gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2020-19-4-115-130gnck-1608Research ArticleОБЗОРЫ ЛИТЕРАТУРЫ И МЕТААНАЛИЗLITERATURE REVIEWS AND METAANALYSISАНОПЛАСТИКА И БОКОВАЯ ПОДКОЖНАЯ СФИНКТЕРОТОМИЯ В ЛЕЧЕНИИ ХРОНИЧЕСКОЙ АНАЛЬНОЙ ТРЕЩИНЫ (систематический обзор литературы и метаанализ)ANOPLASTY AND LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE (systematic review and meta-analysis)https://orcid.org/0000-0001-7373-9103АрсланбековаК. И.ArslanbekovaK. I.

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info@gnck.ruhttps://orcid.org/0000-0003-0556-1782ХрюкинР. Ю.KhryukinR. Yu.https://orcid.org/0000-0003-3403-9731ЖарковЕ. Е.ZharkovE. E.ФГБУ «НМИЦ колопроктологии имени А.Н.Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian Federation202021122020194115130Copyright © Арсланбекова К.И., Хрюкин Р.Ю., Жарков Е.Е., 20202020Арсланбекова К.И., Хрюкин Р.Ю., Жарков Е.Е.Arslanbekova K.I., Khryukin R.Y., 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/1608ВВЕДЕНИЕ

ВВЕДЕНИЕ: боковая подкожная сфинктеротомия (БПС) является «золотым стандартом» хирургического лечения хронической анальной трещины (ХАТ). Преимущество БПС перед другими оперативными методами лечения заключается в более высокой эффективности в отношении эпителизации послеоперационной раны и более низком риске развития рецидивов заболевания. Однако, данная методика сопряжена с высоким риском развития послеоперационной недостаточности анального сфинктера (НАС). Анопластика (АП) – альтернативный хирургический метод, также направленный на лечение ХАТ, заключающийся в пластике дефекта местными тканями, и позволяющий существенно снизить риск развития анальной инконтиненции.

ЦЕЛЬ

ЦЕЛЬ: оценить непосредственные и отдаленные результаты лечения хронической анальной трещины с применением анопластики и боковой подкожной сфинктеротомии.

МЕТОДЫ

МЕТОДЫ: выполнен систематический обзор и метаанализ исследований, сравнивающих результаты лечения после проведения анопластики и боковой подкожной сфинктеротомии. Показатели, оцениваемые при анализе: частота эпителизации послеоперационной раны, частота развития недостаточности анального сфинктера, частота развития послеоперационных осложнений. Статистическая обработка данных при сравнении исследований, включенных в метаанализ, проводилась в программе Review Manager 5.3.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: в систематический обзор включено 4 исследования, включающих 278 пациентов. В группе АП шанс эпителизации трещины на 63% ниже, чем в группе БПС (ОШ=0,37; ДИ=0,19;0,74; р<0,005). При анализе частоты послеоперационных осложнений статистических различий не выявлено (ОШ=1,43; ДИ=0,54;3,78; р=0,47). Вероятность развития послеоперационной анальной инкотиненции на 94% выше в группе БПС, чем в группе АП (ОШ=0,06; ДИ=0,01;0,37; р=0,002)

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: боковая подкожная сфинктеротомия и анопластика являются эффективными методиками лечения ХАТ. Однако, низкие и неоднозначные показатели качества исследований, посвященных сравнению этих методов, высокий риск смещения результатов в сравниваемых группах, а также гетерогенность публикаций, заставляют с осторожностью подходить к трактовке полученных данных и диктуют необходимость проведения дальнейших исследований.

INTRODUCTION

INTRODUCTION: Lateral internal sphincterotomy (LIS) is considered the ‘gold standard’ therapy for chronic anal fissure (CAF).  Advantages of LIS over other surgical techniques include higher rate of healing and lower risk of fissure recurrence. However, this procedure is associated with a high risk of anal sphincter insufficiency (ASI) in the postoperative period. Anal advancement flap (AAF) is an alternative surgical procedure for CAF, which requires the use of local flaps. Anal advancement flap is associated with a significantly lower risk of anal incontinence.

AIM

AIM: to compare short-term and long-term outcomes of аnal advancement flap and lateral internal sphincterotomy in patients with chronic anal fissure.

METHODS

METHODS: a systematic review and meta-analysis of studies comparing outcomes of Anal advancement flap and lateral internal sphincterotomy was conducted. We evaluated the following parameters: the rate of epithelialization, the rate of anal sphincter insufficiency, and the rate of postoperative complications. We carried out statistical analysis using the Review Manager software (Review Manager 5.3.)

RESULTS

RESULTS: the systematic review included four studies that presented the results of 278 patients. Compared with LIS, the odds for healing after AAF were 63% lower (OR=0.37; CI=0.19;0.74; P<0.005). We found no significant differences in the rate of postoperative complications (OR=1.43; CI=0.54;3.78; P=0,47). Compared with AAF, the odds for anal incontinence after LIS were 94% greater (OR=0.06; CI=0.01;0.37; P=0,002).

CONCLUSION

CONCLUSION: both lateral internal sphincterotomy and аnal advancement flap are effective in curing CAF. However, considering the ambiguity and poor quality of data from the studies comparing these procedures, a high risk of bias for comparison groups and heterogeneity of the studies, one should interpret the results with caution; the aforementioned limitations dictate the need for further research.

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