人工直肠括约肌与磁性肛门括约肌对肛门失禁的治疗效果

Comparative study on the therapeutic effects artificial rectal sphincter and magnetic rectal sphincter on anal incontinence

目的目前肛门失禁的手术方式有多种,本研究对人工直肠括约肌(ABS)与磁性肛门括约肌(MAS)对肛门失禁的治疗效果进行对比。方法选取60例女性患者,27例患者接受MAS治疗,33例患者接受ABS治疗。对治疗方式的手术情况、术后并发症、装置移除率进行统计分析,同时利用肛门失禁评分(wexner)和大便失禁的生活质量调查表(FIQL)对MAS和ABS的治疗效果进行评估,并对术后肛门的生理结果进行检测。结果患者行MAS术较行ABS术具有更短的手术时间(P=0.027)和住院时间(P=0.016)。MAS组有3例(11.11%)患者移除装置,ABS组有4例(12.12%)患者需要移除。术后与治疗前比较,MAS组(P=0.001)和ABS组(P=0.000)的wexner平均评分均显著优于治疗前;装置植入半年后与治疗前比较显示,对于wexner评分的改善,ABS比MAS组具有更加的优势(P=0.027)。经过治疗后,与治疗前比较,MAS组(P=0.004)和ABS组(P=0.003)患者的FIQL评分均有显著的提升。在MAS组中,患者的肛门静息压力有显著提升(P=0.016),从33(7~54.5)cm H2O上升到44.5(21~68.5)cm H2O,其最大挤压压力从48.5(0~78.5)cm H2O上升到63(7~99)cm H2O,差异有统计学意义(P=0.049);ABS组中的患者的术前肛门静息压力为34(16~66)cm H2O,而植入ABS后当肛门球囊打开时其静息压力为64.5(36~95.5)cm H2O,差异有统计学意义(P=0.021),而肛门挤压压力则从植入前的46(0~73)cm H2O上升到88(44~136)cm H2O,差异有统计学意义(P=0.014)。结论 MAS是一种有前途的新型的,且侵入少以及手术简单,并可达到与ABS相类似的治疗效果的手术措施,可进一步补充肛门失禁的治疗方案。

Objective To observe and compare the therapeutic effects artificial rectal sphincter（ ABS） and magnetic rectal sphincter（ MAS） on anal incontinence. Methods A total of 60 female patients with anal incontinence were divided into MAS group（ n = 27） and ABS group（ n = 33）,who were treated by MAS or ABS,respectively. The surgery status,postoperative complications and device removal rate were statistically analyzed,moreover,the therapeutic effects in both groups were evaluated accoding to the anus incontinence scores（ wexner） and the questionnaire of quality of life of patients with fecal incontinence（ FIQL）,and the physiological results of anus after operation were observed and compared between the two groups. Results The operation time and hospital stay in MAS group were significantly shorter than those in ABS group（ P〈 0. 05）. The 3 patients（ 11. 11%） in MAS group removed out the equipment and 4 patients（ 12. 12%） in ABS group removed out the equipment. After operation the wexner average scores in both groups were superior to those before treatment（ P〈 0. 05）,moreover,which in ABS group at 6 months after device implantation were superior to those in MAS group（ P〈 0. 05）. After treatment the scores of FIQL in both groups were significantly increased,as compared with those before treatment（ P〈 0. 05）. In MAS group,after treatment the anal resting pressure was significantly increased,as compared with that before treatment（ P〈 0. 05）,which increased from 33（ 7 - 54. 5） cm H2 O to 44. 5（ 21 - 68. 5） cm H2 O,and the maximum extrusion pressure was increased from 48. 5（ 0 - 78. 5） cm H2 O to 63（ 7 - 99） cm H2 O,there were significant differences（ P〈 0. 05）.In ABS group,after treatment the anal resting pressure was significantly increased,as compared with that before treatment（ P〈 0. 05）,which increased from 34（ 16 - 66） cm H2 O to 64. 5（ 36 - 95. 5） cm H2 O,and the maximum extrusion pressure was increased from 46（ 0 - 73） cm H2 O to 88（ 44 - 136） cm H2 O,there were significant differences（ P〈 0. 05）. Conclusion MAS is a promising,new-style surgical method with the advantages of less invasion and simple operation,which can achieve similar therapeutic effects to those of ABS,which is a further supplement therapeutic schedule of anal incontinence.