The Therapeutic Effect Of The Anal Sphincterotomy Operation And The Pathological Changes Of The Sphincter

Purpose:1.To evaluate the therapeutic effect of the anal sphincterotomy operation in patients with the second and third phases of anal fissure.Analyze the characteristics and advantages of the operation.2.Study the pathological changes and the degree of fibrosis at the internal anal sphincter for the theoretical foundation and technical assistance to promote and improve the anal sphincterotomy operation.Methods:118 cases of patients with the second and third phases of anal fissure are random screeninged to be treated with the anal sphincterotomy operation.Observe the clinical course,the disease location,the defecation of patients.And record the hospital stays,the wound healing time,the postoperative Wexner Score,the postoperative recrudescence and the postoperative anal malformation.Explore the influence factors of delayed union,anal incontinence,the ecurrence,and the treatment results.12 cases of patients with the second phase of anal fissure and 22 cases of patients with the third phase of anal fissure treated by the anal sphincterotomy operation are divided into study group A and group B.5 Cases of patients treated by Miles’operation are divided into control group.a.Observe the histological properties (smooth muscle or striated muscle) and pathologic changes (Small blood vessels with expansion and extravasate, inflammatory cells infiltration,hyperplasia of fibre, degeneration) at HE staining organization besides the groove separating the internal and external anal sphincters.b.Comput the ratio of collagen fibers and muscle fibers contents from study groups and the control group of smooth muscle with Masson staining.Compare the ratios of fibrosis roup A and group B and the control group.Results:1.The effective rate of the anal sphincterotomy operation is 100%, the curative ratio is 98.31%.The recurrence rate (1-3 years) is 5.08%, the recurrence rate (3 months,6 months) is O.Patients’ hospital stays is 7.70±1.79 days, the average healing time is 1.76±1.54 months.8 cases are anal function injury,7 cases resume the function.No anal deformity.a.The organization of 1 case with subcutaneous besides the groove separating the internal and external anal sphincters is of inflammatory cells. The rest organization besides the groove separating the internal and external anal sphincters are smooth muscle and striated muscle.Small blood vessels with expansion and extravasate,inflammatory cells infiltration,hyperplasia of fibre, degeneration.b.The ratio of collagen fibers and muscle fibers contents from group A and group B and the control group is 0.25±0.03,0.34±0.14,0.52±0.36.There is no obvious difference (P> 0.05) between the three groups.Conclusion:1.The anal sphincterotomy operation with a high effective rate,a low recurrence rate and complication rate is reliable and worth promoting. But the cacation is the factor of recurrence and delayed union.2.The pathological changes conform to the theory of internal sphincter spasm and provide theory support for the anal sphincterotomy operation.