人工肛门括约肌的材料学特征及其临床应用

Material features and clinical application of artificial anal sphincter

背景:严重肛门失禁由多种原因造成,严重影响患者的生存能力和生活质量。为了有效控制失禁,恢复肛门的正常功能,多年来国内外学者作了多方面的尝试;特别是试图通过手术重建或肌肉移植代替肛门括约肌功能。虽然已不断改进各种重建方式,但肛门功能的恢复并不理想。目的:探讨人工肛门括约肌的材料学特点及其临床应用情况。方法:由第一作者检索Pubmed数据库(http://www.ncbi.nlm.nih.gov/pubmed/)及万方数据库(http://www.wanfangdata.com.cn)1991-01/2009-12有关人工肛门括约肌、人工肛门的材料学特征以及肛门失禁治疗后生活质量评定的文章,英文检索词为"Anal sphincter,fecal incontinence",中文检索词为"肛门括约肌,人工肛门,肛门失禁"。排除较陈旧的文献及重复研究,共纳入22篇符合标准的文献。结果与结论:理想的人工肛门括约肌应该采用具有良好生物相容性的生物材料,尽可能地减少肠组织的炎症反应。和动力性股薄肌移位术一样,人工肛门括约肌也是通过隧道将人工括约肌放置在原来的括约肌周围,这种装置持续维持一定的压力,患者需要排便时通过位于阴囊或阴唇的手动泵进行复原。人工肛门括约肌治疗严重肛门失禁的作用是可以肯定的。

BACKGROUND：Severe anal incontinence is caused by various factors and greatly affects survival and life quality of patients.Efforts have been attempted to control incontinence and restore anal function.In particular,reconstruction by operation or muscle replacement for anal sphincter has been performed.However,the effect is not favorable.OBJECTIVE：To explore the material features and clinical application of artificial anal sphincter.METHODS：A computer-based online search of Pubmed database（http：//www.ncbi.nlm.nih.gov/pubmed/）and Wanfang database（http：//www.wanfangdata.com.cn）was performed for articles published between January 1991 and December 2009 related to artificial anal sphincter,material features of artificial anal sphincter and life quality following treatment,with the key words ＂anal sphincter,fecal incontinence＂in English and＂anal sphincter,enteroproctia,anal incontinence＂in Chinese.Repetitive and outdated studies were excluded.Finally,22 articles were included.RESULTS AND CONCLUSION：Ideal artificial anal sphincter should have good biocompatibility,and minimize intestine inflammation.Similar to dynamic gracilis transposition,artificial anal sphincter is placed around original position through tunnel,which maintains certain pressure and recovers through hand pump localized at scrotum or labia.The effect of artificial anal sphincter on treating severe anal incontinence is positive.