肛门失禁括约肌重建——实践及选择.docVIP

肛门失禁括约肌重建——实践及选择 　　　【摘要】　目的　总结肛门失禁（主要为儿童）行括约肌重建的临床经验并针对性提出括约肌重建的方法。方法　回顾1992～1997年对31例完全性肛门失禁的治疗，其中25例为先天性肛门闭锁术后，2例为会阴损伤术后，4例为盆腔和会阴术后。对此组病例采取不同的括约肌重建术，包括神经压榨股薄肌转移肛门外括约肌重建25次，臀大肌转移5次，Puri-Nixon提肛肌成形术1次，肛门内括约肌成形6次。结果　对25例进行平均25个月的随访，按李正评分法，临床评分达优良22例，占88.0%，客观评价8例，5例达优良。结论　对括约肌肌源性损害致肛门失禁的患者，正确地选择不同的括约肌成形术都可能达到满意的效果。 　　Sphincteroplasty for Fecal Incontinence: Practice and Choice. 　　【Abstract】　Objective　To review our experience of operative management of fecal incontinence.Methods　The management of 31 cases of complete fecal incontinence was reviewed. This included imperforate anus(n=25), trauma(n=2), previous perineal and pelvic operations(n=4). Of them, 8 cases associated with recto-urethral fistulae and 2 with recto-vaginal fistulae. The operation included transposition of neurotripsied gracilis muscle in 25 patients, transposition of gluteus maximus in 5, Puri-Nixon levatoplasty in 1, internal sphincter reconstruction in 6.Results　Twenty-five patients were followed-up with mean duration of 25 months. The function was assessed applying the clinical and objective scoring systems of Li Zheng. Those who were categorized as good and fair accounted for 88% a nd 63% of the patients respectively.Conclusions　The choice of operation depends on the degree of sphincter damage. Striated muscle transposition requires direct contact between the transposed muscle and the residual sphincter to facilitate re-innervation. 　　【Key words】　Fecal incontinence　　Spincteroplasty　　Anus 　　肛门括约肌由于先天性发育不良、外伤或其他医源性损害引起的严重大便失禁患儿，常须行括约肌重建，我们根据近年来临床上施行肛门括约肌成形术的临床实践，对方法选择、注意事项进行了总结。 　　临床资料 　　1992年11月～1997年6月采用肛门括约肌重建治疗大便失禁患儿31例,年龄3～24岁,平均10.6岁,男19例,女12例。先天性肛门闭锁术后25例,外伤性2例,盆腔及会阴术后4例，包括先天性巨结肠术后3例，骶尾部畸胎瘤术后1例,全部为完全性大便失禁［1］,合并有直肠尿道瘘者8例,直肠阴道瘘或舟状窝瘘者2例。手术行神经压榨股薄肌转移、肛门外括约肌重建［2］25次,臀大肌近侧瓣转移肛门外括约肌重建5次,Puri-Nixon提肛肌成形术［3］1次,肛门内括约肌成形术6次。 　　臀大肌转移术失败后又施行股薄肌转移1例, 股薄肌转移术3例失败后行臀大肌瓣转移1例,行另侧股薄肌转移1例,行Puri-Nixon提肛肌成形术1例。 　　内外括约肌同时重建者3例,包括1例土枪炸伤和2例院外多次手术后病例,单独行内括约肌成形者3例,都在行腹会阴拖下术时同时施行。 　　结　果 　　随访25例,术后3个月～5年2个月,