Fissure Pharmacology肛裂药理学ppt课件.ppt

Anal Fissure Pharmacology;Anal fissure pharmacologyChronic fissure-in-ano;Anal fissure pharmacologyPathogenesis;Meta-analysis of RCT comparingsphincterotomy with medical therapy;Lateral internal sphincterotomyRisk of incontinence;Anal fissure pharmacologyRegulation of internal sphincter tone;Agents used to treat chronic anal fissure;Meta-analysis of RCT comparing GTN with placebo;Meta-analysis of RCT comparing GTN with placebo (Studies with abnormally low placebo response rates excluded);Limited clinical efficacy Nelson Dis Colon Rectum 2004; 47: 422-431 Headaches and dizziness Altomare et al Dis Colon Rectum 2000; 43: 174-9 Tachyphylaxis Watson et al Br J Surg 1996; 83:771-5 Mode of application Lindsey et al Dis Colon Rectum 2003; 46: 361-6 Significant reduction in MRP for 15-90 mins Lindsey et al Br J Surg 2004; 91: 270-9 ;Diltiazem ointment 2%Applied three times per day for 8 weeks;Diltiazem versus GTN2% diltiazem ointment applied twice per day for 8 weeks;Nifedipine versus GTN0.2% nifedipine ointment applied four times daily ;Anal fissure pharmacology Botulinum neurotoxin A (Botox?);Botulinum neurotoxin A (Botox?);Botulinum neurotoxin A (Botox?);Botulinum neurotoxin APublished studies ;GTN ointment 0.2% cost ￡13.52 Diltiazem cream 2% cost ￡40.92 Botox? vial (100 units) cost ￡160.15 Lateral sphincterotomy cost ￡560;GTN of only marginal benefit in treating chronic fissure in ano Diltiazem has minimal side-effects and should probably be used as first-line treatment Botox? should be used for those failing diltiazem Lateral sphincterotomy should be reversed for patients who have failed medical and sphincter-conservative treatment options ;Bradford Obstructive Defecation trial