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만성치열 환자에서 해부학적 협착의 유병률과 측방 내괄약근 절개술의 결과

Prevalence of Anatomic Anal Stenosis in Patients with Chronic Anal Fissure and Results of Lateral Internal Sphincterotomy

대한대장항문학회지 2002년 18권 1호 p.7 ~ 9
조동윤 ( Jo Dong-Yoon ) - 학문외과

김동의 ( Kim Dong-Yi ) - 전남대학교 의과대학 외과학교실
김영진 ( Kim Young-Jin ) - 전남대학교 의과대학 외과학교실 위장관외과

Abstract


Purpose: The aim of this study was to estimate the prevalence of anatomic anal stenosis in patients with chronic anal fissure (CAF) and ascertain the results of lateral internal sphincterotomy (LIS) using a new calibrator.
Methods: Ninety-eight adults with CAF and a control group of 40 normal adults underwent anal calibration under spinal anesthesia. The calibrator was a conical design and the diameter was scaled in increments of 1 ㎜. The calibration was standardized and the reliability of it was assessed by two independent examiners for the same group (n=45). Confounding effects of age, sex, body weight, and height on the anal caliber were studied. The internal sphincter was divided to the level of the dentate line during LIS.

Results: The anal caliber was 34.6±1.4 ㎜ (mean±SD) in the control group and 28.7±3.0 ㎜ (mean±SD) in patients with CAF. Excellent correlation was obtained between the two examiners (r=0.958). The confounding effects of age, sex, body weight, and height were not significant. Therefore, anal stenosis was defined as when the measurement was 31 ㎜ or below (mean-2SD of control value). Stenosis was present in 82 of 98 patients (84%) with CAF. Patients with stenosis had an anal caliber of 27.9±2.5 ㎜, with a range of 21 to 31 ㎜. Following LIS, 91 of 98 patients (93%) with CAF attained the normal range, two patients still had stenosis, and five patients had an anal caliber exceeding the normal value.

Conclusions: Anatomic anal stenosis was found in 84% of the patients with CAF. Ninety three percent of these patients attained a normal anal caliber, 2 percent of the patients still had stenosis and 5 percent of the patients had an anal caliber exceeding the normal value after LIS.

키워드

해부학적 항문 협착;만성치열;측방 내괄약근 절개술
Anatomic anal stenosis;Chronic anal fissure;Lateral internal sphincterotomy
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