Pna手术及盆底肌肉折叠术在肛门闭锁术后大便失禁中应用.docVIP

Pna手术及盆底肌肉折叠术在肛门闭锁术后大便失禁中应用 　　　【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，术后增加到5分和6分，3例2分者增加到5～6分，另1例3分者增加到6分。肛门直肠测压显示：术前和术后肛管的静息压力变化不明显，而收缩压力增加显著，由术前的（30.8±16.4）mmHg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 with Imperforate Anus 　　 　　【Abstract】　Objective　To evaluate posterior sagittal anorectal pullthrough(Pnas operation) and levator ani imbrication in the management of postoperat ive fecal incontinence in children with imperforate anus.Methods　Incontinent children(n=9, mean age=6.3 ye ars) with high type imperforate anus were reconstructed using Pnas approach and levator ani imbrication. Operative findings in a ll 9 children revealed that the anorectal canals were not positioned in the cent er of the muscle complex. In 4 patients who were operated on in neonatal period, the rectum was misplaced in the anterio-lateral posit ion. The remaining 5 had the rectum positioned anterior to the muscle complex. The second operation repos itioned the rectum in the center of the muscle complex.Results　The patients were followed-up for 2 years. All 9 children showed some 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 complex is one of the causes of post-oper ative fecal incontinence in children with imperforate anus. Reconstruction using P