改良肛门括约肌折叠术在小型猪肛门失禁模型中的应用及意义

Application and significance of modified anal sphincter folding in animal model of anal incontinence

目的探讨改良肛门括约肌折叠术在小型猪肛门失禁模型中的治疗效果及意义。方法选用20只4~5月龄健康巴马小型猪,采用随机数字表法分为括约肌离断组和骶神经损伤组,每组10只。分别构建括约肌离断所致的小型猪肛门失禁模型及骶神经损伤所致的小型猪肛门失禁模型,两组均采用改良肛门括约肌折叠术进行外科手术治疗,术后正常饲养4周。比较两组小型猪模型术后第1、2、3、7天及术后2周的排便频次和大便控制情况,监测记录手术前后肛管静息压。术后4周取肛门括约肌进行组织形态学观察,对两组小型猪模型的术前术后血液指标(白细胞计数、红细胞计数、血小板计数、C-反应蛋白)水平进行检测。结果括约肌离断组通过改良肛门括约肌折叠术治疗后,术后第1天无变化,术后第2、3、7天、2周排便次数及自控大便情况较术前明显好转(P<0.05),术后排便次数明显减少,能够自行控制排便;肛管静息压(26.25±4.01)mmHg较术前(15.35±2.38)mmHg明显升高(P<0.05);术后4周后括约肌组织形态学与正常括约肌的形态学基本接近;术后第1~3天仅白细胞计数、C-反应蛋白水平与术前比较,差异有统计学意义(P<0.05),术后第7天白细胞计数、红细胞计数、血小板计数、C-反应蛋白水平与术前比较,差异无统计学意义(P>0.05)。骶神经损伤组通过改良肛门括约肌折叠术治疗后,术后第1、2、3、7天、2周排便次数及自控大便情况均较术前无明显改变(P>0.05);肛管静息压(16.83±3.18)mmHg与术前(11.26±3.43)mmHg比较明显升高(P<0.05);术后4周括约肌形态学与正常括约肌的形态学差异较大;术后第1~3天白细胞计数、C-反应蛋白水平与术前比较,差异有统计学意义(P<0.05),术后第7天白细胞计数、红细胞计数、血小板计数与术前比较,差异无统计学意义(P>0.05);C-反应蛋白水平与术前比较差异有统计学意义(P<0.05)。结论改良肛门括约肌折叠术对括约肌损伤造成的肛门失禁效果明显,对骶神经损伤造成的肛门失禁效果不佳,对治疗肛门失禁具有指导意义,为其提供了实验依据。

Objective To investigate the therapeutic effect and the significance of modified anal sphincter folding in animal models of anal incontinence.Methods 20 healthy Bama miniature pigs aged 4 to 5 months were divided into sphincter rupture group and sacral nerve injury group by random number table method,with 10 pigs in each group.The animal model of anal incontinence caused by sphincter separation,and the animal model of anal incontinence caused by sacral nerve injury were constructed respectively.The two groups were treated with modified anal sphincter folding surgery and were fed normally about 4 weeks after the operation.The defecation frequency and stool control in the two groups of animal models on 1st,2nd,3rd and 7th day after the surgery,and 2 weeks after surgery were com⁃pared.The anal canal resting pressure before and after surgery were monitored and were recorded.Four weeks after surgery,anal sphincter was taken for histomorphological observation,and preoperative and postoperative blood indexes(white blood cell count,red blood cell count,platelet count,c-reactive protein level)of the two groups of animal mod⁃els were detected.Results After modified anal sphincter foldout treatment,the defecation frequency and the controlled defecation of sphincter separated group were not changed at 1st day after the operation,and defecation frequency and controlled defecation at 2nd,3rd,7th and 2nd week after the operation were significantly improved,while compared with that before operation(P<0.05).The number of defecation after the operation were significantly reduced,and defe⁃cation could be controlled by themselves.The anal pressure at rest(26.25±4.01)mmHg was significantly higher than that before surgery(15.35±2.38)mmHg(P<0.05).The histological morphology of sphincter was similar to normal sphincter in 4 weeks after the surgery.Only WBC count and C-reactive protein level were significantly different before surgery at 1st to 3rd day after the surgery(P<0.05),while WBC count,RBC count,platelet count and C-reactive pro⁃tein level were not significantly different before surgery at 7th day after the surgery(P>0.05).In the sacral nerve injury group,defecation frequency and controlled defecation situation at 1st,2nd,3rd,7th and 2nd week after the treatment by modified anal sphincter foldout showed no significant change compared with that before the surgery(P>0.05),and anal canal resting pressure(16.83±3.18)mmHg was increased compared with before surgery(11.26±3.43)mmHg(P<0.05).The morphology of sphincter was different from the normal sphincter 4 weeks after the operation.There were sta⁃tistically significant differences in WBC count and C-reactive protein level between the preoperative and postoperative days 1 to 3(P<0.05).There were no statistically significant differences in WBC count,red blood cell count and platelet count between preoperative and postoperative days 7(P<0.05),and only c-reactive protein level between preoperative and postoperative days 7(P<0.05).Conclusion Modified anal sphincter pleat has obvious effect on anal incontinence caused by sphincter injury,but it is not caused by sacral nerve injury.It has guiding significance for clinical treatment of anal incontinence,and it provides experimental basis for clinical treatment of anal incontinence.