gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2020-19-2-113-128gnck-1576Research ArticleОБЗОР ЛИТЕРАТУРЫ, МЕТАНАЛИЗREVIEWБОТУЛИНИЧЕСКИЙ ТОКСИН ТИПА А И БОКОВАЯ ПОДКОЖНАЯ СФИНКТЕРОТОМИЯ В ЛЕЧЕНИИ ХРОНИЧЕСКОЙ АНАЛЬНОЙ ТРЕЩИНЫ СО СПАЗМОМ СФИНКТЕРА. ЧТО ВЫБРАТЬ? (систематический обзор литературы и метаанализ)BOTULINUM TOXIN TYPE A AND LATERAL SUBCUTANEOUS SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE WITH THE SPHINCTER SPASM. WHAT TO CHOOSE? (systematic literature review and meta-analysis)ХрюкинР. Ю.KhryukinR. Yu.

ул. Саляма Адиля, д. 2, Москва, 123423тел.: +7 (499) 199-04-09

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info@gnck.ruКостаревИ. В.KostarevI. V.

г. Москва

Moscow

АрсланбековаК. И.ArslanbekovaK. I.

г. Москва

Moscow

НагудовМ. А.NagudovM. A.

г. Москва

Moscow

ЖарковЕ. Е.ZharkovE. E.

г. Москва

Moscow

ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Centre for Coloproctology of the Ministry of Health of RussiaRussian FederationФГБОУ ДПО РМАНПО Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian FederationRussian Federation202002062020192113128Copyright © Хрюкин Р.Ю., Костарев И.В., Арсланбекова К.И., Нагудов М.А., Жарков Е.Е., 20202020Хрюкин Р.Ю., Костарев И.В., Арсланбекова К.И., Нагудов М.А., Жарков Е.Е.Khryukin R.Y., Kostarev I.V., Arslanbekova K.I., Nagudov M.A., Zharkov E.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1576

ВВЕДЕНИЕ: Для лечения хронической анальной трещины используются различные хирургические методики, основным различием между которыми является способ ликвидации спазма анального сфинктера. Одним из наиболее серьезных послеоперационных осложнений является развитие анальной инконтиненции. На сегодняшний день существует ряд методов медикаментозной релаксации внутреннего сфинктера, позволяющих существенно уменьшить риск развития послеоперационной недостаточности анального жома после вмешательства.ЦЕЛЬ: Оценить безопасность и эффективность ботулинического токсина типа А (БТА) и боковой подкожной сфинктеротомии (БПС) в лечении хронической анальной трещины со спазмом сфинктера.МАТЕРИАЛЫ И МЕТОДЫ: Выполнен систематический обзор и метаанализ 7 отобранных рандомизированных клинических исследований, сравнивающих результаты лечения хронической анальной трещины с использованием БТА и БПС. Проанализированы результаты лечения 489 пациентов с оценкой следующих показателей: частота эпителизации трещин, послеоперационных осложнений, развития недостаточности анального сфинктера и рецидивов заболевания.РЕЗУЛЬТАТЫ: В группе БТА частота эпителизации трещин в 0,88 раза ниже, чем в группе БПС (ОШ=0,12; ДИ=0,06;0,22; р<0,00001). По частоте послеоперационных осложнений в обеих группах статистических различий не выявлено (ОШ=1,07; ДИ=0,50;2,30; р=0,85). Риск развития послеоперационной недостаточности анального сфинктера в 0,86 раза ниже в группе БТА, чем в группе БПС (ОШ=0,14; ДИ=0,03;0,64; р=0,01). Риск развития рецидива после боковой подкожной сфинктеротомии в 6,06 раза ниже, чем при использовании ботулинического токсина типа А (ОШ=6,06; ДИ=3,52;10,42; р<0,00001).ЗАКЛЮЧЕНИЕ: Применение ботулинического токсина типа А в лечении хронической анальной трещины позволяет снизить риск развития послеоперационной недостаточности анального сфинктера, однако данный метод значительно уступает боковой подкожной сфинктеротомии по показателю частоты эпителизации хронических анальных трещин.

INTRODUCTION: for the treatment of chronic anal fissure, various surgical techniques are used, the main difference between which is the method of eliminating the anal sphincter spasm. One of the most serious postoperative complications is the development of anal incontinence. To date, there are a number of methods for drug-induced relaxation of the internal sphincter, which can significantly reduce the risk of developing anal incontinence after surgery.AIM: to evaluate the safety and effectiveness of botulinum toxin type A (BTA) and lateral subcutaneous sphincterotomy (LSS) in the treatment of chronic anal fissure with sphincter spasm.METHODS: a systematic review and meta-analysis of 7 selected randomized clinical trials comparing the results of treatment of chronic anal fissure using BTA and LSS was performed. The results of treatment of 489 patients were analyzed with an assessment of the following indicators: the incidence of epithelization of fissures, postoperative complications, development of anal incontinence and the disease recurrence. RESULTS: In the BTA group, the incidence of fissure epithelization is 0.88 times lower than in the LSS group (OR=0.12; CI=0.06;0.22; p<0.00001). There were no statistical differences in the rate of postoperative complications in both groups (OR=1.07; CI=0.50;2.30; p=0.85). The risk of developing postoperative anal incontinence is 0.86 times lower in the BTA group than in the LSS group (OR=0.14; CI=0.03;0.64; p=0.01). The risk of relapse after lateral subcutaneous sphincterotomy is 6.06 times lower than when using botulinum toxin type A (OR=6.06; CI=3.52;10.42; p<0.00001).CONCLUSION The use of botulinum toxin type A in the treatment of chronic anal fissure reduces the risk of developing postoperative anal incontinence, but this method is significantly inferior to lateral subcutaneous sphincterotomy in terms of the rate of chronic anal fissure epithelization.

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The authors declare that there are no conflicts of interest present.