
[항문 열창] 항문 열창에 습진이 합병
[중상]
항문 열창은 항문 점막의 표면이 째진 상태이며 배변 시 아프고
직장 출혈을 하며 항문 괄략근이 경련으 일으키므로 배변 곤란 증
(배변 실금)을 지닌다
[병태]
항문 내 괄략근이 과민 상태 인자는 치료 해도 재발
[원인]
-외상
-배변 시 가압
-성병 합병 증(임균 Chlamydia, 매독 바이러스,Herpe)
-크론 씨 병, 궤양성 대장 염
[발생 빈도]
350명중 1명
[자연 치유]
섬유 식 밀겨을 등 배변 치료 섬유식하면 자연 치유 될 수 있음
[국소 약물 요법]
1) 국소 마취 제 진통 lidocaine 1.5% ointment
2) glyceryl trinitrate국소 바르면 근육 이완 효과 11-13 있으며
24-38 개월 후 완치14
3) 0.2% ,0.3% 0.4% topical nifedipine19,20
4) diltiazem 2%16-18
[Botunum A Toxin 주사 법]
1) botulinum A toxind 주사로 괄략근 마비를 유발.7-9하면
대부부의 경우 열창이 완치 되는 기간 만큼 효과있음
98%는 치료된다 그러나 57건의 장기 추적 조사10결과 Toxin 약효 살아진 후 재발 율 41.5%
2) botulinum toxin20 주와 외용제와 Nifedipine 경구.21 요법 병용
[근거]
1. 1. Nelson R. A systematic review of medical therapy for anal fissure. Dis Colon Rectum 2004; 47: 422–31. PubMed
2. 2. Nelson R. Non surgical therapy for anal fissure. Available in The Cochrane Database of Systematic Reviews; Issue 4. Chichester: John Wiley; 2006 (accessed 08/05/08). PubMed
3. 3. Cook TA, et al. The pharmacology of the internal anal sphincter and new treatments of ano-rectal disorders. Aliment Pharmacol Ther 2001; 15: 887–98. PubMed
4. 4. American Gastroenterological Association. American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure. Gastroenterology 2003; 124: 233–4. PubMed
5. 5. Madoff RD, Fleshman JW. AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterology 2003; 124: 235–45. PubMed
6. 6. Wray D, et al. Anal fissure: a review. Br J Hosp Med 2008; 69: 455–8. PubMed
7. 7. Jost WH, Schimrigk K. Botulinum toxin in therapy of anal fissure. Lancet 1995; 345: 188–9. PubMed
8. 8. Maria G, et al. A comparison of botulinum toxin and saline for the treatment of chronic anal fissure. N Engl J Med 1998; 338: 217–20. PubMed
9. 9. Jost WH. Ten years' experience with botulin toxin in anal fissure. Int J Colorectal Dis 2002; 17: 298–302. PubMed
10. 10. Minguez M, et al. Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Gastroenterology 2002; 123: 112–17. PubMed
11. 11. Lund JN, Scholefield JH. A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Lancet 1997; 349: 11–14. PubMed Correction. ibid.: 656.
12. 12. Bailey HR, et al. Fissure Study Group. A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures. Dis Colon Rectum 2002; 45: 1192–9. PubMed
13. 13. Scholefield JH, et al. A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures. Gut 2003; 52: 264–9. PubMed
14. 14. Lund JN, Scholefield JH. Follow-up of patients with chronic anal fissure treated with topical glyceryl trinitrate. Lancet 1998; 352: 1681. PubMed
15. 15. Lysy J, et al. Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure. Gut 2001; 48: 221–4. PubMed
16. 16. Jonas M, et al. A randomized trial of oral vs topical diltiazem for chronic anal fissures. Dis Colon Rectum 2001; 44: 1074–8. PubMed
17. 17. Jonas M, et al. Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study. Dis Colon Rectum 2002; 45: 1091–5. PubMed
18. 18. Bielecki K, Kolodziejczak M. A prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure. Colorectal Dis 2003; 5: 256–7. PubMed
19. 19. Ezri T, Susmallian S. Topical nifedipine vs. topical glyceryl trinitrate for treatment of chronic anal fissure. Dis Colon Rectum 2003; 46: 805–8. PubMed
20. 20. Tranqui P, et al. Nonsurgical treatment of chronic anal fissure: nitroglycerin and dilatation versus nifedipine and botulinum toxin. Can J Surg 2006; 49: 41–5. PubMed
21. 21. Cook TA, et al. Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg 1999; 86: 1269–73. PubMed
God bless you!
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