Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials
Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials
复制标题
肉毒毒素注射与外侧内括约肌切开术治疗慢性肛裂：随机对照试验的荟萃分析
DOI：
10.1007/s10151-014-1121-4
复制
发表时间：
2014-08-01
影响因子：
3.3
通讯作者：
Peng, J. -S.
中科院分区：
文献类型：
--
作者：
Chen, H. -L.;Woo, X. -B.;Peng, J. -S.
背景虽然手术是治疗肛裂的金标准，但它的副作用和并发症仍然是人们主要关注的问题。肉毒毒素注射和内括约肌外侧切开术是慢性肛裂患者的技术选择。然而，人们对这两种技术的有效性知之甚少。本Meta分析的目的是比较肉毒毒素注射和内括约肌外侧切开术治疗慢性肛裂的疗效。方法检索MEDLINE数据库、PubMed、Web of Science和Cochrane图书馆数据库，检索英文原文研究。确定了比较肉毒毒素注射和内括约肌外侧切开术的随机对照试验。每个研究的数据是独立提取的，并使用固定和随机效应模型进行荟萃分析。结果来自7个试验的49名患者符合纳入标准。接受内括约肌外侧切开术的患者有较高的愈合率和大小便失禁发生率。肉毒杆菌毒素注射与内括约肌外侧切开术的总并发症差异无统计学意义。内括约肌外侧切开术的复发率明显低于肉毒毒素注射组。结论Meta分析显示，内括约肌外侧切开术在愈合率和复发率方面均优于肉毒毒素注射组。然而，肉毒杆菌毒素是安全的，与较低的大小便失禁发生率有关，并且可以在某些情况下使用。需要进一步的研究和长期的跟踪来证实我们的观察结果。
BackgroundAlthough surgery is the gold standard treatment for anal fissure, the main concern remains its side effects and complications. Botulinum toxin injection and lateral internal sphincterotomy are technical options for patients suffering from chronic anal fissure. However, little is known about the efficacy of these two techniques. The aim of this meta-analysis was to compare the outcomes of botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure.MethodsOriginal studies in English were searched from the MEDLINE database, PubMed, Web of Science, and the Cochrane Library database. Randomized control trials that compared botulinum toxin injection with lateral internal sphincterotomy were identified. Data were independently extracted for each study, and a meta-analysis was performed using fixed and random effects models.ResultsFour hundred and eighty-nine patients from seven trials met the inclusion criteria. Patients undergoing lateral internal sphincterotomy had a higher-healing and incontinence rate. No statistically significant differences were noted in total complications between botulinum toxin injection and lateral internal sphincterotomy. Patients treated with lateral internal sphincterotomy had a significantly lower recurrence rate than the patients treated with botulinum toxin injection.ConclusionsOur meta-analysis shows that lateral internal sphincterotomy was superior to botulinum toxin injection in terms of healing rate and lower recurrence rate. Botox, however, is safe associated with a lower rate of incontinence and could be used in certain situations. Further studies with a long-term follow-up are required to confirm our observations.