肛门失禁的括约肌重建——实践与选择

Sphincteroplasty for Fecal Incontinence: Practice and Choice.

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。

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?% and 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.