Clinical Research of Treatment for Stage Ⅱ and Ⅲ Anal Fissure with Botulinum Toxin Type A Injection Around Internal Anal Sphincter and Sector Resection Combined with Epluchage and Drainage by A Small Incision_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HE Yongheng ¹ , YU Rong ² , XIAO Zhiguo. ²

1. Department of Anorectum，The Second Affiliated Hospital，Hunan University of Traditional Chinese Medicine，Changsha 410005，Hunan Province，China;;
2. Hunan University of Traditional Chinese Medicine，Changsha 410005，Hunan Province，China;

Corresponding author：

Keywords：

Botulinum toxin type A; Injection around internal anal sphincter; Small sector incision; Anal fissure

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Objective 　To evaluate the safety and efficacy of botulinum toxin type A injection around internal anal sphincter and sector resection combined with epluchage and drainage by a small incision in treatment for stage Ⅱ and Ⅲ anal fissure，explore its surgical procedures and key points，and introduce a new surgical treatment for anal fissure.
Methods 　The patients according to the inclusive criteria were divided into trial group and control group in randomized，parallel，controlled clinical trial method．The botulinum toxin type A injection around internal anal sphincter and sector resection combined with epluchage and drainage by a small incision was performed in the trial group, the anal fissure resection and part internal anal sphinctor latero-resection was perfermed in the control group. The safety index （including anal stenosis，incontinence，acute urinary retention，postoperative pain，and rectal anal tube pressure） and validity indicators （including cure rate，operation time，wound healing，wound healing grade，and scar size） were compared before and after operation between two groups．
Results 　No anal stenosis and acute urinary retention occurred in the two groups. The anal incontinence score was not significantly different between two groups （P＞0.05）．The postoperative pain score in the trial group was significantly lower than that in the control group （24 h，the first defecation，and on week one after operation，all P＜0.01）．The difference of rectal anal canal pressure was not statistically significant between two groups （P＞0.05）．The cure rate was higher （P＜0.05），operation time and wound healing time were shorter （P＜0.01），wound healing was better （P＜0.05），scar area was smaller （P＜0.01） in the trial group as compared with the control group．
Conclusions 　Comparing with the control group，high cure rate，short wound healing time，small size of scar，short operation time and minimal invasion are seen in the trial group．The shape and function of the anus are better reserved than that of the control group，this technique has a good clinical efficacy and safety．

Citation： HE Yongheng,YU Rong,XIAO Zhiguo.. Clinical Research of Treatment for Stage Ⅱ and Ⅲ Anal Fissure with Botulinum Toxin Type A Injection Around Internal Anal Sphincter and Sector Resection Combined with Epluchage and Drainage by A Small Incision. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(5): 522-525. doi: Copy

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2. 杨仲璠, 王荫春. A 型肉毒毒素在国内外的临床应用 [J]. 微生物学免疫学进展, 1996, 24(3)：49-51．.
3. Marvin L Corman 主编, 吕厚山主译. 结肠与直肠外科学 [M]. 第4 版, 北京：人民卫生出版社, 2002：188．.
4. 邵万金. 肛裂的治疗进展 [J]. 中国肛肠病杂志, 2004, 24(9)：31- 止页．.
5. 中华中医药学会肛肠分会. 痔、肛瘘、肛裂、直肠脱垂的诊断标准 [J]. 中国肛肠病杂志, 2004, 24(4)：42-43．.
6. 何永恒．实用肛肠外科手册 [M]. 长沙：湖南科学技术出版社, 2004，311-316．.
7. 何永恒. 实用肛肠外科手册 [M]. 长沙：湖南科学技术出版社, 2004：324-326．.
8. ZY/T 001. 1-001. 9-1994, 中医病证诊断疗效标准 [S]. 出版者,年，页.
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10. 徐忠法, 左文述. 现代肛肠诊疗外科学 [M]. 济南：山东科技出版社, 1993：259．.
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13. 丁义江. 丁氏肛肠病学 [M]. 北京：人民卫生出版社, 2006：101-103．.
14. 吴在德, 吴肇汉. 外科学 [M]. 北京：人民卫生出版社, 2004：143．.
15. 李春雨. 实用肛门手术学 [M]．沈阳：辽宁科技出版社,2005：204-206．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Research of Treatment for Stage Ⅱ and Ⅲ Anal Fissure with Botulinum Toxin Type A Injection Around Internal Anal Sphincter and Sector Resection Combined with Epluchage and Drainage by A Small Incision

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