带蒂臀大肌瓣皮下括约肌成形术治疗小儿闭肛术后肛门失禁

Reconstruction of Anal Sphincter with Pedicled Glutaeus Maximus Muscle for Anal Incontinence of Children after Anal Imperforation Operations

本文报告用带蒂臀大肌瓣括约肌成形术治疗小儿闭肛术后肛门完全失禁6例.年龄5～11岁.5例术后随诊2个月～5年,失禁均已治愈;另1例术后一周明显好转,正在训练括约功能.6例术后均作了肛直肠测压对照检查,都恢复括约肌收缩反射和松弛反射,肛直肠压力差比术前升高1～4倍,高压区长度增加50%至3倍,患儿自主收缩臀大肌时,肛管括约部产生相当高的收缩压,达115～212mmH_2O,而手术前则为'零'.作者认为手术年龄以5岁以上为合适,双侧带蒂臀大肌瓣左右交义成形肛门括约肌效果快而确实.保证肌瓣血循环和防止感染是手术成败的关键.

The operation of reconstructing anal sphincter with pedicled glutaeus maximus was performed on six children suffering from anal incontinence after anal operations, four being boys and two being girls, their age ranging from 5 to 11 years. Bilateral pedicled glutaeus maximus flaps were used in five cases and single muscle flap was used in one case. Five cases were followed up for from two months to five years, and all of them were cured.Anorectal manometric studies were conducted before and after operation. In all cases the anorectal control was almost normal after the operation.To sum up it is stated in this paper that the sphincter function recovers rapidly, as a result of the use of bilateral pedicled glutaeus maxi -mus flaps to make the artificial anal sphincter. This operation is considered to be preferrable when performed on children aged more than five years. And the key to the success of the operation is the preservation of good blood supply of the muscular flaps and prevention of infections.