Pna手术及盆底肌肉折叠术在肛门闭锁术后大便失禁中的应用论文.docVIP

　　Pna手术及盆底肌肉折叠术在肛门闭锁术后大便失禁中的应用论文 【摘要】 目的 了解Pna手术及盆底肌折叠术治疗无肛术后大便失禁的效果。方法 采用再次Pna手术和盆底肌折叠术治疗高中位无肛畸形术后大便失禁患儿9例(平均年龄6.3岁)。术中见9例患儿肛门和直肠均未穿过横纹肌复合体的中心，其中4例新生儿期行腹会阴肛门成形术的患儿，直肠偏于复合体的左侧或右侧，另外5例直肠偏于复合体的前方。术中将直肠重新固定在横纹肌复合体之中心。结果 术后随访半年到两年，显示患儿的排便控制功能均有改善，3 例术前临床评分为0者，术后增加到4～5分，2例术前1分者.freelmHg增加到（52.7 ±11.1）mmHg。结论 直肠错过横纹肌复合体中心是高中位肛门畸形患儿术后大便失禁的病因之一。再次行 Pna手术和盆底肌折叠术可以改善患儿的排便控制功能。 【关键词】P～na手术 PnasApproach and Levator Ani Imbrication on Pos toperative Fecal Incontinence in Children perforate Anus 【Abstract】 Objective To evaluate posterior sagittal anorectal pullthrough(Pna’s operation) and levator ani imbrication in the management of postoperat ive fecal incontinence in children perforate anus.Methods Incontinent children(n=9, mean age=6.3 ye ars) perforate anus brication. Operative findings in a ll 9 children revealed that the anorectal canals uscle plex. In 4 patients isplaced in the anterio-lateral posit ion. The remaining 5 had the rectum positioned anterior to the muscle plex. The second operation repos itioned the rectum in the center of the muscle plex.Results The patients e degree of improvement. Post-operatively the functional sc ores improved from 0 to 4-5 in 3 patients, from 1 to 5-6 in 2 patients, from 2 to 5-6 in 3 and from 3 to 6 in one. Anorectal manometry did not demonstrate signi ficant change in resting pressure but the contraction pressure improved from(3 0.8±16.4)mmHg to(52.7±11.1)mmHg post-operatively.Conclusions The study demonstrates that failure to positi on the rectum in the center of muscle plex is one of the causes of post-oper ative fecal incontinence in children perforate anus. Reconstruction using Pna’s approach and levator ani imbrication may improve the fecal continence. 【Key perforate anus Fecal incontinence Pnaso peration Levator ani imbrication 大便失禁是高中位肛门闭锁患儿术后最常见的并发症之一，治疗方法有股薄肌移位［1 ，2］，臀大肌移位［3］，盆底肌折叠及脉冲电刺激器埋植等手术方法［4，5 ］，均有成功的疗效报告。Pna［6］手术自1980 年应用于治疗肛门闭锁后，患儿术后的排便控制功能有了显著的提高，此手术有良好显露横纹肌复合体（striated muscle plex）、层次清楚和损伤小等优点。本研究目