自体双掌长肌游离移植肛门括约肌复合体重建术治疗小儿肛门失禁(附18例报告)

Free Autogenous Double Palmaris Longus Muscle Transplantation: A New Approach to the Treatment of tie Fecal Incontinence

本文报告使用双掌长肌游离移植治疗小儿肛门失禁18例,术后随诊有16例疗效满意.手术要点是利用一条肌肉替代外括约肌复合体的顶环,另一条肌肉替代中间环,两肌重获神经支配和血液循环后反向收缩,通过'绞锁机制'有效关闭肛门,节约肌能,弥补横纹肌容易疲劳的缺点.较移植一条肌肉仅替代耻骨直肠肌的手术有明显优越性.本文还探讨了脊膜膨出术后肛门失禁的治疗问题.

This paper presents a new approach to the treatment of sick children with the anal incontinence . The procedure in autogenous transplantation consists of two steps: the bilateral palma-ris longus denervation, and the free muscle transplantation. Ordinarily, two weeks after the first step is taken, the denervated muscles are transplanted as slings around the rectum, in such positions that they can perform the functions of the top loop and the intermediate loop of external sphincter complex. The contraction of the transplanted top muscle draws the posterior anal wall anteriorly while the contraction of the transplanted intermediate loop sling draws the anterior wall posteriorly. As the transplanted muscles are voluntary muscles, they are fatigued easily.The double muscles effect an anal occlusion not only through direct compression but also through the 'kinking mechanism' which causes a rapid and tight closure with the least muscular energy. The cross-loop arrangement could provide the muscle with the maximal efficiency necessary for its funtional performance.From 1984 to 1986 this procedure was followed up in 18 cases of fecal incontinence. It is believed that new approach is better than single muscle transplantation.