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Current Understanding of Anal Fissure Pathophysiology

机译：对肛裂病理生理学的最新认识

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The etiology and pathogenesis of anal fissure (AF) is one of the most common causes of severe anal pain yet has never been fully understood. Factors which predispose people to developing AF include diarrhea, constipation, childbirth, medication as well as constant saddle vibration (amongst professional mountain-bikers) and using a jet of water from a bidet-toilet. For many years, it has been generally accepted that a sphincterotomy, whether surgical or pharmacologic, treats chronic AF because it produces a reduction in anal pressure, reverses sphincter spasms, and promotes fissure healing. However, recent studies cast doubt upon this explanation. A new theory explains that AF healing depends on biochemical processes in the anal passage. Eruption of tissues in the fissure region during defecation releases platelet products such as ADP, ATP, 5-HT, platelet activation factor, thrombin and substance P which cause the contraction of smooth muscles (of Internal Anal Sphicter and vessels) and result in difficulties in AF healing. The effect of a sphincterotomy is to reduce sphincter trauma during defecation and the consequent release of these potent smooth muscle contractors. An injection of botulinum toxin is thought to release the blockage in glyceryl trinitrate bioactivation in smooth muscle cells and suppress basal continuous sympathetic activity, resulting in AF healing.
机译：肛裂（AF）的病因和发病机制是严重肛门痛的最常见原因之一，但至今尚未完全了解。导致人们发展房颤的因素包括腹泻，便秘，分娩，药物治疗以及持续的鞍座振动（在专业的山地自行车中）以及使用坐浴盆水流。多年来，人们普遍接受括约肌切开术，无论是外科手术还是药物治疗，都可治疗慢性房颤，因为它可降低肛门压力，扭转括约肌痉挛并促进裂痕愈合。但是，最近的研究对该解释产生了怀疑。一种新理论解释了房颤的愈合取决于肛门通道中的生化过程。排便过程中裂隙区域的组织破裂释放出血小板产物，例如ADP，ATP，5-HT，血小板活化因子，凝血酶和P物质，这些物质会导致（内部肛门括约肌和血管）平滑肌收缩，并导致在AF康复。括约肌切开术的作用是减少排便期间的括约肌创伤，并减少这些有效的平滑肌收缩物的释放。注射肉毒杆菌毒素被认为可以释放平滑肌细胞中三硝酸甘油酯生物激活的阻滞，并抑制基础持续的交感神经活动，从而导致房颤愈合。

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