高、中位无肛畸形保留内括约肌的肛门成形术后随访观察

Long Term Follow up of High and Intermediate Imperforate Anus with Preservation of Internal Anal Sphincter

目的：观察保留内括约肌的肛门成形术后排便功能。方法：无肛畸形患儿２６例，高位１５例，中位１１例，全部行保留内括约肌的肛门成形术，随访平均６．２８年。通过临床评分、肛管直肠测压、肌电图、钡灌肠等客观评分标准进行综合评定肛门排便功能。结果：术后肛门功能临床和综合评定优者分别由过去的２３．１％、２６．９％提高到７３．３％和６６．７％（Ｐ＜０．０１和Ｐ＜０．０５），而术后肛门功能差者由过去的２３．１％、２３．１％分别下降到６．７％和０。结论：多数无肛畸形包括有直肠泌尿生殖道瘘的无肛畸形，在直肠远端有内括约肌，手术尽量保留和利用，以便获较好的排便功能。

Objective: To assess anal continence after anoplasty with preservation of internal sphincter. Methods: Twenty six patients with imperforate anus, 15 high types and 11 intermediate types, were followed up for a mean duration of 6.28 years. Defecation and sphincter function were graded in a combination with clinical scores, anorectal manometry, electromyography and barium enema. Results: In patients with high imperforate anus, the percentages of the satisfactory and overall scores increased from 23.1% and 26.9% to 73.3% and 66.7% respectively ( P < 0.01 and P < 0.05 ). The percentages of the lowest scores decreased from 23.1% and 23.1% to 6.7% and 0% respectively. Conclusions: Most of the distal pouches of rectum, especially those associated with urogenital fistulae, contain functional internal sphincter. These sphincters should be kept to achieve better function.