■外侧内括约肌切开术(LIS)一直是治疗慢性肛裂(CAF)的金标准,尽管采取了其他措施,但仍持续存在。作者旨在评估与开放式方法(OLIS)相比,执行LIS的封闭方法(CLIS)的效果。
■在数据库中搜索相关研究,并筛选结果以确定符合条件的文章,在使用RevMan5.4的荟萃分析模型中,将所有相关结局汇总为奇数比(OR)或平均差(MD)和95%CI.
■来自16项试验的1,711例特发性CAF患者的汇总数据显示,CLIS具有明显较低的延迟裂隙愈合风险[OR:0.28,95%CI(0.10,0.77),P=0.01],住院时间[MD:-0.82,95%CI(-1.07,-0.57),P<0.00001]和术后24h视觉模拟疼痛评分(VAPS)[MD:-0.30,95%CI(-0.39,-0.21),P<0.00001]。此外,总体并发症的风险[OR:0.33,95%CI(0.19,0.55),P<0.0001],失禁[OR:0.28,95%CI(0.20,0.38),P<0.00001],和术后疼痛[OR:0.56,95%CI(0.35,0.91),P=0.02]显著低于CLIS。
■CLIS是比OLIS治疗肛裂更安全的选择。裂缝延迟愈合的风险,失禁,术后疼痛和总体并发症显著降低。然而,手术部位感染的风险,术后出血和复发没有差异.未来的研究需要更长时间的随访,以可靠地记录复发。
UNASSIGNED: Lateral internal sphincterotomy (LIS) has been the gold standard for treating chronic anal fissure (CAF) that persists despite other measures. The authors aim to evaluate the effects of the close method (CLIS) of performing LIS as compared to the open method (OLIS).
UNASSIGNED: Databases were searched for relevant studies and results were screened to identify eligible articles, and all concerned outcomes were pooled as odd ratio (OR) or mean difference (MD) with 95% CI in the meta-analysis models using RevMan 5.4.
UNASSIGNED: Pooled data from 16 trials with 1,711 patients with idiopathic CAF showed that the CLIS has significant lower risk of delayed fissure healing [OR: 0.28, 95% CI (0.10, 0.77), P = 0.01], duration of hospital stay [MD: -0.82 with 95% CI (-1.07, -0.57), P < 0.00001] and postoperative visual analogue pain score (VAPS) at 24 h [MD: -0.30 with 95% CI (-0.39, -0.21), P < 0.00001]. Also, the risk of overall complications [OR: 0.33 with 95% CI (0.19, 0.55), P < 0.0001], incontinence [OR: 0.28 with 95% CI (0.20, 0.38), P < 0.00001], and postoperative pain [OR: 0.56 with 95% CI (0.35, 0.91), P = 0.02] was significantly lower with CLIS.
UNASSIGNED: CLIS is a safer option than OLIS for treating anal fissure. The risk of delayed fissure healing, incontinence, post-op pain and overall complication was significantly lower. However, the risk of surgical site infection, postoperative bleeding and recurrence did not differ. Future research with more prolonged follow-up is necessary to document recurrence reliably.