女性会阴缺损伴瘘及大便失禁手术方法探析.docVIP

女性会阴缺损伴瘘及大便失禁手术方法探析 　 作者：谭妍妍，丁曙晴，张苏闽 【摘要】 目的：探讨女性会阴缺损伴瘘和大便失禁的手术方法。方法：对27例患者的临床资料进行回顾分析。其中产后会阴撕裂伤14例；有肛直肠前庭瘘10例，8例经会阴手术修补感染，2例曾行挂线术。括约肌功能长度、肛管最大收缩压、直肠感觉阈值等均较正常对照组有明显差异（Plt;0.001）根据患者会阴缺损及瘘的具体情况采用经前庭或经会阴入路手术。结果：27例中20例1次手术成功，3例2次手术成功；27例中有效随访16例，时间6～36月，13例感觉满意。术后测压10例，上述指标较术前明显改善。结论：女性会阴缺损伴瘘和大便失禁多由产伤及直肠前庭瘘处理不当造成，关键在预防，经前庭或经会阴入路手术疗效满意。 【关键词】 会阴缺损； 直肠前庭瘘； 手术方法 　　Surgical Management of Perineal Defection with Fistula and Fecal Incontinence for Female 　　　　Abstract： Objective： To investigate the surgical treatment of perineal defection(PD) with fistula and fecal incontinence for female. Method： Clinical data of 27 cases (14 patients with perineal laceration after childbirth ; 10 cases with Rectovestibular Fistula) .The preoperative anorectal manometry (such as anal functional length, anorectal sphincteric squeezing pressure, rectal sensation threshold) was significant different from normal persons(Plt;0.001). The operative procedures transrectal or transvaginal were discussed. Result： Of 27 patients, 20 recovered after the operation ,3 patients recovered by the second operation; 16 patients were followed up by 6～36 months,13 of which were satisfied;The postoperative anorectal manometry on 10 patients showed that all the upper index were improved. Conclusion： PD with fistula and fecal incontinence is mostly caused by obstetric injury and improper medical treatment; It is important to prevent; Transrectal and transperineal approach are satisfactory procedures. 　 　　Key words： Perineal defection; Rectovestibular fistula; Surgical method 　　 　　女性会阴缺损伴瘘和大便失禁的原因多为难产分娩、不适当的手术、外伤及感染所致。现收集我院自1997年至2004年间收治的27例病例，就此类疾病的发病原因、诊治过程进行探讨。 　　1 资料与方法 　　1.1 研究对象：27例患者，年龄2～65岁，平均25.0±17.1岁。原因及伴发症状见表1。14例产后会阴撕裂合并大便失禁患者术前肛门直肠测压情况见表2。该14例患者中10例术前行盆底肌电图检查，4例耻骨直肠肌肌电图反常电活动，4例肌电活动减弱，2例正常；会阴神经潜伏期测定，3例正常，5例延长，2例缩短。 　　表1 疾病原因及伴发症状　略 　　1.2 治疗方法：根据患者会阴缺损及瘘的具体情况采用经前庭或经会阴入路。在会阴陈旧裂伤处切开皮肤及皮下，会阴体瘢痕松解后在直肠阴道隔平面将直肠和阴道壁分开至两侧，保持松弛，近端游离约4～5cm，分离肛管括约肌断端凹陷处后“U”形缝合，再间断缝合提肛肌2针，会阴深浅横肌，缝合阴道粘膜和皮肤。会阴皮肤可采用“S”、“Z”形等作皮瓣转移，避免