard to be mentioned. Recently, with the improvement of people's living standard and change of the patients'view, the number of anal fissure patients is increasing, so do their therapy requirements.This causes more and more surgeons to participate in the studies and treatments of crissum diseases, and form the independent anal-intestines surgery. Then it achieved further progress in the pathophysiology of different kinds of crissum diseases, the etiological factors of anatomy,and the prophylaxis and treatment of anal fissure, etc..While anal fissure, as a common crissum disease, its basic theory and clinical treatment levels also achieved noticeable improvement.The surgical combined modality therapy of anal fissure takes surgery treatment as the priority supplemented by different expectant treatment. The release operation of anus internal sphincter muscle is the cornerstone of treating anal fissure as well as the only possible radical cure. With chinese and oversea scholars'cooperative efforts, the level of anal fissure treatment has achieved noticeable improvements. Clinical data indicate that ridical cure rate of anal fissure surgery has obvious progress. with the enhancement of the patients'requirements, how to furtherly decrease postoperative pain, shorten the postoperative healing time, reduce postoperative complications to the greatest extent as well as healing the disease have been research hotspot on anus—intestines operation of different clinical institutions. Now, the anal fissure surgery approach commonly accepted by anus—intestines surgeons is different surgical styles based on the chop amputation of anal internal sphincter muscle, including open-loop and close-loop operation. Because different opinions on advantages and disadvantages of different surgeries, comparison between surgical styles and improvement on surgical methods. However, many documents show that the back part of anus is the area easily suffered anal fissure, because it's the ischemic region which stands most potentia and blood transportation is poor. Scholars agree that the amputation site of musculus sphincter should be lateral position. Therefore, based on this point, choosing open-loop or close-loop method more and more becomes the comparative focus of surgical styles. This experiment is going to carry out the clinical study on two groups of patients who are suffering chronicity anal fissure in department of general surgery of our hospital. One group of patients will be treated by the improved slitting-transverse joint internal sphincter muscle chop amputation, while the other group will be treated by lateral position open-loop internal sphincter muscle chop amputation. Then I will observe them in terms of the differences of the following aspects, such as the degree of postoperative resting pain and its duration, the postoperative Urination Disorder, the pain of change of dressing and its duration, the edema of anus fringe, the wound healing time, the postoperative anus pressure, the postoperative complications, postoperative infection, etc. so as to find out the better and easily generalized operation approaches to treat anal fissure to improve the patients'postoperative life.Clinical data and methodsChoose 98 cases in basi-surgery department of the Second Hospital of Jilin University from 10, 2007 to 3, 2009 and divid them into two groups randomly, each group 49 patients. There are no statistic differences between them on sex, age, the morbid degree, complicatin, etc.. All of the choosen cases are diagnosed by postoperative routine examination and its standards are based on Directory of Anal Fissure Clinical Diagnoses (2006). The 98 patients suffering chronicity anal fissure all successfully finished their operation. We mainly focus on whether there are differences on the degree of postoperative resting pain and its duration, the postoperative Urination Disorder, the pain of change of dressing and its duration, the edema of anus fringe, the wound healing time, the postoperative anus pressure, the postoperative complications, postoperative infection, etc.. Then they will be followed up after discharging from hospital between 6-8 months to see whether there are differences on recurrence and the function of defecation control between the two groups of patients.Results: 1. Comparision of postoperative resting pain: we do not provide the two groups of patients prolonged-action anodyne crissum injection with methylthioninium chloride,etc. but give them 100mg Tramadol intramscular injection so as to make the comparision results true and effective, because the differences of the patients'sensitivity to it are different. The results show that treatment group is obviously outweigh the contrast group on the postoperative resting pain.(p<0.01)2. Postoperative Urination Disorder : treatment group is obviously outweigh the contrast group on the postoperative resting pain.(p<0.05)3. Pain of the first-time postoperation dressing change: treatment group is obviously outweigh the contrast group on the postoperative resting pain.(p<0.01)4. Wound healing time: average healing time of treatment is (8.26±0.99), contrast group is (14.75±1.36). There is remarkably statistic difference between them (p<0.01).5. Postoperative infection: there is no statistic differences between the treatment group and the contrast group. (p>0.05)6. 6-8 months following-up hospital discharging: two groups of patients didn't show up recurrence and the functional disorder of defecation controlConclusion:1. As far as anal fissue is concerned, there are many advantages of lateral position open-loop internal sphincter muscle chop amputation on precisely curative effect, high recovery rate,etc.. However, with gradually increasing of the patients'requirements, more and more scholars devote themselves to improve the operation methods so as to achieve the aim of micro-distress, high curative effect. The patients of the treament group are provided by the improved slitting-transverse joint internal sphincter muscle chop amputation to treat anal fissure. It's obviously more superior than the lateral position open-loop internal sphincter muscle chop amputation on lessoning postoperative pain, shortening wound healing time, but there are no clear difference on the rate of radical cure. The contrast group is slightly inferior on infection rate control, while this can be remedied by increasing antibiotics injection and the asepsis degree of dressing change. So the improved operation method is a better anal fissue treating method.2. Comparing with the operation method of contrast group, the improved one is simple. It's easy to learn and spread, which is fit for being handled by the anus and intestines surgeons of the basic-level hospitals.3. We got the ideal consequence on small-sphere treatment. However, it lacks multi-centered and big-sampled clinical experiment studies that's where the treatment falls down.